INTRODUCTION  介紹 — 

Colonic diverticulosis is a common finding on colonoscopy. The prevalence of diverticulosis increases with age. More than 70 percent of adults 80 years and older have diverticulosis on colonoscopy [1]. Only 1 to 4 percent of patients with colonic diverticulosis will develop acute diverticulitis over seven years of follow-up [2]. Colonic diverticulitis is defined as inflammation in and adjacent to a diverticulum. Diverticulitis is a common cause of acute onset abdominal pain in the United States.
結腸憩室病是結腸鏡檢查的常見發現。憩室病的患病率隨著年齡的增長而增加。超過 70% 的 80 歲及以上成人結腸鏡檢查顯示憩室病 [1]。只有 1%-4%的結腸憩室病患者會在 7 年的隨訪中發展為急性憩室炎[2]。結腸憩室炎被定義為憩室內和鄰近的炎症。憩室炎是美國急性發作性腹痛的常見原因。

This topic will review the clinical manifestations and diagnosis of acute diverticulitis. The epidemiology of diverticulosis, diverticular disease, and diverticular bleeding and the management of acute diverticulitis and diverticular bleeding are discussed in detail, separately. (See "Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis" and "Acute colonic diverticulitis: Triage and inpatient management" and "Diverticular fistulas" and "Colonic diverticular bleeding".)
本專題將總結急性憩室炎的臨床表現和診斷。憩室病、憩室病和憩室出血的流行病學，以及急性憩室炎和憩室出血的治療詳見其他專題。（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” 和 “急性結腸憩室炎的分診和住院治療” 和 “憩室瘺” 和 “結腸憩室出血”）

DEFINITIONS  定義

●A diverticulum is a sac-like protrusion of the colonic wall.
憩室是結腸壁的囊狀突起。

●Diverticulosis merely describes the presence of diverticula. Uncomplicated diverticulosis does not cause symptoms (eg, abdominal pain, abnormal bowel habits) in individuals without a history of acute diverticulitis [3].
憩室病僅描述憩室的存在。無併發症的憩室病不會在沒有急性憩室炎病史的個體中引起癥狀（如腹痛、排便習慣異常）[3]。

●Acute diverticulitis is defined as inflammation in and adjacent to a diverticulum.
急性憩室炎被定義為憩室內和鄰近的炎症。

●Complicated diverticulitis is defined as diverticulitis with one of the following associated complications: bowel obstruction, stricture, abscess, fistula, or perforation. (See 'Acute complications' below.)
複雜性憩室炎定義為憩室炎伴有以下相關併發症之一：腸梗阻、狹窄、膿腫、瘺管或穿孔。（參見下文 '急性併發症'）

●Uncomplicated diverticulitis is defined as acute diverticulitis without an associated complication.
單純性憩室炎定義為無相關併發症的急性憩室炎。

●Smoldering or chronic diverticulitis is diverticular inflammation that persists for weeks to months.
冒煙或慢性憩室炎是持續數周至數月的憩室炎症。

CLINICAL FEATURES  臨床特徵

Clinical manifestations — The clinical presentation of acute diverticulitis depends on the location of the inflammation in the colon, the severity of the underlying inflammatory process, and the presence of associated complications. Diverticulitis is most commonly managed in the ambulatory setting but is also a common indication for hospital admission [4]. The incidence of diverticulitis increases with age but is not uncommon in young adults [5].
臨床表現  —  急性憩室炎的臨床表現取決於炎症在結腸中的位置、潛在炎症過程的嚴重程度以及是否存在相關併發症。憩室炎最常在門診治療，但也是住院的常見指征 [4]。憩室炎的發病率隨年齡增長而增加，但在年輕成人中並不少見[5]。

Sudden onset abdominal pain is the most common complaint in patients with acute diverticulitis. The pain is usually in the left lower quadrant due to involvement of the sigmoid colon. However, patients may experience pain in other locations in the abdomen [6-8]. While diverticulitis is most common in the sigmoid colon, diverticulitis can also develop in the descending, transverse, ascending colon, and cecum [9]. The pain is usually constant [10]. (See "Acute colonic diverticulitis: Triage and inpatient management".)
突發腹痛是急性憩室炎患者最常見的主訴。由於乙狀結腸受累，疼痛通常發生在左下腹。然而，患者可能在腹部其他部位感到疼痛[6-8]。憩室炎最常見於乙狀結腸，但憩室炎也可發生於降結腸、橫結腸、升結腸和盲腸[9]。疼痛通常是持續的[10]。（參見 “急性結腸憩室炎的分診和住院管理”）

Patients may also have a fever. Hemodynamic instability with hypotension and shock are rare and are associated with perforation and peritonitis. A tender mass is palpable in approximately 20 percent of patients due to pericolonic inflammation or a peridiverticular abscess [11]. Patients may have localized peritoneal signs with localized guarding, rigidity, and rebound tenderness. Rectal examination may reveal a mass or tenderness to palpation in the presence of a distal sigmoid abscess. Stool may be positive for occult blood. (See "Etiologies, clinical manifestations, and diagnosis of mechanical small bowel obstruction in adults" and 'Acute complications' below and "Evaluation of the adult with abdominal pain" and "Evaluation of occult gastrointestinal bleeding", section on 'Testing for occult blood'.)
患者也可能發熱。血流動力學不穩定伴低血壓和休克很少見，與穿孔和腹膜炎有關。約 20%的患者可觸及壓痛腫塊，原因是結腸周圍炎症或憩室周圍膿腫[11]。患者可能有局部腹膜體征，伴有局部肌緊張、強直和反跳痛。直腸檢查可能顯示遠端乙狀結腸膿腫時觸診有腫塊或壓痛。糞便潛血可能呈陽性。（參見 “成人機械性小腸梗阻的病因、臨床表現和診斷” 和 '急性併發症' 和 “成人腹痛的評估” 和 “隱匿性消化道出血的評估”，關於'潛血檢測'一節 ）

