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우측대장 게실염의 치료에 있어서 대장내시경의 유용성

The Usefulness of Colonoscopy in the Management of Right Side Colonic Diverticulitis

대한대장항문학회지 2001년 17권 6호 p.283 ~ 288
이은규, 김홍대, 손병호, 한원곤,
소속 상세정보
이은규 ( Lee Eun-Kyu ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
김홍대 ( Kim Heung-Dae ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
손병호 ( Sohn Byung-Ho ) - 성균관대학교 의과대학 강북삼성병원 일반외과
한원곤 ( Han Won-Kon ) - 성균관대학교 의과대학 강북삼성병원 일반외과

Abstract


Purpose: Most patients who finally diagnosed as the cecal and ascending colonic diverticulitis would complain pain on right low quadrant of abdomen. So many of them unfortunately would be performed emergency operation for presumed appendicitis. We are purposed to verify the usefulness of colonoscopy for the diagnosis and aimed to treat many patients with this disease conservatively.

Methods: We reviewed retrospectively the medical records of the 46 patients who diagnosed as the cecal
and ascending colonic diverticulitis under admission at general surgery department during 4 years from January, 1997 to December, 2000.

Results: The mean age was 40.1 years and the male to female ratio was 1.2 : 1. Most common clinical
manifestation was abdominal pain (46 cases) and nausea/vomiting (13 cases), fever/chill (4 cases) followed. On physical examination on abdomen, 26 patients had tenderness with rebound tenderness on right low quadrant and 18 patients showed only tenderness on right low quadrant. The mean peripheral WBC count was 10,600.9/㎟. Diagnostic tools were abdominal ultrasonography (34 cases), adominal CT (13 cases), barium enema (8 cases) and colonoscopy (22 cases). The sensitivities of each modalities were 52.6%, 46.2%, 33.3% ad 81.8% respectively. The respective mean hospital days depending on the treatment arms were as follows: 6.0 days of the conservatively treated group, 8.0 days of whom were operated as exploratory laparotomy with incidental appendectomy and 16.9 days of whom were operated as Right-hemicolectomy. 17 patients of 24 colonoscopy-done patients were recovered with conservative treatment, compared with only 7 patients of 22 colonoscopy-undone patients (P=0.0005). 2 cases of the conservatively managed groups were operated later due to recurrences (mean follow up periods=20 months). 2 operated patients had complications of postoperative ileus.

Conclusion: Based on our study, the indications of colonoscopy are that in whom impressed clinically as acute appendicitis, on physical examination there e obvious tenderness on right low quadrant but obscure rebound tenderness, on peripheral blood smear the WBC counts range from normal to mild increased (<15,000/㎟), and on ultrasonography, appendix couldn’t be detected or colonic wall show thickening. In patients who selected fit for indications, colonoscopy is safe and highly sensitive. We would manage these patients more conservatively, and may reduce their hospital stay.

키워드

맹장;상행 결장;게실염;대장내시경
Cecum;Right colon;Diverticulitis;Colonoscopy

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