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Bardají Bofill Manel

Cirugía General Adultos

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Divertículos de colon

La diverticulosis colónica es una de las enfermedades más comunes de la civilización occidental y es debida a la dieta pobre en fibras. En los Estados Unidos aproximadamente 1/3 de la población desarrolla diverticulosis a los 50 años y 2/3 a los 80 años. La diverticulitis esta descrita como una complicación de la enfermedad infecciosa del colon afectando en la mayoría de los casos exclusivamente al colon sigmoide y descendente. Mientras que la mayoría de los casos de diverticulitis aguda pueden ser manejados exitosamente con tratamiento medico, los ataques recidivados y las complicaciones de la diverticulitis son de tratamiento quirúrgico. Las complicaciones mas importantes de la diverticulitis son la peritonitis difusa, los abscesos localizados, las fistulas (colovesicales o colovaginales ) y la obstrucción.

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Treatment
Most patients with acute diverticulitis require hospitalization for administration of parenteral hydration, broad-spectrum antibiotics, nasogastric tube placement to decompress the intestine.
Risks
In the surgical treatment of diverticulitis, mortality for elective resection and primary anastomosis is 0% to 2% compared to 5% to 20% for emergency surgeries. The increased morbidity and mortality of emergency surgery is related to inadequate control of the septic process, resection of the perforated colonic segment has clear advantages over previous procedures of proximal colostomia and perforation drainage.

Technical complications related to colonic surgery include bleeding, leakage of the anastomosis with associated infection, and occasionally inadvertent injury to adjacent organs, particularly the ureter. These risks are lower in patients who undergo elective collectomia, with complications being less than 5%.

Although the risks of hemorrhage and injury to neighboring organs are greater in emergency surgery, not performing primary anastomoses reduces the problem of anastomosis leaks. As diverticulitis affects older people, the risks of surgery are associated with other general pathologies of patients such as heart or lung diseases.
Prognosis
In patients who have a first picture of diverticulitis with a successful treatment only between 10 and 20% repeat the picture, but the need for surgical intervention in these patients is very high. When surgery is performed electively, the hospitalization time is 5 to 7 days. Because the colonic resections that are performed are not very extensive, the recovery of colonic functioning is normal. After successful colonic resection with anastomosis the rate of recurrence of diverticulitis is below 5% but if the extension does not include the rectosigmoid junction it is greater.

Approximately 15 to 20% of patients with diverticulitis require surgery for abscesses, peritonitis, or fistula. These patients have a high degree of perioperative morbidity and high mortality rates, and usually require a second operation to close the colostomy. Either way after reconstruction.

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Centro Médico Teknon

Bardají Bofill Manel

Consultorios Marquesa (despacho 34)

Marquesa de Vilallonga, 12

08017 Barcelona

93 290 64 34 / 93 417 23 02 (Fax)

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	Mañana	Tarde
Lunes	09.00 - 13.00 h	16.00 - 20.00 h
Martes	09.00 - 13.00 h	16.00 - 20.00 h
Miércoles	09.00 - 13.00 h	16.00 - 20.00 h
Jueves	09.00 - 13.00 h	16.00 - 20.00 h
Viernes	09.00 - 13.00 h	16.00 - 20.00 h

Carrer de Vilana, 12, 08022 Barcelona

932 906 200