INTRODUCTION  介紹 — 

Diverticular disease of the colon is an important cause of hospital admissions and a significant contributor to health care costs in Western and industrialized societies [1,2]. In the United States, acute diverticulitis is the third most common gastrointestinal illness that requires hospitalization and the leading indication for elective colon resection [3,4].
結腸憩室病是西方和工業化社會住院的重要原因，也是醫療保健費用的重要貢獻者 [1,2]。在美國，急性憩室炎是需要住院治療的第三大常見胃腸道疾病，也是擇期結腸切除術的主要適應證[3,4]。

The triage and inpatient management of patients with acute colonic diverticulitis is discussed in this topic. The discussion pertains mostly to the treatment of sigmoid diverticulitis; a brief discussion of diverticulitis of the right colon can be found at the end of the topic (see 'Right-sided (cecal) diverticulitis' below). Outpatient management and follow-up is the focus of another topic. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
本專題將討論急性結腸憩室炎患者的分診和住院管理。討論主要涉及乙狀結腸憩室炎的治療;本專題末尾將簡要討論右結腸憩室炎（參見下文 』右側（盲腸）憩室炎'）。門診管理和隨訪是另一個專題的重點。（參見 “急性結腸憩室炎的門診管理和隨訪”）

The epidemiology, pathophysiology, clinical manifestations, diagnosis, complications, and surgical treatment of diverticulitis are discussed elsewhere:
憩室炎的流行病學、病理生理學、臨床表現、診斷、併發症和手術治療詳見其他專題：

●(See "Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis".)
（參見 “結腸憩室病和憩室病的流行病學、危險因素和發病機制 ”）

●(See "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults".)
（參見 “成人急性結腸憩室炎的臨床表現和診斷”）

●(See "Diverticular fistulas".)
（參見 “憩室瘺”）

●(See "Colonic diverticular bleeding".)
（參見 “結腸憩室出血”）

●(See "Acute colonic diverticulitis: Surgical management".)
（參見 “急性結腸憩室炎的手術治療”）

UNCOMPLICATED VERSUS COMPLICATED DIVERTICULITIS
單純性憩室炎 VS 複雜性憩室炎 — 

Acute diverticulitis is suspected in patients with lower abdominal pain, abdominal tenderness with focal guarding (most typically in the left lower abdomen) on physical examination, and leukocytosis on laboratory testing. (See "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults", section on 'Clinical manifestations'.)
以下患者應懷疑急性憩室炎：下腹痛、體格檢查有腹部壓痛伴局灶性肌衛（最常見於左下腹部）和實驗室檢查有白細胞增多。（參見 “成人急性結腸憩室炎的臨床表現和診斷”，關於'臨床表現'一節 ）

The diagnosis is usually confirmed by an abdominopelvic computed tomography (CT) scan, which may also exclude alternative conditions (eg, perforated colon cancer, infectious or ischemic colitis) and distinguish complicated from uncomplicated disease by one of the following [5] (see "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults", section on 'Acute complications'):
通常通過腹盆腔 CT 掃描確診，CT 掃描也可排除其他疾病（如結腸穿孔癌、感染性或缺血性結腸炎），並通過以下任一情況區分併發症和無併發症[5]（參見 “成人急性結腸憩室炎的臨床表現和診斷”，關於'急性併發症'一節 ）：

●Abscess  膿腫

●Perforation  穿孔

●Obstruction  梗阻

●Fistulization  瘺管形成

Acute uncomplicated diverticulitis can be treated nonoperatively in most patients (70 to 100 percent) [6-8], regardless of the treatment setting (out- versus inpatient) [9-13]. In systematic reviews of studies of uncomplicated diverticulitis, including a randomized trial (DIVER) [14], no differences in outcomes were found between outpatient and inpatient care [15,16]. However, acute complicated diverticulitis generally requires hospitalization and possibly interventional radiologic procedures and/or surgery. (See 'Treatment of complications' below.)
大多數患者（70%-100%）可以通過非手術治療[6-8]，無論治療環境如何（門診 vs 住院）[9-13]。在一項針對單純性憩室炎研究的系統評價中，包括一項隨機試驗 （DIVER） [14]，未發現門診和住院治療之間的結局存在差異 [15,16]。然而，急性複雜性憩室炎通常需要住院治療，並可能需要介入放射學作和/或手術。（參見下文 '併發症的治療'）

TRIAGE  分流 — 

Based upon findings from the history, physical examination, laboratory studies, and CT scan, patients are triaged to either inpatient or outpatient treatment as discussed below and illustrated by the accompanying algorithm (algorithm 1).
根據病史、體格檢查、實驗室檢查和 CT 掃描的結果，將患者分流為住院或門診治療，如下所述，並按隨附的流程圖進行說明（ 流程圖 1）。(Related Pathway(s): Diverticulitis: Indications for hospitalization and empiric antibiotic selection for adults.)

Criteria for inpatient treatment — Patients with acute diverticulitis should receive inpatient treatment if [10,12,17] (table 1):
住院治療  標準 —  急性憩室炎患者如果滿足以下條件，應接受住院治療[10,12,17]（ 表 1）：

●CT shows complicated diverticulitis. (See 'Uncomplicated versus complicated diverticulitis' above.)
CT 顯示複雜性憩室炎。（參見上文 '單純性憩室炎 vs 複雜性憩室炎'）

●CT shows uncomplicated diverticulitis, but the patient has one or more of the following characteristics [18]:
CT 顯示單純性憩室炎，但患者具有以下 1 項或多項特徵 [18]：

•Sepsis or systemic inflammatory response syndrome as defined by more than one of the following: Temperature >38 or <36°C, heart rate >90 beats per minute, respiration rate >20 respirations per minute, white blood cell count >12,000/mL or <4000/mL, C-reactive protein >15 mg/dL.
敗血症或全身炎症反應綜合征定義為以下一項以上 ：體溫 >38 或 <36°C，心率 >90 次/分鐘，呼吸頻率 >20 次呼吸/分鐘，白細胞計數 >12,000/mL 或 <4000/mL，C 反應蛋白 >15 mg/dL。

•Severe abdominal pain with failure to control abdominal pain in the emergency department to <5 on a visual analog scale.
嚴重腹痛，急診科未能控制腹痛，視覺類比量表為 <5。