Acute diverticulitis may be associated with a change in bowel habits, with constipation reported in approximately 50 percent of patients and diarrhea in 25 to 35 percent of patients [12,13]. Hematochezia is rare.
急性憩室炎可能與排便習慣改變有關，據報導，約 50%的患者存在便秘，25%-35%的患者出現腹瀉[12,13]。便血很少見。

Approximately 10 to 15 percent of patients with acute diverticulitis have urinary urgency, frequency, or dysuria due to irritation of the bladder from an inflamed sigmoid colon [12].
約 10%-15%的急性憩室炎患者因乙狀結腸發炎刺激膀胱而出現尿急、尿頻或排尿困難[12]。

Acute complications — According to a population study of over 3000 individuals from Minnesota, approximately 12 percent of those with acute diverticulitis have associated acute or chronic complications, including pericolonic abscess (69 percent), peritonitis (27 percent), obstruction (15 percent), and fistula (14 percent) [5]. Patients may have an acute complication of diverticulitis at initial presentation or may develop an acute complication subsequently. (See 'Disease course' below.)
急性併發症  —  一項針對明尼蘇達州 3000 多例患者的人群研究顯示，約 12%的急性憩室炎患者伴有急性或慢性併發症，包括結腸周圍膿腫（69%）、腹膜炎（27%）、梗阻（15%）和瘺管（14%）[5].患者在初次就診時可能有憩室炎的急性併發症，或者隨後可能出現急性併發症。（參見下文 '病程'）

Obstruction — During an attack of acute diverticulitis, partial colonic obstruction can occur because of relative luminal narrowing due to pericolonic inflammation or compression from a diverticular abscess. However, high-grade colonic obstruction is rare in the acute setting and is usually associated with the subsequent development of a stricture due to chronic diverticular inflammation. (See 'Disease course' below.)
梗阻  —  急性憩室炎發作期間，結腸周圍炎症或憩室膿腫壓迫導致管腔相對狹窄，可發生部分結腸梗阻。然而，高度結腸梗阻在急性情況下很少見，通常與隨後由慢性憩室炎症引起的狹窄發展有關。（參見下文 '病程'）

Acute diverticulitis can also cause a small bowel obstruction if a loop of small intestine becomes incorporated in a pericolonic inflammatory mass, or due to localized irritation and the development of an ileus.
如果小腸袢摻入結腸周圍炎性腫塊，或由於局部刺激和腸梗阻的發展，急性憩室炎也可引起小腸梗阻。

Depending on the degree and site of obstruction, patients may have abdominal pain, nausea, vomiting, abdominal distension, constipation, or obstipation. Patients with an ileus or obstruction may have abdominal distention and tympany on percussion due to the presence of dilated loops of bowel. Bowel sounds may be either high-pitched with obstruction or hypoactive in the case of ileus. (See "Etiologies, clinical manifestations, and diagnosis of mechanical small bowel obstruction in adults", section on 'Intra-abdominal inflammation or infection' and "Etiologies, clinical manifestations, and diagnosis of mechanical small bowel obstruction in adults", section on 'Clinical presentations'.)
根據梗阻的程度和部位，患者可能會出現腹痛、噁心、嘔吐、腹脹、便秘或頑固性便秘。腸梗阻或梗阻患者由於腸袢擴張，叩診時可能出現腹脹和鼓室。腸鳴音可能為高音調伴梗阻或腸梗阻時減退。（參見 “成人機械性小腸梗阻的病因、臨床表現和診斷”，關於'腹腔內炎症或感染'一節和 “成人機械性小腸梗阻的病因、臨床表現和診斷”，關於'臨床表現'一節 ）

Abscess — Diverticular abscesses occur in approximately 17 percent of patients hospitalized with acute diverticulitis [14,15]. The symptoms of a diverticular abscess are similar to acute diverticulitis. A diverticular abscess may be noted on abdominal CT scan at initial presentation or may develop subsequently. A diverticular abscess should therefore be suspected in patients with uncomplicated diverticulitis who have no improvement in abdominal pain or a persistent fever despite three days of antibiotic treatment. (See "Acute colonic diverticulitis: Triage and inpatient management", section on 'Abscess'.)
膿腫  —  約 17%的急性憩室炎住院患者存在憩室膿腫[14,15]。憩室膿腫的癥狀與急性憩室炎相似。憩室膿腫可能在初次就診時通過腹部 CT 掃描發現，也可能隨後出現。因此，對於無併發症的憩室炎患者，如果經過 3 天的抗生素治療後腹痛或持續發熱仍未改善，應懷疑憩室膿腫。（參見 “急性結腸憩室炎的分診和住院管理”，關於'膿腫'一節 ）

In rare cases, patients may develop a pyogenic liver abscess due to the spread of infection through the portal circulation. (See "Pyogenic liver abscess", section on 'Clinical manifestations'.)
在極少數情況下，由於感染通過門靜脈迴圈傳播，患者可能會發展為化膿性肝膿腫。（參見 “化膿性肝膿腫”，關於'臨床表現'一節 ）

Perforation — Perforation with generalized peritonitis may result from rupture of a diverticular abscess into the peritoneal cavity or free rupture of an inflamed diverticulum with fecal contamination of the peritoneum. Although only 1 to 2 percent of patients with acute diverticulitis have a perforation with purulent or fecal peritonitis, mortality rates approach 20 percent [16-19]. In patients with a free perforation, the abdomen is distended and diffusely tender to light palpation. There is diffuse guarding, rigidity, and rebound tenderness, and bowel sounds are absent. (See "Evaluation of the adult with abdominal pain".)
穿孔  —  全身性腹膜炎穿孔可能是由於憩室膿腫破裂進入腹膜腔或發炎的憩室自由破裂伴糞便污染腹膜引起的。雖然只有 1%-2%的急性憩室炎患者存在膿性或糞便性腹膜炎穿孔，但死亡率接近 20%[16-19]。在遊離穿孔患者中，腹部膨脹，輕度觸診時瀰漫性壓痛。有瀰漫性肌緊張、強直和反跳痛，並且沒有腸鳴音。（參見 “成人腹痛的評估”）

