Kolon Divertiküliti
Özet
Kolon divertikülü, organ içi basınç artışı nedeniyle kolon duvarındaki mukoza ve serozanın en dayansız noktalardan dışa doğru fıtıklaşmasıyla oluşan yalancı ve pulsiyon divertikülleridir. Batılı ve sanayileşmiş ülkelerde %5-45 oranında görülen bu durumun en sık yerleştiği bölge sigmoid kolondur. Liften fakir diyet, kırmızı et tüketimi, sigara, obezite ve nonsteroid antienflamatuvar kullanımı gibi faktörler etyolojide rol oynar. En sık klinik belirti sol alt kadran karın ağrısı olup, divertikül içine sıkışan fekalit ve staz akut divertikülite, ilerleyen durumlarda ise perforasyon ve apseye yol açabilir. Tanıda klinik bulgular, C-reaktif protein yüksekliği ve bilgisayarlı tomografi kritik öneme sahiptir. Tedavi yaklaşımı Dünya Acil Cerrahi Derneği (WSES) evrelemesine göre belirlenir. Komplikasyonsuz olgularda ayaktan takip ve seçilmiş vakalarda antibiyotik önerilirken; büyük apselerde perkütan drenaj, yaygın peritonit veya serbest hava saptanan ileri evrelerde ise Hartmann rezeksiyonu veya primer anastomoz gibi cerrahi müdahaleler uygulanır.
Colonic diverticulum refers to pseudodivertictula and pulsion diverticula formed by the herniation of colonic wall layers through the weakest points due to increased intraluminal pressure. Seen at a rate of 5-45% in Westernized and industrialized societies, it is most commonly localized in the sigmoid colon. Etiological factors include a low-fiber diet, high red meat consumption, smoking, obesity, and the use of nonsteroidal anti-inflammatory drugs. The most frequent clinical manifestation is left lower quadrant abdominal pain; fecalith entrapment and stasis within the diverticulum lead to acute diverticulitis, which can progress to perforation and abscess formation. Clinical findings, elevated C-reactive protein levels, and computed tomography are essential for accurate diagnosis. Management is guided by the World Society of Emergency Surgery (WSES) staging. Uncomplicated cases are managed conservatively with outpatient follow-up and selective antibiotics, whereas large abscesses require percutaneous drainage, and advanced stages with generalized peritonitis or free air necessitate surgical interventions such as Hartmann's resection or primary anastomosis.
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