•Age >70 years.   年齡 >70 歲。

•Significant comorbidities (eg, diabetes mellitus with organic involvement [eg, retinopathy, angiopathy, nephropathy], a recent cardiogenic event [eg, acute myocardial infarction, angina, heart failure], or recent decompensation of chronic liver disease [≥Child B] or end-stage renal disease).
顯著的合併症（例如，糖尿病伴器質性受累 [例如，視網膜病變、血管病、腎病]、最近的心源性事件 [例如，急性心肌梗死、心絞痛、心力衰竭]或近期慢性肝病失代償 [≥Child B] 或終末期腎病）。

•Immunosuppression (eg, poorly controlled diabetes mellitus, chronic high-dose corticosteroid use, use of other immunosuppressive agents, advanced human immunodeficiency virus infection or acquired immunodeficiency syndrome, B or T cell leukocyte deficiency, active cancer of hematologic malignancy, or organ transplant).
免疫抑制（例如，糖尿病控制不佳，長期大劑量皮質類固醇使用，使用其他免疫抑製劑，晚期人類免疫缺陷病毒感染或獲得性免疫缺陷綜合征，B 細胞或 T 細胞白細胞缺乏症，血液系統惡性腫瘤的活動性癌症或器官移植）。

•Intolerance of oral intake secondary to bowel obstruction or ileus.
繼發於腸梗阻或腸梗阻的經口攝入不耐受。

•Noncompliance with care/unreliability for return visits/lack of support system.
不遵守護理/回訪不可靠/缺乏支持系統。

•Failed outpatient treatment.
門診治療失敗。

Criteria for outpatient treatment — Patients may be able to receive outpatient treatment for diverticulitis if they do not meet any of the criteria for inpatient treatment listed above. Outpatient management of diverticulitis is discussed in another topic. (See 'Criteria for inpatient treatment' above and "Acute colonic diverticulitis: Outpatient management and follow-up".)
門診治療  標準 —  如果患者不符合上述任何住院治療標準，則可能能夠接受憩室炎的門診治療。憩室炎的門診治療詳見其他專題。（參見上文 '住院治療標準' 和 “急性結腸憩室炎的門診管理和隨訪”）

INPATIENT TREATMENT  住院治療 — 

Inpatient treatment of acute diverticulitis varies depending upon whether the patient has complicated or uncomplicated disease. All patients undergo treatment for diverticulitis with intravenous antibiotics, fluids, and pain medications. Patients with complicated diverticulitis must also undergo treatment specific to their complications (algorithm 1). (See 'Uncomplicated versus complicated diverticulitis' above.)
急性憩室炎的住院治療因患者是併發症還是無併發症而異。所有患者都接受靜脈注射抗生素、液體和止痛藥治療憩室炎。複雜性憩室炎患者還必須接受針對其併發症的特異性治療（ 流程圖 1）。（參見上文 '單純性憩室炎 vs 複雜性憩室炎'）

Treatment of diverticulitis — Inpatient treatment of acute diverticulitis typically begins with administration of intravenous antibiotics, fluids, and pain medications. Patients can be made nil per os to allow for complete bowel rest or be offered a clear liquid diet depending upon their clinical status. Patients without complications typically show a clinical response within two to three days, at which point their diet can be advanced further. Patients who continue to improve are discharged to complete a course of oral antibiotics; those who fail to improve are referred for surgical evaluation.
憩室炎  的治療 —  急性憩室炎的住院治療通常從靜脈注射抗生素、輸液和止痛藥開始。患者可以口服零尿以完全腸道休息，或者根據他們的臨床狀況提供清流質飲食。沒有併發症的患者通常在 2 到 3 天內表現出臨床反應，此時他們的飲食可以進一步發展。持續改善的患者出院以完成一個療程的口服抗生素治療;那些沒有改善的人被轉診進行手術評估。

Intravenous antibiotics — Patients requiring hospitalization should begin intravenous antibiotics with activities against gram-negative rods and anaerobic organisms. The choice of agents depends upon the severity of the illness (table 2 and table 3). In rare occasions when acute diverticulitis develops in patients who are already hospitalized or have undergone percutaneous drainage, antibiotic coverage should be broadened to also include nosocomial organisms (table 4). If a culture has been taken at the time of percutaneous abscess drainage or surgery, the antibiotic regimen should be revised based upon susceptibility results. Anaerobic coverage should be continued if polymicrobial infection is identified. Detailed discussion of antibiotic therapy for intra-abdominal infections can be found in another topic. (See "Antimicrobial approach to intra-abdominal infections in adults".)
靜脈使用抗生素  —  需要住院治療的患者應開始靜脈使用抗生素，並對革蘭陰性桿菌和厭氧菌有活性。藥物的選擇取決於疾病的嚴重程度（ 表 2 和表 3）。在極少數情況下，當已住院或經皮引流的患者發生急性憩室炎時，應擴大抗生素覆蓋範圍，以包括院內微生物（ 表 4）。如果在經皮膿腫引流或手術時進行了培養，則應根據藥敏結果調整抗生素方案。如果發現多種微生物感染，應繼續進行厭氧菌覆蓋。腹腔內感染的抗生素治療詳見其他專題。（參見 “成人腹腔內感染的抗生素治療”）(Related Pathway(s): Diverticulitis: Indications for hospitalization and empiric antibiotic selection for adults.)

Intravenous antibiotics should be continued until the inflammation is stabilized, evidenced by resolving abdominal pain and tenderness. This process typically takes three to five days. The patient is then transitioned to oral antibiotics (most commonly ciprofloxacin plus metronidazole or amoxicillin-clavulanate) to complete a 10- to 14-day course (inclusive of intravenous and oral antibiotic therapy). (See 'Oral antibiotics' below.)
靜脈注射抗生素應持續至炎症穩定，腹痛和壓痛消退證明。此過程通常需要 3 到 5 天。然後，患者過渡到口服抗生素（最常見的是環丙沙星加甲硝唑或阿莫西林克拉維酸 ），以完成 10 至 14 天的療程（包括靜脈注射和口服抗生素治療）。（參見下文 '口服抗生素'）

The duration of intravenous antibiotic therapy in patients who undergo procedures for definitive source control (percutaneous abscess drainage or surgery) is discussed separately. (See "Antimicrobial approach to intra-abdominal infections in adults", section on 'Duration of therapy'.)
對於接受明確感染源控制手術（經皮膿腫引流或手術）的患者，靜脈抗生素治療的持續時間詳見其他專題。（參見 “成人腹腔內感染的抗生素治療”，關於'治療持續時間'一節 ）

