대장게실염의 진단 및 치료
Diagnosis and Treatment of Colon Diverticulitis
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대장게실염, 특히 우측 대장게실염은 한국인에서 비교적 흔한 질환이며 치료 전 정확한 진단은 올바른 치료 방법 선택 및 예후에 영향을 미치는 필수적인 요소이다. 많은 수의 환자들이 응급실로 내원하는데, 대부분 복부 CT 검사를 통하여 진단할 수 있고 급성기에 대장내시경이 필요한 경우는 드물다. 합병증이 동반되지 않은 대장게실염의 경우 항생제 정주를 통해 안전하고 효과적으로 치료를 시행할 수 있으며 외래에서 증상 평가 및 염증 지표(예: 백혈구, C-reactive protein)검사를 통해 경구 항생제 투여를 지속할 것인지 결정하여야 한다. 심한 합병증이 동반 되었을 때 그리고 대장암과의 감별이 되지 않을 때는 수술을 고려하여야 한다. 결론적으로 대장게실염의 수술에 따른 합병증도 항상 고려해야 하므로 수술 전 정확한 진단 및 효과적인 치료를 위해 내과, 영상의학과, 외과의 상호 토의에 의해 치료 방향을 결정하는 것은 좋은 예후를 확보하기 위한 필수적인 과정일 것으로 생각한다.
Abstract
Colonic diverticular disease is the common conditions in industrialized and westernized countries, but it is relatively rare in areas such as Asia. Colonic diverticula are asymptomatic in most cases, only 10-25% develop diverticulitis and 1% finally gets surgery. The location of colonic diverticulitis are significantly different in Western countries and Asia. Left-sided diverticulitis is common in Western countries, while in Asians, right-sided diverticulitis is more prevalent. A CT scans is commonly used to diagnose diverticulitis and its complication such as abscess, obstruction, fistula and perforation. It also has been used in percutaneous drainage of diverticular abscess and predicting the success of medical therapy. After resolution of clinical attack of diverticulitis, colonoscopy can be performed to exclude colon cancer. The current therapeutic approaches for colonic diverticulitis are relieving symptoms and preventing complications. Uncomplicated diverticulitis is successfully treated with antibiotics, bowel rest and pain control, while complicated diverticulitis require surgical consultation. Treatment strategy of recurrent diverticulitis depends on age and comorbid diseases as well as the frequency and severity of subsequent attacks.
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