Fistula — Inflammation from acute diverticulitis may result in the formation of a fistula between the colon and adjacent viscera. Fistulas most commonly involve the bladder [20]. (See "Diverticular fistulas", section on 'Introduction'.)
瘺管  —  急性憩室炎引起的炎症可能導致結腸和鄰近臟器之間形成瘺管。瘺管最常累及膀胱[20]。（參見 “憩室瘺”，關於'引言'一節 ）

Patients with a colovesical fistula may have pneumaturia, fecaluria, or dysuria. Patients with a colovaginal fistula may report vaginal passage of feces or flatus. The clinical manifestations, diagnosis, and treatment of fistulas in patients with acute diverticulitis are discussed in detail separately. (See "Diverticular fistulas", section on 'Clinical features'.)
腦瘺患者可能有氣尿、糞便尿或排尿困難。結腸陰道瘺患者可能報告糞便或腸胃脹氣的陰道排出。急性憩室炎患者瘺管的臨床表現、診斷和治療詳見其他專題。（參見 “憩室瘺”，關於'臨床特徵'一節 ）

Laboratory findings — Patients with acute diverticulitis may have an elevated C-reactive protein and/or leukocytosis [21,22]. However, the white count may be normal in up to 45 percent of patients [23]. C-reactive protein is not reliable for ruling out complicated disease [24]. Serum amylase and lipase may be normal or mildly elevated, especially in patients with a free perforation and peritonitis. (See "Approach to the patient with elevated serum amylase or lipase", section on 'Causes'.)
實驗室檢查結果  —  急性憩室炎患者的 C 反應蛋白可能升高和/或白細胞增多[21,22]。然而，多達 45%的患者白細胞計數可能正常[23]。C 反應蛋白不能可靠地排除複雜性疾病 [24]。血清澱粉酶和脂肪酶可能正常或輕度升高，尤其是在遊離性穿孔和腹膜炎患者中。（參見 “血清澱粉酶或脂肪酶升高患者的概述”，關於'病因'一節 ）

Urinalysis may reveal sterile pyuria due to adjacent inflammation. The presence of colonic flora on urine culture suggests the presence of a colovesical fistula. (See "Sampling and evaluation of voided urine in the diagnosis of urinary tract infection in adults", section on 'Sterile pyuria' and "Diverticular fistulas", section on 'Clinical features'.)
尿液分析可能顯示由於鄰近炎症引起的無菌性膿尿。尿培養中存在結腸菌群提示存在共陰道瘺。（參見 “成人尿路感染診斷中排尿樣本和評估”，關於'無菌性膿尿'一節和 “憩室瘺”，關於'臨床特徵'一節 ）

Imaging — Several features may be seen on imaging in patients with acute diverticulitis.
影像學檢查  —  急性憩室炎患者的影像學檢查可能顯示幾個特徵。

Computed tomography scan — Computed tomography (CT) findings suggestive of acute diverticulitis include the presence of localized bowel wall thickening (>4 mm), pericolonic fat stranding secondary to inflammation, and the presence of colonic diverticula (image 1A-B) [25-27]. The sensitivity and specificity of abdominal CT for the diagnosis of acute diverticulitis are 94 and 99 percent, respectively [28].
計算機體層成像掃描  —  提示急性憩室炎的 CT 表現包括：存在局部腸壁增厚（>4mm）、繼發於炎症的結腸周圍脂肪擱淺，以及存在結腸憩室（ 影像 1A-B）[25-27]。腹部 CT 診斷急性憩室炎的敏感性和特異性分別為 94%和 99%[28]。

Complications of diverticulitis can also be visualized on abdominal CT scan. Abscesses are identified as fluid collections surrounded by an area with inflammatory changes. The center of the collection may contain air, air-fluid levels, or tissue with low attenuation representing necrotic debris [29]. Abdominal CT scan findings in patients with a bowel obstruction due to acute diverticulitis include the presence of dilated loops of bowel with air-fluid levels in proximity of an area with pericolonic inflammation (fat stranding). Extracolonic air collections within organs other than the bowel and the abdominal wall are suggestive of a fistula. In patients with peritonitis, free air can be seen on abdominal CT scan.
憩室炎的併發症也可以在腹部 CT 掃描中觀察到。膿腫被確定為液體積液，周圍有炎症改變的區域。收集的中心可能包含空氣、氣液平面或低衰減代表壞死碎片的組織[29]。急性憩室炎所致腸梗阻患者的腹部 CT 掃描結果包括結腸周圍炎症（脂肪擱淺）區域附近出現擴張的腸袢和氣液平面。除腸道和腹壁外器官內的結腸外空氣聚集提示瘺管。在腹膜炎患者中，腹部 CT 掃描可見遊離氣體。

Abdominal ultrasound — Ultrasound features suggestive of acute diverticulitis include:
腹部超聲  —  提示急性憩室炎的超聲特徵包括：

●A hypoechoic peridiverticular inflammatory reaction
低回聲型憩室周圍炎症反應

●Mural and peridiverticular abscess formation with or without gas bubbles
壁狀和憩室周圍膿腫形成，伴有或不伴有氣泡

●Bowel wall thickening (segmental mural thickening greater than 4 mm) at the point of maximal tenderness
腸壁增厚（節段性壁增厚大於 4 mm）在最大壓痛點