The need for intravenous antibiotics for acute uncomplicated diverticulitis treated as inpatient has been studied in two European trials and one Oceanic trial [19]:
兩項歐洲試驗和一項 Oceanic 試驗研究了住院治療急性單純性憩室炎是否需要靜脈使用抗生素[19]：

●In the Swedish trial (AVOD), 623 patients with CT-confirmed uncomplicated left-sided diverticulitis were treated with or without antibiotics as inpatients [20]. Complication rates (1.9 versus 1.0 percent), hospital length of stay (three days in both groups), and recurrence rates (16 percent in both groups) were similar. Ten patients initially treated without antibiotics subsequently received antibiotics due to increasing abdominal pain, fever, or increasing C-reactive protein (CRP). A subsequent study, which followed 556 of the original participants for a median of 11 years, reported similar outcomes between the antibiotic and no-antibiotic groups in the rates of recurrences, complications, surgery for diverticulitis, and colorectal cancer [21].
瑞典試驗 （AVOD） 納入了 623 例經 CT 證實的無併發症左側憩室炎患者作為住院患者接受抗生素治療或不聯合抗生素治療 [20]。併發症發生率（1.9% vs 1.0%）、住院時間（兩組均為 3 天）和復發率（兩組均為 16%）相近。10 例最初未接受抗生素治療的患者隨後因腹痛、發熱或 C 反應蛋白 （CRP） 增加而接受抗生素治療。隨後的一項研究對 556 名原始參與者進行了中位 11 年的隨訪，結果顯示，抗生素組和無抗生素組在復發率、併發症率、憩室炎手術率和結直腸癌方面的結局相似 [21]。

●A second Dutch trial (DIABOLO) randomly assigned 528 patients with first-episode, CT-proven, left-sided acute diverticulitis to observation or 10 days of antibiotics (Augmentin in most, ciprofloxacin plus metronidazole in the rest) [22]. Patients with complicated diverticulitis, with the exception of a small (<5 cm) abscess, were excluded. Most (93 percent) of the trial participants were admitted to the hospital. The median times to recovery without (14 [interquartile range 6 to 35] days) or with antibiotics (12 [7 to 30] days) were similar. At six months, the outcomes were similar in terms of complicated diverticulitis (3.8 percent observation versus 2.6 percent antibiotics), smoldering diverticulitis (7.3 versus 4.1 percent), recurrent diverticulitis (3.4 versus 3 percent), need for sigmoid resection (3.8 versus 2.3 percent), need for readmission (17.6 versus 12.0 percent), adverse events (48.5 versus 54.5 percent), or mortality (1.1 versus 0.4 percent).
另一項荷蘭試驗（DIABOLO）將 528 例經 CT 證實的首發左側急性憩室炎患者隨機分配至觀察組或抗生素組 10 日（大多數患者使用 Augmentin，其餘患者使用環丙沙星加甲硝唑 ）[22]。排除複雜性憩室炎患者，除小膿腫 （<5 cm） 外。大多數 （93%） 試驗參與者被送入醫院。不使用抗生素（14 [四分位距 6 至 35] 天）或使用抗生素（12 [7 至 30] 天）的中位恢復時間相似。6 個月時，併發症性憩室炎（觀察組 3.8% vs 抗生素組 2.6%）、冒煙性憩室炎（7.3% vs 4.1%）、復發性憩室炎（3.4% vs 3%）、需要乙狀結腸切除術（3.8% vs 2.3%）、需要再入院（17.6% vs 12.0%）、不良事件（48.5% vs 54.5%）或死亡率（1.1% vs 0.4%）的結局相似。

●A double-blind, placebo-controlled Australian/New Zealand trial (STANDARD) randomly assigned 180 patients with CT-proven uncomplicated diverticulitis to either intravenous cefuroxime/Flagyl followed by Augmentin or placebo for seven days [23]. All patients were initially admitted to the hospital. There was no significant difference in hospital stay (40 hours antibiotics versus 46 hours placebo), adverse event rate, or 7- or 30-day readmission rate.
一項雙盲、安慰劑對照的澳大利亞/紐西蘭試驗（Australian/New Zealand， STANDARD）將 180 例經 CT 證實的單純性憩室炎患者隨機分配至靜脈給予頭孢呋辛 /Flagyl 后接受 Augmentin 治療或安慰劑治療組，治療 7 日[23]。所有患者最初都被送往醫院。住院時間 （抗生素組 40 小時與安慰劑組 46 小時） 、不良事件發生率或 7 天或 30 天再入院率無顯著差異。

Given that these trials used different exclusion criteria, CT imaging is not perfect in detecting complicated diverticular disease, and most patients admitted for inpatient treatment of acute diverticulitis have either severe disease or serious comorbid conditions, we suggest treating all inpatients with antibiotics rather than selectively based on whether the disease is complicated. This issue remains controversial [24,25], however, particularly between providers based in Europe versus North America [26,27].
鑒於這些試驗使用不同的排除標準，CT 成像在檢測複雜性憩室病方面並不完美，而且大多數接受急性憩室炎住院治療的患者病情嚴重或有嚴重共存疾病，我們建議所有住院患者都使用抗生素治療，而不是根據疾病是否複雜進行選擇性治療。然而，這個問題仍然存在爭議[24,25]，特別是在歐洲和北美的供應商之間[26,27]。

Intravenous fluid — Patients who are admitted for inpatient treatment of acute diverticulitis should be given intravenous fluid (eg, Ringer lactate or normal saline) to correct volume deficits. Intravenous fluid is typically continued until patients are tolerating adequate liquids.
靜脈輸液  —  急性憩室炎住院治療的患者應靜脈輸液（如乳酸林格液或生理鹽水 ）以糾正容量不足。通常持續靜脈輸液，直到患者能夠耐受足夠的液體。

Pain control — Patients who are admitted for acute diverticulitis often have severe abdominal pain from localized peritonitis. For such patients, parenteral analgesics (eg, acetaminophen, ketorolac, morphine, or hydromorphone) are administered when patients are taking nothing by mouth, while oral analgesics (eg, acetaminophen, ibuprofen, oxycodone) are appropriate when patients are consuming an oral diet.
疼痛控制  —  因急性憩室炎入院的患者常因局限性腹膜炎而出現嚴重腹痛。對於這類患者，腸外鎮痛藥（如對乙醯氨基酚 、 酮咯酸 、 嗎啡或氫嗎啡酮 ）在患者不口服時給葯，而口服鎮痛藥（如對乙醯氨基酚、 布洛芬 、 羥考酮 ）在患者口服時是合適的。

