Diverticular disease

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源

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最后审阅： 20 Apr 2026
最后更新： 30 Dec 2025

小结

定义

病史和体格检查

关键诊断因素

  • left lower quadrant abdominal pain
  • fever
完整详情

其他诊断因素

  • guarding in left lower quadrant
  • tenderness in left lower quadrant
  • rebound tenderness
  • diffuse abdominal tenderness
  • change in bowel habit
  • palpable abdominal mass
完整详情

危险因素

  • age >50 years
  • low dietary fiber
  • diet rich in salt, meat, and sugar
  • obesity (BMI >30)
  • use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or opioids
  • tobacco smoking
  • alcohol consumption
完整详情

诊断性检查

首要检查

  • CBC with differential
  • CRP
  • basic metabolic panel
  • contrast CT scan of abdomen
完整详情

需考虑的检查

  • blood culture
  • ABG and serum lactate
  • noncontrast CT scan of abdomen
  • abdominal ultrasound (graded-compression)
  • abdominal MRI scan
  • colonoscopy or sigmoidoscopy
  • diagnostic laparoscopy/exploratory laparotomy
完整详情

治疗流程

急症处理

asymptomatic diverticulosis

acute uncomplicated diverticulitis

acute complicated diverticulitis

持续性治疗

recurrent diverticulitis

撰稿人

专家顾问

Marilyse Boutros, MD, FACS, FRCSC

Vice-Chair and Regional Director of Research for the Digestive Disease Institute, Cleveland Clinic Weston Hospital

Colorectal Surgeon, Cleveland Clinic Florida

Weston

Clinical Affiliate Professor of Surgery, Florida Atlantic University

Boca Raton, FL

Professor of Surgery, McGill University

Montreal

Canada

利益声明

MB has received teaching honorarium from Ethicon and Johnson and Johnson.

Sameh Hany Emile, MBBCh, MSc, MD, FACS

Project Scientist

Department of Colorectal Surgery

Cleveland Clinic Florida

Weston

Clinical Affiliate Associate Professor of Surgery

Florida Atlantic University

Boca Raton, FL

Associate Professor of Surgery

Mansoura University Faculty of Medicine

Mansoura City

Egypt

利益声明

SHE receives consultancy fees from Becton, Dickinson and Company.

鸣谢

Dr Marilyse Boutros and Dr Sameh Hany Emile would like to gratefully acknowledge Dr Mohamed A. Thaha, Dr Jayan D. Jayasinghe, Dr Emma Carrington, Ms Kathryn Lynes, Professor Norman S. Williams, and Dr Abbasi Akhtar, the previous contributors to this topic.

利益声明

MAT declares he has no competing interests. JDJ declares that he has no competing interests. EC has received honoraria for teaching, and acts as a consultant for Laborie Medical Management Systems. KL has received funding for a research fellowship from the David Johnston Fellowship through the Royal College of Surgeons of England. NSW is an author of a reference cited in this topic. AA declares that he has no competing interests.

同行评议者

Ned Snyder, MD, FACP

Professor of Medicine

Chief of Clinical Gastroenterology and Hepatology

University of Texas Medical Branch

Galveston, TX

利益声明

NS declares that he has no competing interests.

Nicolas Regenet, MD

Clinic of digestive and endocrine surgery

University Hospital

Nantes

France

利益声明

NR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-47.全文  摘要

Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.全文  摘要

Stollman N, Smalley W, Hirano I; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9.全文  摘要

Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.全文  摘要

American College of Radiology. ACR appropriateness criteria: left lower quadrant pain. 2023 [internet publication].全文

Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):399-415.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

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  • 指南

    • Diagnosis and management of acute left-sided colonic diverticulitis
    • 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
    更多 指南

  • 患者教育信息

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