●Presence of diverticula in the surrounding segments
周圍節段存在憩室

Complications of diverticulitis may also be visualized by ultrasonography. An abscess appears as an anechoic masses containing echogenic debris (image 2). Features suggestive of a fistula include the presence of a hypoechoic area next to inflamed diverticula with extraluminal air bubbles extending in the bladder, vagina, or abdominal wall. In patients with peritonitis, ascites, diffuse peritoneal thickening, and scattered loculated fluid collections may be seen. (See "Transabdominal ultrasonography of the small and large intestine", section on 'Diverticulitis'.)
憩室炎的併發症也可以通過超聲檢查顯示。膿腫表現為含有回聲碎片的消聲腫塊（ 影像 2）。提示瘺管的特徵包括發炎憩室旁邊存在低回聲區域，腔外氣泡在膀胱、陰道或腹壁中延伸。在腹膜炎患者中，可能出現腹水、瀰漫性腹膜增厚和散在的包裹性積液。（參見 “小腸和大腸經腹超聲檢查”，關於'憩室炎'一節 ）

High-resolution, graded, compression ultrasound has comparable sensitivity and specificity for acute diverticulitis as compared with abdominal CT scan [30]. Ultrasound also has the advantage that it is widely available, inexpensive, and avoids radiation exposure. However, abdominal ultrasound is operator dependent and cannot exclude other causes of abdominal pain. (See 'Differential diagnosis' below.)
與腹部 CT 掃描相比，高解析度分級加壓超聲對急性憩室炎的敏感性和特異性相當[30]。超聲還有一個優點，即它廣泛可用、價格低廉，並且避免了輻射暴露。然而，腹部超聲檢查取決於作者，不能排除腹痛的其他原因。（參見下文 '鑒別診斷'）

Magnetic resonance imaging — Abdominal magnetic resonance imaging (MRI) findings suggestive of acute diverticulitis include colonic wall thickening, presence of diverticula, and pericolonic exudates and edema [31,32]. Nonspecific findings that can be seen on MRI include segmental narrowing of the colon, ascites, and an abscess.
磁共振成像  —  提示急性憩室炎的腹部 MRI 表現包括結腸壁增厚、存在憩室、結腸周圍滲出物和水腫[31,32]。MRI 上可見的非特異性發現包括結腸節段性狹窄、腹水和膿腫。

MRI has the advantage of avoiding radiation exposure. However, before MRI can routinely be used to diagnose acute diverticulitis and rule out other causes of abdominal pain, more studies are needed to compare the sensitivity, specificity, and cost-effectiveness of abdominal MRI with CT scan [33]. In most institutions where both abdominal CT and MRI are available, CT is usually obtainable more expeditiously.
MRI 的優點是避免了輻射暴露。然而，在 MRI 常規用於診斷急性憩室炎並排除腹痛的其他原因之前，還需要更多的研究來比較腹部 MRI 與 CT 掃描的敏感性、特異性和成本效益[33]。在大多數同時提供腹部 CT 和 MRI 的機構中，通常可以更迅速地獲得 CT。

Abdominal and chest radiographs — Nonspecific abnormalities can be seen on abdominal radiographs in 30 to 50 percent of patients with acute diverticulitis [34]. These findings include air-fluid levels with small or large intestinal dilation due to an ileus or obstruction and soft tissue densities due to the presence of an abscess. An upright chest radiograph may demonstrate the presence of pneumoperitoneum with air under the diaphragm in 3 to 12 percent of patients with acute diverticulitis [34].
腹部和胸部 X 線片  — 30%-50%的急性憩室炎患者在腹部 X 線片上可見非特異性異常[34]。這些發現包括氣液平面，由於腸梗阻或梗阻導致小腸或大腸擴張，以及由於膿腫的存在而導致軟組織密度。直立位胸片可能顯示 3%-12% 的急性憩室炎患者存在氣腹和橫膈膜下有空氣[34]。

DIAGNOSTIC APPROACH  診斷方法

Diagnosis — The diagnosis of acute diverticulitis should be suspected in a patient with lower abdominal pain and abdominal tenderness on physical examination. The pain is usually in the left lower quadrant in Western populations but may be suprapubic or in the right lower quadrant, particularly in patients with right-sided diverticulitis. Laboratory findings of an elevated CRP (>50 mg/L) or leukocytosis, while not sensitive or specific for acute diverticulitis, can support the diagnosis. We perform abdominal imaging (preferably computed tomography [CT] scan) to establish the diagnosis of acute diverticulitis. (See 'Imaging' above.)
診斷  —  體格檢查發現下腹痛和腹部壓痛的患者應懷疑急性憩室炎。在西方人群中，疼痛通常位於左下腹，但也可能在恥骨上或右下腹，尤其是在右側憩室炎患者中。CRP 升高 （>50 mg/L） 或白細胞增多的實驗室檢查結果，雖然對急性憩室炎不敏感或不特異，但可以支持診斷。我們進行腹部影像學檢查（最好是計算機斷層掃描 [CT] 掃描）以確定急性憩室炎的診斷。（參見上文 '影像學檢查'）

The authors' practice is to perform an abdominopelvic CT scan with oral and intravenous (IV) contrast to establish the diagnosis of acute diverticulitis because it has a high sensitivity and specificity for acute diverticulitis and can exclude other causes of abdominal pain. However, some guidelines suggest that imaging can be performed more selectively, and that a diagnosis can be made without abdominal imaging in patients with localized left lower quadrant pain in the absence of vomiting, a CRP>50 mg/L, and/or a prior history of acute diverticulitis [35]. (See 'Computed tomography scan' above and 'Differential diagnosis' below.)
作者的做法是使用口服和靜脈注射 （IV） 造影劑進行腹盆腔 CT 掃描，以確定急性憩室炎的診斷，因為它對急性憩室炎具有很高的敏感性和特異性，並且可以排除腹痛的其他原因。然而，一些指南建議，對於無嘔吐、CRP>50mg/L 和/或有急性憩室炎既往史的局限性左下腹疼痛患者，可以更有選擇性地進行影像學檢查，無需腹部影像學檢查即可做出診斷 [35]。（參見上文 'CT 掃描' 和 '鑒別診斷'）

Evaluation — The goal of the evaluation is to establish the diagnosis of acute diverticulitis and to rule out other causes of abdominal pain. Evaluation should begin with a history and physical examination, which includes a pelvic examination in women to rule out pelvic pathology. (See 'Clinical manifestations' above and 'Differential diagnosis' below and "Evaluation of the adult with abdominal pain", section on 'Lower abdominal pain' and "The gynecologic history and pelvic examination", section on 'Components of the examination'.)
評估  —  評估的目的是確定急性憩室炎的診斷，並排除腹痛的其他原因。評估應從病史和體格檢查開始，包括對女性進行盆腔檢查以排除盆腔病變。（參見上文 '臨床表現' 和 '鑒別診斷' 和 “成人腹痛的評估”，關於'下腹痛'一節和 “婦科病史和盆腔檢查”，關於'檢查內容'一節 ）

Laboratory evaluation should include a complete blood count, electrolytes, and urine analysis. A pregnancy test should be performed in all women of childbearing age. The presence of leukocytosis or elevated CRP is supportive of the diagnosis of acute diverticulitis. (See 'Laboratory findings' above.)
實驗室評估應包括全血細胞計數、電解質和尿液分析。所有育齡婦女都應進行妊娠試驗。白細胞增多或 CRP 升高支援急性憩室炎的診斷。（參見上文 '實驗室檢查結果'）

In patients with a suspected perforation and diffuse peritonitis, serum aminotransferases, alkaline phosphatase, bilirubin, amylase, and lipase levels should be obtained to rule out other causes of acute abdominal pain. (See "Evaluation of the adult with abdominal pain", section on 'Initial workup'.)
對於疑似穿孔和瀰漫性腹膜炎的患者，應檢測血清轉氨酶、鹼性磷酸酶、膽紅素、澱粉酶和脂肪酶水準，以排除急性腹痛的其他原因。（參見 “成人腹痛的評估”，關於'初始病情檢查'一節 ）

Stool studies should be performed only in patients with diarrhea to rule out infectious etiologies. Stool studies should include stool Clostridioides difficile toxin, routine stool cultures (Salmonella, Shigella, Campylobacter, Yersinia), specific testing for E. coli O157:H7, microscopy for ova and parasites (three samples), and a Giardia stool antigen test. In patients with a clear diagnosis of diverticulitis on imaging studies, stool studies are rarely indicated.
應僅在腹瀉患者中進行糞便檢查，以排除感染性病因。糞便檢查應包括糞便艱難梭菌毒素、常規糞便培養（ 沙門氏菌 、 志賀菌 、 彎曲桿菌 、 耶爾森菌 ）、 大腸桿菌 O157：H7 特異性檢測、蟲卵和寄生蟲顯微鏡檢查（3 個樣本）和賈第鞭毛蟲糞便抗原檢測。在影像學檢查中明確診斷為憩室炎的患者中，很少需要糞便檢查。

We perform an abdominal CT scan with oral and intravenous (IV) contrast to establish the diagnosis of acute diverticulitis. High-resolution, graded, compression ultrasound should be performed if abdominal CT scan is unavailable [36,37]. Abdominal CT scan and ultrasound features suggestive of acute diverticulitis are reviewed above (image 1A and image 1B) [25-27]. (See 'Computed tomography scan' above and 'Abdominal ultrasound' above.)
我們使用口服和靜脈注射 （IV） 造影劑進行腹部 CT 掃描，以確定急性憩室炎的診斷。如果無法進行腹部 CT 掃描，應進行高解析度分級的加壓超聲[36,37]。提示急性憩室炎的腹部 CT 掃描和超聲特徵見上文（ 影像 1A 和影像 1B）[25-27]。（參見上文 '計算機體層成像掃描' 和 '腹部超聲'）

DIFFERENTIAL DIAGNOSIS  鑒別診斷 — 

The differential diagnosis of acute diverticulitis includes other etiologies of lower abdominal pain. Acute diverticulitis can be distinguished from most other causes of lower abdominal pain based on the clinical features, physical examination, laboratory studies, and abdominal computed tomography (CT) scan.
急性憩室炎的鑒別診斷包括下腹痛的其他病因。急性憩室炎可根據臨床特徵、體格檢查、實驗室檢查和腹部計算機斷層掃描 （CT） 掃描與大多數其他原因的下腹痛相鑒別。

●Irritable bowel syndrome (IBS) – The abdominal discomfort seen in patients with IBS can be similar to patients with diverticulitis. However, the symptoms of abdominal pain and altered bowel habits are chronic in patients with IBS. Patients with IBS usually also have symptoms of bloating, distension, and diarrhea and/or constipation. CT scan is diagnostic in patients with diverticulitis and normal in patients with IBS. (See "Clinical manifestations and diagnosis of irritable bowel syndrome in adults".)
腸易激綜合征 （IBS） – IBS 患者出現的腹部不適可能與憩室炎患者相似。然而，腹痛和排便習慣改變的癥狀在 IBS 患者中是慢性的。IBS 患者通常還會出現腹脹、腹脹、腹瀉和/或便秘的癥狀。憩室炎患者的 CT 掃描具有診斷意義，而 IBS 患者的 CT 掃描則正常。（參見 “成人腸易激綜合征的臨床表現和診斷”）

●Colorectal cancer – Patients with colorectal cancer (CRC) and acute diverticulitis may present with similar clinical features and have bowel wall thickening on abdominal CT. However, the presence of pericolonic and mesenteric inflammation, involvement of greater than 10 cm of the colon, and absence of enlarged pericolonic lymph nodes on abdominal CT are suggestive of acute diverticulitis [38,39]. In 10 to 20 percent of patients, it remains difficult to distinguish between acute diverticulitis and a CRC on abdominal CT scan, and a CRC can only be excluded with a colonoscopy after resolution of acute inflammation [40,41]. (See "Clinical presentation, diagnosis, and staging of colorectal cancer", section on 'Clinical presentation' and 'Exclusion of an underlying malignancy' below.)
結直腸癌 – 結直腸癌 （CRC） 和急性憩室炎患者可能出現相似的臨床特徵，並在腹部 CT 上出現腸壁增厚。然而，腹部 CT 顯示結腸周圍和腸系膜炎症、結腸受累>10cm 以及結腸周圍淋巴結腫大，提示急性憩室炎[38,39]。10%-20%的患者在腹部 CT 掃描中仍然難以區分急性憩室炎和 CRC，只有在急性炎症消退后，結腸鏡檢查才能排除 CRC[40,41]。（參見 “結直腸癌的臨床表現、診斷和分期”，關於'臨床表現'一節和 '排除潛在惡性腫瘤'）