Inpatient diet — Patients requiring hospitalization should initially be kept on complete bowel rest with intravenous hydration. Patients without complications typically show a clinical response within two to three days, at which point they can be started on a liquid diet and advanced as tolerated.
住院飲食  —  需要住院治療的患者最初應保持完全腸道休息並靜脈補液。無併發症的患者通常在 2 到 3 天內表現出臨床反應，此時他們可以開始流質飲食，並在耐受的情況下進展。

Treatment of complications — Of the acute complications of diverticulitis, abscesses and microperforations are quite common. Frank perforation is not common, and obstruction and fistulization are rare.
併發症  的治療 —  在憩室炎的急性併發症中，膿腫和微穿孔很常見。明顯的穿孔並不常見，梗阻和瘺管很少見。

Frank perforation — Evidenced by free air under the diaphragm with or without extravasation of contrast or fluid, frank perforation of the colon results in diffuse peritonitis from intra-abdominal spread of feculent fluid and bacterial organisms. Acute diverticulitis that presents with frank perforation is life-threatening and mandates emergency surgery [28-31]. (See "Acute colonic diverticulitis: Surgical management", section on 'Perforation with generalized peritonitis'.)
明顯的穿孔  —  結腸的明顯穿孔表現為膈肌下有或沒有造影劑或液體外滲，糞便液和細菌微生物在腹腔內擴散導致瀰漫性腹膜炎。急性憩室炎表現為明顯的穿孔，可危及生命，需要急診手術[28-31]。（參見 “急性結腸憩室炎的手術治療”，關於'穿孔伴全身性腹膜炎'一節 ）

Microperforation — Microperforation, also called contained perforation, is the presence of a small amount of air bubbles but no oral contrast outside of the colon on abdominopelvic CT imaging. Most patients who have microperforation should be treated initially with intravenous antibiotics (see 'Treatment of diverticulitis' above); the majority of them (94 percent) can be managed nonoperatively [32], but with the following caveats:
微穿孔  —  微穿孔也稱為封閉式穿孔，是指腹盆腔 CT 成像顯示結腸外存在少量氣泡，但無口服造影劑。大多數微穿孔患者最初應靜脈給予抗生素治療（參見上文 』憩室炎的治療'）;大多數（94%）可以通過非手術治療[32]，但需要注意以下幾點：

●Patients with pericolonic air bubbles only can be managed the same way as those with uncomplicated diverticulitis. The success rate of nonoperative management is from 85 to 99 percent [33,34]. (See 'Treatment of diverticulitis' above.)
僅存在結腸周圍氣泡的患者可以採用與無併發症憩室炎相同的處理方式。非手術治療的成功率為 85%-99% [33,34]。（參見上文 '憩室炎的治療'）

●Patients with pericolonic air bubbles associated with an abscess should be managed according to the abscess. The expected success rate of nonoperative management is lower than that of uncomplicated diverticulitis. (See 'Abscess' below.)
對於伴有膿腫的結腸周圍氣泡患者，應根據膿腫情況進行管理。非手術治療的預期成功率低於單純性憩室炎。（參見下文 '膿腫'）

●Patients with a small amount of distant intraperitoneal air bubbles (eg, over the liver, under the diaphragm) or distant retroperitoneal air bubbles require an individualized approach; those with a benign abdominal examination and absence of immunosuppression may be managed nonoperatively while those with peritonitis or on significant immunosuppression should undergo surgery. In these patients, the success rate of nonoperative management varies from 34 to 93 percent, depending on whether there is an associated abscess or pelvic fluid [7,33,35,36]. (See "Acute colonic diverticulitis: Surgical management", section on 'Perforation with generalized peritonitis'.)
有少量遠處腹膜內氣泡（例如，在肝臟上、膈肌下）或遠處腹膜后氣泡的患者需要個體化方法;腹部檢查良性且無免疫抑制的患者可進行非手術治療，而腹膜炎或嚴重免疫抑制的患者應接受手術治療。在這些患者中，非手術治療的成功率為 34%-93% 不等，具體取決於是否有相關的膿腫或盆腔積液 [7,33,35,36]。（參見 “急性結腸憩室炎的手術治療”，關於'穿孔伴全身性腹膜炎'一節 ）

Abscess — Abscesses occur in 16 to 40 percent of patients with complicated acute diverticulitis [37]. We suggest a stepwise approach to treating diverticular abscesses [27]:
膿腫  — 16%-40% 的複雜急性憩室炎患者會出現膿腫[37]。我們建議採用階梯式方法治療憩室膿腫[27]：

●Antibiotics are the first-line treatment for all diverticular abscesses, particularly those <4 cm. (See 'Intravenous antibiotics' above.)
抗生素是所有憩室膿腫的一線治療，尤其是<4cm 的憩室膿腫。（參見上文 '靜脈使用抗生素'）

●Percutaneous drainage may be added, if feasible, for abscesses ≥4 cm, those that do not resolve with antibiotic therapy, or in the presence of clinical deterioration. (See 'Large abscess (≥4 cm)' below.)
如果可行，對於 ≥4 cm 的膿腫、抗生素治療未消退的膿腫或存在臨床惡化的膿腫，可增加經皮引流。（參見下文 '大膿腫（≥4cm）'）

The guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) also advocate a stepwise approach to treating diverticular abscesses, but with a different cutoff size of 3 cm for recommending percutaneous drainage [12]. This discrepancy may not be clinically significant.
美國結腸直腸外科醫師學會（American Society of Colon and Rectal Surgeons， ASCRS）的指南也主張採用階梯式方法治療憩室膿腫，但推薦經皮引流的截斷大小不同，均為 3cm[12]。這種差異可能沒有臨床意義。

The overall success rate of nonoperative management for diverticular abscess is approximately 80 percent regardless of approach (antibiotics, percutaneous drainage, or both) [37]. The remaining 20 percent need surgery [38].
憩室膿腫非手術治療的總體成功率約為 80%，無論採用何種方法（抗生素、經皮引流或兩者兼而有之）[37]。其餘 20% 需要手術 [38]。

