La Revue du praticien
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La Revue du praticien · Apr 1995
Review[Treatment of acute sigmoid diverticulitis and development].
In acute diverticulitis of the sigmoid colon, the initial therapeutic decision is wether to employ medical or surgical treatment and, thereafter, wether elective resection of the involved bowel is needed. According to the criteria used for the diagnosis of diverticulitis and to the length of the medical follow-up 10 to 25 per cent of patients with diverticulosis will develop some form of peridiverticular inflammation. Adequate treatment of diverticulitis requires antimicrobial therapy directed against both facultative and obligate anaerobic gram-negative bacteria. ⋯ Urgent operation or percutaneous drainage is required for paracolic abscess not confined to the mesocolon. Common indications for delayed operations are residual abscesses, stenosis, fistulae, well defined recurrent diverticulitis and failure to exclude a colonic carcinoma. However, recent prospectives studies have demonstrate that the high frequency of disease recurrence justify to propose prophylactic sigmoidectomy after the first attack of diverticulitis, especially if the patient is younger than 50 years, obese or immuno-compromised.
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Irritable bowel syndrome and (or) non complicated diverticulosis, associated with fever, could simulate diverticulitis. Cancer of the sigmoid colon appears the main differential diagnosis, when diverticulitis is associated with an atypical or complete colonic stenosis on opaque enema, with a vesicoenteric fistula or with a peritonitis due to a colonic perforation. ⋯ When massive and life-threatening bleeding occurs, the diverticular origin is difficult to assess. Bleeding due to peptic ulcer disease and thermometric ulceration being precluded, arteriography performed on emergency is necessary to differentiate between diverticular bleeding and angiodysplasia.
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La Revue du praticien · Apr 1995
[Quantified semiology of acute sigmoid diverticulitis. Associations de Recherche en Chirurgie].
Using a data base of 7,000 acute abdominal pains, we have described the assessed clinical features of acute diverticulitis of the sigmoid colon. Percentages of sensitivities have been replaced by adverbs or adjectives, applying a scale of equivalence. The modifications of the positive predictive values have been also replaced by verbs or typical expressions. In this article, abscesses, fistulas, generalized peritonitis and hemorrhage arising from an acute diverticulitis of the sigmoid colon were not studied.