●Acute appendicitis – Classic symptoms of appendicitis include right lower quadrant abdominal pain, anorexia, fever, nausea, and vomiting. The abdominal pain is initially periumbilical and subsequently in the right lower quadrant. Abdominal CT scan can differentiate between acute appendicitis and acute diverticulitis. The abdominal CT scan findings in patients with acute appendicitis are discussed in detail, separately. (See "Acute appendicitis in adults: Diagnostic evaluation", section on 'Computed tomography'.)
急性闌尾炎 – 闌尾炎的典型癥狀包括右下腹痛、厭食、發燒、噁心和嘔吐。腹痛最初發生在臍周，隨後位於右下腹。腹部 CT 掃描可以區分急性闌尾炎和急性憩室炎。急性闌尾炎患者的腹部 CT 掃描結果詳見其他專題。（參見 “成人急性闌尾炎的診斷性評估”，關於'計算機體層成像'一節 ）

●Inflammatory bowel disease – In patients with inflammatory bowel disease (IBD), diarrhea rather than abdominal pain is the predominant symptom. In addition, patients have symptoms for several months prior to presentation. Although abdominal CT scan may demonstrate wall thickening in both acute diverticulitis and IBD, the presence of diverticulosis and peridiverticular inflammation are suggestive of acute diverticulitis. (See "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults", section on 'Imaging'.)
炎症性腸病 – 在炎症性腸病 （IBD） 患者中，腹瀉而不是腹痛是主要癥狀。此外，患者在就診前數月出現癥狀。雖然腹部 CT 掃描可能顯示急性憩室炎和 IBD 患者憩室壁增厚，但憩室病和憩室周圍炎症的存在提示急性憩室炎。（參見 “成人潰瘍性結腸炎的臨床表現、診斷和預後”，關於'影像學檢查'一節 ）

●Infectious colitis – In patients with infectious colitis, diarrhea is the predominant symptom. Patients may have a history of prior antibiotic use or recent travel. Stool cultures may identify the causative pathogen. While an abdominal CT may demonstrate wall thickening in infectious colitis, peridiverticular inflammation, as seen in patients with acute diverticulitis, is absent. (See 'Evaluation' above.)
感染性結腸炎 – 在感染性結腸炎患者中，腹瀉是主要癥狀。患者可能有既往抗生素使用史或近期旅行史。糞便培養可以識別致病病原體。雖然腹部 CT 可能顯示感染性結腸炎患者憩室壁增厚，但不存在急性憩室炎患者可見的憩室周圍炎症。（參見上文 』評估'）

●Ischemic colitis – Patients with ischemic colitis usually present with rapid onset of abdominal pain, hematochezia, or bloody diarrhea. Patients may have risk factors for ischemic colitis (eg, age >60 years, hemodialysis, hypertension, diabetes mellitus, dehydration, or stimulant laxative use). On abdominal CT scan, segmental bowel wall thickening can be seen, similar to patients with acute diverticulitis, but pericolonic inflammation is absent. (See "Colonic ischemia", section on 'Clinical features' and "Colonic ischemia", section on 'Diagnosis'.)
缺血性結腸炎 – 缺血性結腸炎患者通常表現為快速發作的腹痛、便血或血性腹瀉。患者可能有缺血性結腸炎的危險因素（例如，年齡 >60 歲、血液透析、高血壓、糖尿病、脫水或使用興奮性瀉藥）。腹部 CT 掃描可見節段性腸壁增厚，與急性憩室炎患者相似，但無結腸周圍炎症。（參見 “結腸缺血”，關於'臨床特徵'一節和 “結腸缺血”，關於'診斷'一節 ）

●Other – Alternative diagnoses should also be considered in the differential diagnosis of acute diverticulitis. These include tubo-ovarian abscess, ovarian cyst, ovarian torsion, ectopic pregnancy, cystitis, and nephrolithiasis. These can be differentiated from acute diverticulitis by history, physical examination, laboratory studies, and imaging and are discussed in detail, separately. (See "Evaluation of the adult with abdominal pain", section on 'Lower abdominal pain'.)
其他 – 在急性憩室炎的鑒別診斷中也應考慮其他診斷。這些包括輸卵管卵巢膿腫、卵巢囊腫、卵巢扭轉、異位妊娠、膀胱炎和腎結石。這些可通過病史、體格檢查、實驗室檢查和影像學檢查與急性憩室炎相鑒別，詳見其他專題。（參見 “成人腹痛的評估”，關於'下腹痛'一節 ）

EXCLUSION OF AN UNDERLYING MALIGNANCY
排除潛在的惡性腫瘤 — 

Colonoscopy has no role in establishing the diagnosis of acute diverticulitis as the inflammation is peridiverticular. Endoscopic evaluation of the colon should be avoided in the acute setting due to the risk of perforation or exacerbation of the existing inflammation. After the complete resolution of symptoms associated with acute diverticulitis (typically in six to eight weeks), a colonoscopy is performed to rule out missed malignancy in patients with a history of complicated diverticulitis, atypical imaging findings, or atypical course [8,42-44]. The risk of malignancy is four times higher in patients with a history of complicated diverticulitis as compared with a colon cancer screening population [45]. (See "Acute colonic diverticulitis: Outpatient management and follow-up", section on 'Colonoscopy for select patients'.)
結腸鏡檢查對確定急性憩室炎的診斷沒有作用，因為炎症發生在憩室周圍。在急性情況下，應避免對結腸進行內窺鏡評估，因為存在穿孔或現有炎症加重的風險。急性憩室炎相關癥狀完全消退后（通常在 6-8 周內），對於有複雜性憩室炎病史、影像學表現不典型或病程不典型的患者，應進行結腸鏡檢查以排除漏診惡性腫瘤[8,42-44]。與結腸癌篩查人群相比，有複雜性憩室炎病史的患者發生惡性腫瘤的風險高出 4 倍 [45]。（參見 “急性結腸憩室炎的門診管理和隨訪”，關於'特定患者的結腸鏡檢查'一節 ）

NATURAL HISTORY  自然史 — 

Patients with acute diverticulitis present with lower abdominal pain, usually in the left lower quadrant and a low-grade fever.
急性憩室炎患者表現為下腹痛，通常在左下腹和低熱。

Disease course — Disease course depends on multiple factors including patient characteristics, prior history of diverticulitis, and severity of the episode [5].
病程  —  病程取決於多種因素，包括患者特徵、憩室炎既往史和發作嚴重程度[5]。

The most common presentation of diverticulitis is acute uncomplicated disease. Most patients with this presentation recover from the acute episode. Median time to recovery is 14 days [46]. Among patients with acute uncomplicated diverticulitis at initial presentation, 5 percent will develop a complication, usually within 10 days of presentation. Obstruction is the most common complication followed by perforation and abscess [47].
憩室炎最常見的表現是急性單純性疾病。大多數有這種表現的患者從急性發作中恢復。中位恢復時間為 14 日[46]。在初次就診時患有急性單純性憩室炎的患者中，5% 的患者會在就診后 10 天內出現併發症。梗阻是最常見的併發症，其次是穿孔和膿腫[47]。

Ongoing abdominal discomfort is common after resolution of acute inflammation. In a cohort study of patients with imaging-confirmed acute uncomplicated diverticulitis, 45 percent of patients reported abdominal pain and 33 percent reported altered bowel habits at one-year follow-up. The differential diagnosis for ongoing symptoms is broad. Imaging and colonoscopy may need to be considered to rule out an alternative diagnosis or ongoing inflammation. In approximately 5 percent of patients, chronic abdominal pain is due to chronic or smoldering diverticulitis with persistent chronic diverticular inflammation [48].
急性炎症消退後持續的腹部不適很常見。在一項針對影像學證實的急性單純性憩室炎患者的佇列研究中，45% 的患者報告腹痛，33% 的患者在一年的隨訪中報告排便習慣改變。持續癥狀的鑒別診斷範圍很廣。可能需要考慮影像學檢查和結腸鏡檢查，以排除其他診斷或持續炎症。在大約 5%的患者中，慢性腹痛是由慢性或冒煙型憩室炎伴持續性慢性憩室炎症引起的[48]。

After recovery from an acute episode managed conservatively, patients are at risk for recurrent episodes. The risk of recurrence depends on the number of prior episodes and disease severity. After a first episode of diverticulitis, the risk of a second episode is 22 percent within 10 years. After a second episode, the risk of a third episode is 55 percent. The risk of recurrence increases with every episode. Diverticulitis complicated by abscess or perforation is usually the first or sometimes the second presentation. Recurrent diverticulitis is not associated with an increased risk of perforation or abscess [5].
從保守治療的急性發作中恢復后，患者有復發的風險。復發風險取決於既往發作次數和疾病嚴重程度。憩室炎首次發作後，10 年內第二次發作的風險為 22%。第二次發作后，第三次發作的風險為 55%。每次發作時，復發的風險都會增加。憩室炎併發膿腫或穿孔通常是首發或有時第二表現。復發性憩室炎與穿孔或膿腫風險增加無關 [5]。

A fibrotic diverticular stricture can develop after an episode of acute diverticulitis. Recurrent episodes are not a risk factor for the development of a diverticular stricture [49]. Patients with a colonic stricture usually present with obstructive symptoms without diverticulitis or sometimes with more insidious symptoms of abdominal pain and constipation. Fistulizing disease from diverticulitis is rare, but the risk increases with recurrence [49]. (See "Acute colonic diverticulitis: Triage and inpatient management", section on 'Obstruction'.)
纖維化憩室狹窄可在急性憩室炎發作後發生。反覆發作不是憩室狹窄的危險因素[49]。結腸狹窄患者通常表現為梗阻癥狀，但無憩室炎，有時表現為更隱匿的腹痛和便秘癥狀。憩室炎引起的瘺管性疾病很少見，但風險會隨著復發而增加[49]。（參見 “急性結腸憩室炎的分診和住院管理”，關於'梗阻'一節 ）

Mortality — In patients with acute diverticulitis, mortality rates vary depending on the presence of complications and patient comorbidities. In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible [50]. (See "Acute colonic diverticulitis: Triage and inpatient management".)
死亡率  —  急性憩室炎患者的死亡率因併發症和患者合併症而異。在急性單純性憩室炎患者中，保守治療成功率為 70%-100%，死亡率可忽略不計[50]。（參見 “急性結腸憩室炎的分診和住院管理”）

In patients with complicated diverticulitis undergoing an operation, the mortality rate is approximately 0.6 to 5 percent [51-53]. Although mortality rates are up to 20 percent in patients with perforated diverticulitis with purulent or fecal peritonitis, these complications are rare in the absence of diffuse peritonitis [16-19]. (See "Acute colonic diverticulitis: Triage and inpatient management" and "Acute colonic diverticulitis: Surgical management".)
在接受手術的複雜憩室炎患者中，死亡率約為 0.6%-5% [51-53]。雖然伴有膿性或糞便性腹膜炎的穿孔性憩室炎患者的死亡率高達 20%，但在無瀰漫性腹膜炎的情況下，這些併發症很少見[16-19]。（參見 “急性結腸憩室炎的分診和住院治療” 和 “急性結腸憩室炎的手術治療”）