The recurrence rate after successful nonoperative management is 15 to 25 percent [37,39] and is higher for abscesses >5 cm [40]. Whether all asymptomatic patients with a healed diverticular abscess require elective surgery is controversial and discussed elsewhere. (See "Acute colonic diverticulitis: Surgical management", section on 'Healed diverticular abscess'.)
非手術治療成功后的復發率為 15%-25%[37,39]，膿腫>5cm 的復發率更高[40]。是否所有已癒合的無癥狀憩室膿腫患者都需要擇期手術尚存在爭議，詳見其他專題。（參見 “急性結腸憩室炎的手術治療”，關於'已癒合的憩室膿腫'一節 ）

Small abscess (<4 cm) — For smaller abscesses, antibiotic therapy alone and percutaneous drainage have similar success rates, morbidity, and mortality [37]. One study that treated 23 abscesses <3 cm with antibiotics alone reported a treatment failure rate of 0 percent [38]. In another study, 93 of 107 diverticular abscesses <4 cm were successfully treated with antibiotics alone [41].
小膿腫（<4cm） —  對於較小的膿腫，單純抗生素治療和經皮引流的成功率、併發症發生率和死亡率相似[37]。一項研究單用抗生素治療了 23 例 <3 cm 膿腫，治療失敗率為 0% [38]。在另一項研究中，107 例 <4 cm 的憩室膿腫中有 93 例單獨使用抗生素成功治療 [41]。

Patients who respond to antibiotics are followed with serial CT scans until the resolution of the abscess; patients who deteriorate or fail to improve after two to three days of antibiotic therapy may require surgery if percutaneous drainage is not an option.
對抗生素有反應的患者進行連續 CT 掃描，直到膿腫消退;如果不能選擇經皮引流，抗生素治療 2 至 3 天后病情惡化或未改善的患者可能需要手術。

Abscesses may not be amenable to percutaneous drainage because they are too small (ie, <2 cm) or there are important structures (eg, small bowel) adjacent to them that preclude percutaneous access [38,40,42].
膿腫可能不適合經皮引流，因為它們太小（即<2cm）或附近有重要結構（如小腸）妨礙經皮通路[38,40,42]。

Large abscess (≥4 cm) — The benefit of percutaneous drainage is greater for larger abscesses. As the size of the abscess increases from ≤3 cm to 3 to 10 cm and 3 to 18 cm, the success rate of antibiotics-alone therapy decreases from 100 to 82 and 66 percent, respectively [37]. By contrast, 80 percent of diverticular abscesses >4 cm resolve after percutaneous drainage [27]. In order to maximize the success rate of nonoperative management, we suggest percutaneous drainage of diverticular abscesses ≥4 cm, whenever feasible, in addition to antibiotic therapy.
大膿腫 （≥4 cm） —  對於較大的膿腫，經皮引流的好處更大。隨著膿腫大小從≤3cm 增加到 3cm 到 10cm 和 3cm 到 18cm，單用抗生素治療的成功率分別從 100%下降到 82%和 66%[37]。相比之下，80% 的憩室膿腫 >4 cm 在經皮引流后消退 [27]。為了最大限度地提高非手術治療的成功率，我們建議在抗生素治療的基礎上，盡可能經皮引流 ≥4 cm 的憩室膿腫。

CT-guided drainage is performed for abscesses that are amenable to percutaneous drainage. An approach through the anterior abdominal wall is favored for most abscesses, while abscesses deep in the pelvis or obscured by other organs are drained transgluteally. Transrectal or transvaginal approaches to abscess drainage have also been described but are rarely used [43,44]. Once a drainage catheter is placed, it is left until the output is minimal, a process that can take a longer course [45].
CT 引導下引流適用於適合經皮引流的膿腫。大多數膿腫傾向於通過前腹壁入路，而骨盆深處或被其他器官遮擋的膿腫則經臀部引流。也有經直腸或經陰道膿腫引流的報導，但很少使用[43,44]。放置引流導管后，應將其放置至排出量最小，這一過程可能需要更長的療程 [45]。

After percutaneous drainage of a diverticular abscess, patients typically defervesce within 24 to 48 hours. Surgical intervention should be considered for patients who do not improve within 48 hours or whose disease is not amenable to percutaneous drainage. (See "Acute colonic diverticulitis: Surgical management".)
憩室膿腫經皮引流后，患者通常在 24 至 48 小時內退熱。對於 48 小時內沒有改善或疾病不適合經皮引流的患者，應考慮手術干預。（參見 “急性結腸憩室炎的手術治療”）

Obstruction — Patients with acute sigmoid diverticulitis can present with large bowel obstruction at the site of the acute inflammation. Rarely, the phlegmonous or abscess cavity can secondarily involve the small bowel causing a complete small bowel obstruction. (See "Acute colonic diverticulitis: Surgical management", section on 'Obstruction or stricture'.)
梗阻  —  急性乙狀結腸憩室炎患者可在急性炎症部位表現為大腸梗阻。極少數情況下，蜂窩織造腔或膿腫腔可繼發累及小腸，導致完全性小腸梗阻。（參見 “急性結腸憩室炎的手術治療”，關於'梗阻或狹窄'一節 ）

Fistula — A fistula can develop between the colon and bladder, vagina, uterus, other bowel segments, and abdominal wall. Diverticular fistulas rarely close spontaneously, and a resection of the affected bowel segment is generally required. Though fistulization may also lead to intra-abdominal abscesses, these typically do not usually present acutely. The management of a diverticular fistula is discussed separately. (See "Diverticular fistulas".)
瘺管  —  瘺管可能在結腸和膀胱、陰道、子宮、其他腸段和腹壁之間形成。憩室瘺很少自發閉合，通常需要切除受影響的腸段。雖然瘺管也可能導致腹腔內膿腫，但這些膿腫通常不會急性出現。憩室瘺的治療詳見其他專題。（參見 “憩室瘺”）

Subsequent care — Patients are assessed daily and typically show improvement after two to three days of antibiotics. Patients who show continued improvement can be discharged. Failure to improve should prompt repeat imaging.
後續護理  —  患者每日評估，通常在抗生素治療 2-3 日後出現改善。顯示持續改善的患者可以出院。如果病情未改善，應重複影像學檢查。

Repeat imaging — Disease progression with or without new complications should be suspected in patients with clinical deterioration and those who fail to improve after two to three days of intravenous antibiotic therapy. Repeat imaging may be required in such patients.
重複影像學檢查  —  對於臨床惡化的患者以及靜脈給予抗生素治療 2-3 日後仍未改善的患者，應懷疑疾病進展伴或不伴新發併發症。此類患者可能需要重複影像學檢查。

