Doença diverticular
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- dor abdominal no quadrante inferior esquerdo
- leucocitose
- febre
- sangramento retal
Outros fatores diagnósticos
- defesa no quadrante inferior esquerdo
- sensibilidade no quadrante inferior esquerdo
- distensão abdominal
- constipação
- sensibilidade pélvica no exame de toque retal
- desconforto abdominal difuso
- diarreia
- massa abdominal palpável
Fatores de risco
- dieta pobre em fibras
- dieta rica em sal, carne e açúcar
- idade >50 anos
- obesidade (índice de massa corporal [IMC] >30)
- uso de anti-inflamatórios não esteroidais (AINEs)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Hemograma completo com diferencial
- proteína C-reativa
Investigações a serem consideradas
- tomografia computadorizada (TC) do abdome
- hemocultura
- radiografia abdominal
- ultrassonografia abdominal (compressão graduada)
- ressonância nuclear magnética (RNM) abdominal
- radiografia torácica
- enema com contraste
- colonoscopia
- sigmoidoscopia
- angiografia
- laparoscopia diagnóstica/laparotomia exploratória
Algoritmo de tratamento
diverticulose assintomática
doença diverticular sintomática
diverticulite sintomática (não complicada)
diverticulite sintomática (complicada)
diverticulite recorrente
Colaboradores
Autores
Mohamed A. Thaha, PhD, FRCS (Gen Surg), PG Cert Hlt Econ
Senior Lecturer & Consultant in Colorectal Surgery
National Bowel Research Centre
Blizard Institute
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
The Royal London Hospital
Barts Health NHS Trust
London
UK
Declarações
MAT declares that he has no competing interests.
Jayan Dewanta Jayasinghe, MD
International Senior Fellow in Colorectal Surgery
The Royal London Hospital
Barts Health NHS Trust
London
UK
Declarações
JDJ declares that he has no competing interests.
Agradecimentos
Dr Mohamed A. Thaha and Dr Jayan D. Jayasinghe would like to gratefully acknowledge Dr Emma Carrington, Ms Kathryn Lynes, Professor Norman S. Williams, and Dr Abbasi Akhtar, the previous contributors to this topic.
Declarações
EC has received honoraria for teaching, and acts as a consultant for Laborie Medical Management Systems. KL has received funding for a research fellowship from the David Johnston Fellowship through the Royal College of Surgeons of England. NSW is an author of a reference cited in this topic. AA declares that he has no competing interests.
Revisores
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Declarações
NS declares that he has no competing interests.
Nicolas Regenet, MD
Clinic of digestive and endocrine surgery
University Hospital
Nantes
France
Declarações
NR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
American College of Radiology. ACR appropriateness criteria: left lower quadrant pain. 2023 [internet publication].Texto completo
Peery AF, Shaukat A, Strate LL. AGA Clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.Texto completo Resumo
Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-47.Texto completo Resumo
Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):399-415.Texto completo Resumo
Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.Texto completo Resumo
Stollman N, Smalley W, Hirano I; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Endometriose
- Câncer colorretal
- Apendicite
Mais Diagnósticos diferenciaisDiretrizes
- Appropriateness criteria: left lower quadrant pain
- 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
Mais DiretrizesFolhetos informativos para os pacientes
Appendicitis
Constipation in adults
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal