Asymptomatic diverticulosis identified by computed tomography is not a risk factor for enteric peritonitis
Asymptomatic diverticulosis identified by computed tomography is not a risk factor for enteric peritonitis
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DOI：
10.1093/ndt/gfr685
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发表时间：
2012-06-01
影响因子：
6.1
通讯作者：
Matsuo, Seiichi
中科院分区：
文献类型：
--
作者：
Toda, Susumu;Ito, Yasuhiko;Matsuo, Seiichi
背景结肠憩室炎是多菌性腹膜炎的重要原因，需要手术治疗和停止腹膜透析（PD）。本研究的目的是检查腹部CT平扫是否有助于评估慢性肾脏病（CKD）患者的结肠憩室病，并探讨结肠憩室病是否是肠源性腹膜炎的危险因素。受试者包括2005年2月至2009年11月期间作为PD候选者的137例连续CKD患者（4期或5期）。对所有PD候选人进行了无造影剂的腹部CT检查。结果。CT平扫发现结肠憩室57例（41.6%）。憩室数目随年龄增长而增多。憩室病最常见的累及部位是升结肠。在接受PD治疗的患者中，憩室病患者的腹膜炎发生率高于无憩室病患者（P = 0.004）。然而，在憩室病患者中仅观察到一例肠腹膜炎。憩室病的存在不影响累积或技术生存率。4例病例由于憩室伴腹痛发作的频率较高而未选择PD。2例发生严重憩室炎伴腹膜炎，行结肠切除术。我们的研究表明，平扫CT检查是有用的检测憩室病的CKD患者。无症状性憩室病不是肠憩室病相关性腹膜炎的危险因素。经常伴有下腹部疼痛的憩室病患者可能禁忌使用PD。
Background. Colonic diverticulitis is an important cause of polymicrobial peritonitis, which requires surgical treatment and cessation of peritoneal dialysis (PD). The aim of this study was to examine whether plain abdominal computed tomography (CT) is useful for evaluating colonic diverticulosis in chronic kidney disease (CKD) patients and to explore whether colonic diverticulosis is a risk factor for enteric peritonitis.Methods. The subjects consisted of 137 consecutive CKD patients (Stage 4 or 5) who were candidates for PD from February 2005 to November 2009. Abdominal CT without contrast media was performed in all PD candidates.Results. Diverticula of the colon were detected by plain CT in 57 cases (41.6%). The number of diverticula tended to increase with age. The most common site of involvement of diverticulosis was the ascending colon. In patients treated with PD, the incidence of peritonitis was higher in patients with diverticulosis than in those without diverticulosis (P = 0.004). However, only one episode of enteric peritonitis was observed among patients with diverticulosis. The presence of diverticulosis did not affect cumulative or technical survival. PD was not selected in four cases due to a high frequency of diverticula with episodes of abdominal pain. Two cases developed severe diverticulitis with peritonitis and underwent resection of the colon.Conclusions. Our study suggests that plain CT examination is useful for detecting diverticulosis in CKD patients. Silent diverticulosis is not a risk factor for enteric diverticulosis-related peritonitis. PD may be contraindicated in cases having frequent diverticulosis with episodes of lower abdominal pain.