The purpose of repeat imaging, typically with an abdominopelvic CT scan, is to look for new complications (eg, abscess or perforation) that may require further intervention (eg, percutaneous drainage or surgery).
重複影像學檢查，通常使用腹盆腔 CT 掃描，目的是尋找可能需要進一步干預（如經皮引流或手術）的新併發症（如膿腫或穿孔）。

Criteria for discharge — Most patients with uncomplicated diverticulitis have significant clinical improvement after two to three days of intravenous antibiotics. They are then reassessed daily to determine if they are eligible to be discharged from the hospital. The patient must meet all criteria listed below before they can be discharged:
出院  標準 —  大多數單純性憩室炎患者在靜脈使用抗生素 2-3 日後有顯著的臨床改善。然後每天對他們進行重新評估，以確定他們是否有資格出院。患者必須滿足下列所有標準才能出院：

●Normalization of vital signs (ie, resolution of high fever, tachycardia, or hypotension)
生命體征恢復正常（即高熱、心動過速或低血壓消退）

●Resolution of severe abdominal pain
嚴重腹痛的消退

●Resolution of significant leukocytosis
嚴重白細胞增多症的消退

●Tolerance of oral diet  對口服飲食的耐受性

●Resumption of bowel movements
恢復排便

Oral antibiotics — Patients are discharged with oral antibiotics . We use one of the following oral antibiotic regimens in adult patients with normal renal and hepatic function (table 5):
口服抗生素  —  患者出院時口服抗生素 。對於腎功能和肝功能正常的成人患者，我們使用以下口服抗生素方案之一（ 表 5）：

●Amoxicillin-clavulanate (1 tablet [contains 875 mg amoxicillin and 125 mg clavulanic acid] every 8 hours) or amoxicillin-clavulanate extended-release (2 tablets [each tablet contains 1 g amoxicillin and 62.5 mg clavulanic acid] every 12 hours) [14,46,47]
阿莫西林-克拉維酸鈉（1 片[含 875mg 阿莫西林和 125mg 克拉維酸]，每 8 小時一次）或阿莫西林-克拉維酸緩釋劑（2 片[每片含有 1g 阿莫西林和 62.5mg 克拉維酸]，每 12 小時一次）[14,46,47]

●Ciprofloxacin (500 mg every 12 hours) plus metronidazole (500 mg every 8 hours)
環丙沙星 （500 毫克，每 12 小時一次）加甲硝唑 （500 毫克，每 8 小時一次）

●Levofloxacin (750 mg once daily) plus metronidazole (500 mg every 8 hours)
左氧氟沙星 （750 毫克，每天一次）加甲硝唑 （500 毫克，每 8 小時一次）

●Trimethoprim-sulfamethoxazole (1 double-strength tablet every 12 hours) plus metronidazole (500 mg every 8 hours)
甲氧苄啶-磺胺甲噁唑 （1 片雙倍強度片劑，每 12 小時一次）加甲硝唑 （500 毫克，每 8 小時一次）

The local antibiogram should be consulted to avoid prescribing a regimen to which bacterial resistance exceeds 10 percent. As an example, in areas where the prevalence of Escherichia coli resistance to fluoroquinolones exceeds 10 percent, amoxicillin-clavulanate or trimethoprim-sulfamethoxazole plus metronidazole are the preferred agents. Moxifloxacin is reserved for those who cannot use the other regimens because of high rates of resistance among anaerobes [48]. There is also clinical evidence that fluoroquinolones plus metronidazole were associated with a higher rate of Clostridioides difficile than amoxicillin-clavulanate at one year [49].
應查閱當地抗菌譜，以避免開具細菌耐藥性超過 10% 的方案。例如，在大腸埃希菌對氟喹諾酮類藥物耐葯率超過 10% 的地區， 阿莫西林-克拉維酸或甲氧苄啶-磺胺甲噁唑加甲硝唑是首選藥物。 莫西沙星僅用於因厭氧菌耐葯率高而無法使用其他方案的患者[48]。還有臨床證據表明，氟喹諾酮類藥物聯合甲硝唑在 1 年內的艱難梭菌發生率高於阿莫西林-克拉維酸[49]。(Related Pathway(s): Diverticulitis: Indications for hospitalization and empiric antibiotic selection for adults.)

Most immunocompetent patients should complete a course of four to seven days (inclusive of both intravenous and oral antibiotics), except for those with an undrained abscess or phlegmon, who should receive 7 to 10 days of antibiotics. Immunocompromised patients should be treated with antibiotics for 10 to 14 days.
大多數免疫功能正常的患者應完成 4 至 7 天的療程（包括靜脈注射和口服抗生素），但膿腫或蜂窩織炎未引流的患者除外，應接受 7 至 10 天的抗生素治療。免疫功能低下的患者應接受10至14天的抗生素治療。

The optimum duration of antibiotic therapy for various forms of diverticulitis has not been well studied. One small trial showed that the outcomes of four and seven days of intravenous antibiotics were similar for uncomplicated diverticulitis, although such patients probably did not require antibiotic therapy [50]. The current recommendations for a shorter duration are based on expert opinions rather than clinical data [51-54]. Thus, the actual duration should be tailored to individual patients based on how quickly they improve and whether source control has been achieved.
尚未對各種形式的憩室炎進行抗生素治療的最佳持續時間進行充分研究。一項小型試驗顯示，靜脈使用抗生素 4 日和 7 日對單純性憩室炎的結局相似，但此類患者可能不需要抗生素治療[50]。目前關於較短療程的建議是基於專家意見，而不是臨床數據[51-54]。因此，應根據患者改善的速度以及是否實現了感染源控制，為個體患者量身定製實際持續時間。

After discharge, patients should be reassessed within one week and then weekly until all symptoms have resolved. Patients with a microperforation or undrained abscess/phlegmon are particularly prone to recurrence and thus require vigilant follow-up. In a retrospective cohort study of over 200,000 patients, the readmission rate for treatment failure was 6.6 percent, with complicated diverticulitis being the strongest predictor of readmissions [55]. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
出院后，應在 1 周內對患者進行重新評估，然後每周進行一次評估，直到所有癥狀都消退。微穿孔或膿腫/蜂窩織炎未引流的患者特別容易復發，因此需要警惕隨訪。一項納入 200,000 多例患者的回顧性佇列研究顯示，治療失敗的再入院率為 6.6%，其中複雜性憩室炎是再入院的最強預測指標[55]。（參見 “急性結腸憩室炎的門診管理和隨訪”）