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".)
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”）

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)")
基礎篇（參見 “患者教育：憩室炎（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

●Definition – Acute diverticulitis is defined as inflammation and/or infection of a diverticulum. (See 'Definitions' above.)
定義 – 急性憩室炎被定義為憩室的炎症和/或感染。（參見上文 '定義'）

Diverticulitis is most commonly managed in the ambulatory setting. The incidence of diverticulitis increases with age but is not uncommon in young adults.
憩室炎最常在門診環境中進行治療。憩室炎的發病率隨著年齡的增長而增加，但在年輕人中並不少見。

●Clinical manifestations – Abdominal pain is the most common complaint in patients with acute diverticulitis. The pain is left sided in approximately 85 percent of patients. However, patients may present with right lower quadrant or suprapubic pain due to the presence of a redundant inflamed sigmoid colon or right-sided (cecal) diverticulitis. Patients may also have a fever. Other associated symptoms include nausea, vomiting, constipation, diarrhea, and dysuria. (See 'Clinical features' above.)
臨床表現 – 腹痛是急性憩室炎患者最常見的主訴。大約 85%的患者疼痛發生在左側。然而，由於存在冗餘的發炎乙狀結腸或右側（盲腸）憩室炎，患者可能會出現右下腹或恥骨上疼痛。患者也可能發熱。其他相關癥狀包括噁心、嘔吐、便秘、腹瀉和排尿困難。（參見上文 '臨床特徵'）

●Acute complications – Approximately 12 percent of patients with acute diverticulitis have associated complications. Acute complications include bowel obstruction, development of an abscess, fistula, stricture, or a colonic perforation into the peritoneum and peritonitis. Diverticulitis complicated by an abscess or perforation is usually the first or second presentation of the disease. Recurrent episodes are not a risk factor for developing perforation or abscess. (See 'Acute complications' above and 'Disease course' above.)
急性併發症 – 大約 12% 的急性憩室炎患者有相關併發症。急性併發症包括腸梗阻、膿腫、瘺管、狹窄或結腸穿孔進入腹膜和腹膜炎。憩室炎併發膿腫或穿孔通常是該病的首發或繼發表現。反覆發作不是發生穿孔或膿腫的危險因素。（參見上文 '急性併發症' 和 '病程'）

●Diagnosis – The diagnosis of acute diverticulitis should be suspected in a patient with lower abdominal pain with tenderness to palpation on physical examination. Laboratory findings of leukocytosis, while not sensitive or specific for acute diverticulitis, can support the diagnosis. Abdominal imaging is required to establish the diagnosis of acute diverticulitis. We perform an abdominal computed tomography (CT) scan with oral and intravenous contrast to establish the diagnosis of acute diverticulitis because it has a high sensitivity and specificity for acute diverticulitis and can exclude other causes of abdominal pain. However, repeated CT scans can sometimes be avoided in patients who present with mild and typical symptoms and have a history of diverticulitis previously diagnosed by CT. (See 'Diagnosis' above.)
診斷 – 對於體格檢查時伴有觸診壓痛的下腹痛患者，應懷疑急性憩室炎的診斷。白細胞增多的實驗室檢查結果雖然對急性憩室炎不敏感或不特異，但可支持診斷。需要腹部影像學檢查來確定急性憩室炎的診斷。我們使用口服和靜脈造影劑進行腹部計算機斷層掃描（computed tomography， CT）掃描，以確定急性憩室炎的診斷，因為急性憩室炎對急性憩室炎具有很高的敏感性和特異性，並且可以排除腹痛的其他原因。然而，對於表現為輕度和典型癥狀且既往有 CT 診斷為憩室炎病史的患者，有時可以避免重複進行 CT 掃描。

CT scan findings suggestive of acute diverticulitis include the presence of localized bowel wall thickening (>4 mm), pericolonic fat stranding secondary to inflammation, and the presence of colonic diverticula. (See 'Computed tomography scan' above.)
提示急性憩室炎的 CT 掃描結果包括存在局部腸壁增厚 （>4 mm）、繼發於炎症的結腸周圍脂肪擱淺以及結腸憩室的存在。（參見上文 '計算機體層成像掃描'）

●Role of delayed colonoscopy – Colonoscopy has no role in establishing the diagnosis of acute diverticulitis and should not be performed in the acute setting due to the risk of perforation. However, a colonoscopy should generally be performed at least six to eight weeks after recovery to definitively rule out the presence of an underlying colorectal cancer in patients with complicated diverticulitis, atypical imaging findings, or atypical course. (See 'Exclusion of an underlying malignancy' above.)
延遲結腸鏡檢查的作用 – 結腸鏡檢查在確定急性憩室炎的診斷中沒有作用，由於存在穿孔的風險，因此不應在急性情況下進行。然而，對於複雜性憩室炎、影像學表現不典型或病程不典型的患者，通常應在恢復后至少 6 至 8 周進行結腸鏡檢查，以明確排除潛在結直腸癌的存在。（參見上文 '排除基礎惡性腫瘤'）

●Natural history – Ongoing abdominal discomfort is common after resolution of acute inflammation. The differential for ongoing symptoms is broad. Imaging and colonoscopy may need to be considered to rule out an alternative diagnosis or ongoing inflammation.
自然病程 – 急性炎症消退後，持續的腹部不適很常見。持續癥狀的鑒別診斷範圍很廣。可能需要考慮影像學檢查和結腸鏡檢查，以排除其他診斷或持續炎症。

ACKNOWLEDGMENT  確認 — 

The editorial staff at UpToDate acknowledges John H Pemberton, MD, Tonia Young-Fadok, MD, and Per Olav Vandvik, MD, PhD, who contributed to an earlier version of this topic review.
UpToDate 的編輯人員感謝 John H Pemberton 醫學博士、Tonia Young-Fadok 醫學博士和 Per Olav Vandvik 醫學博士對本專題綜述的早期版本做出了貢獻。