大腸憩室症の手術適応

Surgical Indication on Diverticular Disease of the Colon

　日本人における大腸憩室症ほど欧米のものとの間に差のある消化器疾患は数が少ないのではなかろうか¹⁾．したがって大腸憩室症の手術適応を考えるにあたって，欧米先駆者の意見は参考にはなるとしても，そのままわが国の憩室症にあてはめることができない点もあり，国内における新しい知識や経験^2)～4)を集積して，現状をふまえた手術適応の方向づけがなされなければならないと考える．

　無症状の大腸憩室症の処置

　大腸X線検査により大腸に憩室が認められても，症状があまりなければ手術の適応とはならない²⁾³⁾．患者には大腸憩室より起きてくるかもしれない合併症，とくに憩室炎，憩室からの出血などについて説明し，あらかじめ注意を与えておく．

　There is no surgical indication on asymptomatic diverticular disease of the colon. However, if the patient has severe symptoms even though inflammatory findings are un-clear, operation of the right sided diverticular disease of the colon should be determined cautiously, and left sided one should be operated on positively.

　Emergency operation should be carried out for free-intraabdominal perforation of the diverticular disease of the colon. Either on the right side or left side of the colon, if a diagnosis of diverticulitis is made, a conservative treatment should be performed initially for 2～3 days and if inflammation persists, laparotomy should be done without delay. On the other hand, if flare-up of diverticulitis occurs or it complicated with fistula formation between skin or other organs, elective surgery should be performed. If laparotomy is performed with a diagnosis of appendicitis and it discose acute diverticulitis of the right side of the colon, resection of the inflammed region should be done if it is not difficult. And if it is difficult to remove the inflammed diverticulae, only appendectomy should be performed and the patient should be followed up carefully with antibiotics.

　For massive bleeding from the diverticular disease of the colon, the patient should be admitted and placed on bedrest, NPO, I. V. fluid or blood transfusion. If the above treatment are performed, hemorrhage will stop spontaneously in the majority of the cases. If hemorrhage persists and requires more than 2,000 ml of blood transfusion for the first day and more than 1,000 ml for the second day, laparotomy should be considered. In that case, it is important to perform barium enema prior to the operation to know the location of the diverticular disease.