Failure of inpatient medical treatment — Surgical evaluation is indicated at any point during admission if the patient's condition deteriorates (eg, increased abdominal pain or leukocytosis, or development of diffuse peritonitis). (See "Acute colonic diverticulitis: Surgical management".)
住院內科治療  失敗 —  如果患者病情惡化（如，腹痛或白細胞增多增加，或出現彌漫性腹膜炎），則需在入院期間隨時進行手術評估。（參見 “急性結腸憩室炎的手術治療”）

Patients who fail to improve with two to three days of intravenous antibiotics should undergo repeat imaging to identify new-onset complications of diverticulitis (eg, abscess or perforation). Certain complications may require surgery. (See 'Repeat imaging' above and 'Treatment of complications' above.)
靜脈注射抗生素 2 至 3 天仍未改善的患者應進行重複影像學檢查，以識別憩室炎新發併發症（如膿腫或穿孔）。某些併發症可能需要手術。（參見上文 '重複影像學檢查' 和 '併發症的治療'）

In addition, surgery may be warranted in patients who fail to improve after another one to two days of medical management, even if no complications are identified with repeat imaging.
此外，對於經過 1 至 2 天的藥物治療後仍未改善的患者，即使重複影像學檢查未發現併發症，也可能需要手術。

SPECIAL PATIENT GROUPS  特殊患者群體

Young patients (age <40) — Although some studies have reported more frequent and severe recurrences in patients younger than 40 years of age and some have advocated early elective surgery in such patients [56-60], other studies have suggested that the risk of recurrence is better predicted by the severity of the initial attack than the age of onset [61,62]. In concordance with the American Society of Colon and Rectal Surgeons (ASCRS) practice parameters for sigmoid diverticulitis, we do not offer elective surgery to patients who have a history of diverticulitis simply because they are young [12].
年輕患者（年齡<40） —  雖然一些研究報導了 40 歲以下患者的復發更頻繁和更嚴重，一些研究主張對此類患者進行早期擇期手術[56-60]，但其他研究表明，與發病年齡相比，初始發作的嚴重程度更能預測復發風險[61,62].根據美國結腸直腸外科醫師協會（American Society of Colon and Rectal Surgeons， ASCRS）對乙狀結腸憩室炎的實踐參數，我們不會僅僅因為年輕就為有憩室炎病史的患者提供擇期手術[12]。

Right-sided (cecal) diverticulitis — In Western countries, acute colonic diverticulitis is primarily left sided (72 percent sigmoid, 33 percent descending, 3 percent transverse, 5 percent ascending colon). Right-sided (cecal) diverticula account for only 1.5 percent of diverticulitis cases in Western countries but 38 to 75 percent of diverticulitis cases in Asian countries [63].
右側（盲腸）憩室炎  —  在西方國家，急性結腸憩室炎主要為左側憩室炎（72%為乙狀結腸，33%為降結腸，3%為橫結腸，5%為升結腸）。在西方國家，右側（盲腸）憩室僅占憩室炎病例的 1.5%，但在亞洲國家，右側（盲腸）憩室炎病例佔 38%-75%[63]。

Patients with right-sided diverticulitis tend to be younger than those with left-sided disease [64]. Right-sided diverticulitis is less likely to be complicated. Several studies from both Western and Asian countries have reported lower complication rates, lower mortality rates, and lower recurrence rates to be associated with right-sided, as compared with left-sided, diverticulitis [64,65].
右側憩室炎患者往往比左側憩室炎患者年輕[64]。右側憩室炎不太可能複雜。來自西方和亞洲國家的幾項研究報導，與左側憩室炎相比，右側憩室炎的併發症發生率較低，死亡率較低，復發率較低[64,65]。

The management of right-sided diverticulitis ranges from medical therapy to surgery, depending upon patient presentation. When the diagnosis is made nonoperatively, medical management with antibiotics is usually sufficient. In a systematic review and meta-analysis of 11 studies, the pooled recurrence rate after nonoperative management was 12 percent (95% CI 10 to 15 percent) with a median follow-up of 34 months [66]. Only 10 percent of those who recurred required urgent surgery at the first recurrence, and there was no mortality.
右側憩室炎的治療範圍從藥物治療到手術，具體取決於患者的臨床表現。當非手術診斷時，抗生素的藥物治療通常就足夠了。一項系統評價和 meta 分析納入了 11 項研究，發現非手術治療后的合併復發率為 12%（95%CI 10%-15%），中位隨訪時間為 34 個月[66]。只有 10% 的復發患者在第一次復發時需要緊急手術，並且沒有死亡率。

Patients who are diagnosed with right-sided diverticulitis during exploratory operations for abdominal discomfort can undergo an appendectomy if the base of the appendix and the cecum are not inflamed [67-69]. This is then followed by antibiotic therapy. Diverticulectomy can be performed if there is a localized perforation of the involved diverticulum [67,70]. One prospective nonrandomized study associated diverticulectomy with similar success and complication rates but lower recurrence rates than medical management [71]. Most commonly, a right hemicolectomy is performed if there is inflammation of the area or a mass suggestive of a carcinoma [69].
對於因腹部不適而進行探查手術診斷為右側憩室炎的患者，如果闌尾底部和盲腸沒有發炎，可以進行闌尾切除術[67-69]。然後進行抗生素治療。如果受累憩室有局部穿孔，可以進行憩室切除術[67,70]。一項前瞻性非隨機研究發現，憩室切除術的成功率和併發症發生率相似，但復發率低於藥物治療[71]。最常見的是，如果右側半結腸區域存在炎症或有提示癌症的腫塊，則進行右半結腸切除術[69]。

SOCIETY GUIDELINE LINKS  學會指南連結 — 

Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Colonic diverticular disease" and "Society guideline links: Intra-abdominal infections in adults".)
全球選定國家和地區的學會和政府贊助的指南鏈接詳見其他專題。（參見 “學會指南鏈接：結腸憩室病” 和 “學會指南連結：成人腹腔內感染”）

INFORMATION FOR PATIENTS
患者教育 — 

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5^th to 6^th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10^th to 12^th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
UpToDate 提供兩種類型的患者教育材料，即“基礎”和“超越基礎”。基礎患者教育文章以通俗易懂的語言編寫，適合 5 ^{至 6 年級的}閱讀水準，它們回答了患者可能對特定疾病提出的四五個關鍵問題。這些文章最適合想要一般概述和喜歡簡短、易於閱讀材料的患者。Beyond the Basics 患者教育文章更長、更複雜、更詳細。這些文章是在 10 ^至 12 ^年級閱讀水準上寫的，最適合想要深入資訊並熟悉一些醫學術語的患者。

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
以下是與此主題相關的患者教育文章。我們鼓勵您將這些主題列印或通過電子郵件發送給您的患者。（您還可以透過搜索“患者資訊”和感興趣的關鍵字來找到有關各種主題的患者教育文章。

●Basics topics (see "Patient education: Diverticulitis (The Basics)" and "Patient education: Diverticulitis – Discharge instructions (The Basics)")
基礎篇（參見 “患者教育：憩室炎（基礎篇）” 和 “患者教育：憩室炎–出院說明（基礎篇）”）

●Beyond the Basics topics (see "Patient education: Diverticular disease (Beyond the Basics)")
基礎篇（參見 “患者教育：憩室病（基礎篇）”）

SUMMARY AND RECOMMENDATIONS
總結與推薦

●Complicated versus uncomplicated diverticulitis – Acute complications of colonic diverticulitis include:
複雜性憩室炎與非複雜性憩室炎 – 結腸憩室炎的急性併發症包括：

•Abscess (common)  膿腫（常見）

•Perforation (common)  穿孔（常見）

•Obstruction (rare)  梗阻（罕見）

•Fistulization (rare)  瘺管形成（罕見）

The need for surgical intervention is much higher for complicated diverticulitis than for uncomplicated diverticulitis. (See 'Uncomplicated versus complicated diverticulitis' above.)
複雜性憩室炎對手術干預的需求遠高於無併發症的憩室炎。（參見上文 '單純性憩室炎 vs 複雜性憩室炎'）

●Decision on outpatient versus inpatient care – Based upon findings on the history, physical examination, laboratory tests, and abdominopelvic CT scan, patients with acute colonic diverticulitis are triaged to either inpatient or outpatient treatment. Inpatient care is indicated for those with (algorithm 1):
決定門診治療還是住院治療 – 根據病史、體格檢查、實驗室檢查和腹盆腔 CT 掃描結果，急性結腸憩室炎患者應分流至住院治療或門診治療。住院治療適用於以下患者（ 流程圖 1）：

•Complicated diverticulitis (ie, perforation, abscess, obstruction, or fistula), and/or
複雜性憩室炎（即穿孔、膿腫、梗阻或瘺管），和/或

•Risk factors for worse outcomes as an outpatient (table 1)
門診結局較差的危險因素（ 表 1）

Patients without these risk factors have similar outcomes regardless of care setting. (See 'Triage' above.)
無論護理環境如何，沒有這些危險因素的患者都有相似的結局。（參見上文 '分類'）

●Treating diverticulitis – For patients in whom inpatient management of acute colonic diverticulitis is appropriate, we suggest administering intravenous antibiotics (Grade 2C). Some of these patients have clear indications for antibiotics (eg, abscess), and others have severe diverticulitis that requires hospital admission.
憩室炎的治療 – 對於適合住院治療急性結腸憩室炎的患者，我們建議靜脈注射抗生素（Grade 2C）。其中一些患者有明確的抗生素指征（如膿腫），而另一些患者患有嚴重的憩室炎，需要住院治療。

The choice of agents depends on disease severity and risk factors for antibiotic resistance or treatment failure (eg, advanced age, major medical comorbidities, immunocompromise, travel to areas with resistant organisms):
藥物的選擇取決於疾病的嚴重程度和抗生素耐葯或治療失敗的危險因素（例如，高齡、主要軀體合併症、免疫功能低下、前往耐藥微生物地區旅行）：

•Mild to moderate symptoms without risk factors (table 2)
無危險因素的輕至中度癥狀（ 表 2）

•Severe symptoms and/or risk factors (table 3)
嚴重癥狀和/或危險因素（ 表 3）

•Hospital-acquired infection (table 4)
醫院獲得性感染（ 表 4）

Patients should initially be kept on complete bowel rest with intravenous hydration. If symptoms improve, start a liquid diet and advance as tolerated. Immunocompetent patients who continue to improve are discharged with oral antibiotics to complete a total of four to seven days of antibiotic therapy (7 to 10 days for undrained abscess or phlegmon) (table 5). Immunocompromised patients should be treated with antibiotics for 10 to 14 days. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
患者最初應保持完全腸道休息並靜脈補液。如果癥狀改善，開始流質飲食，並在耐受的情況下進行。免疫功能正常但病情持續改善的患者出院後口服抗生素，以完成總共 4-7 天的抗生素治療（未引流的膿腫或蜂窩織炎為 7-10 天）（ 表 5）。免疫功能低下的患者應接受 10 至 14 天的抗生素治療。（參見 “急性結腸憩室炎的門診管理和隨訪”）

If symptoms do not improve, repeat imaging and evaluate the need for surgery. (See 'Treatment of diverticulitis' above and "Acute colonic diverticulitis: Surgical management".)
如果癥狀沒有改善，請重複影像學檢查並評估是否需要手術。（參見上文 '憩室炎的治療' 和 “急性結腸憩室炎的手術治療”）

●Treating complications – Patients with complicated diverticulitis must receive intravenous antibiotics and undergo appropriate surgical/interventional radiology management. Diverticular abscesses ≥4 cm should be drained percutaneously if feasible; patients who are not amenable to or do not respond to percutaneous drainage may require surgical intervention. Smaller abscesses may respond to antibiotics alone. Frank perforation, obstruction, or fistulization requires timely surgical intervention. (See 'Treatment of complications' above and "Acute colonic diverticulitis: Surgical management".)
治療併發症 – 複雜性憩室炎患者必須接受靜脈抗生素治療，並接受適當的手術/介入放射治療。如果可行，應經皮引流 ≥4 cm 的憩室膿腫;不適合經皮引流或對經皮引流無反應的患者可能需要手術干預。較小的膿腫可能對單獨使用抗生素有反應。明顯的穿孔、梗阻或瘺管形成需要及時手術干預。（參見上文 』併發症的治療' 和 “急性結腸憩室炎的手術治療”）

ACKNOWLEDGMENT  確認 — 

The editorial staff at UpToDate acknowledge Tonia Young-Fadok, MD, and John H Pemberton, MD, who contributed to earlier versions of this topic review.
感謝 UpToDate 編輯人員對本專題的早期版本做出了貢獻的 Tonia Young-Fadok 醫學博士和 John H Pemberton 醫學博士。