Côlon & Rectum

, Volume 11, Issue 1, pp 13–18 | Cite as

Place de l’imagerie diagnostique et thérapeutique au cours des complications locales des diverticulites sigmoïdiennes Hinchey II

  • A. David
  • O. Morla
  • F. Douane
  • J. Meyer
  • E. Frampas
Dossier Thématique / Thematic File
  • 33 Downloads

Résumé

Les abcès périsigmoïdiens représentent une complication fréquente des diverticulites, survenant dans 15 à 40 % des cas. Le scanner abdominal est l’examen de référence pour le diagnostic des abcès périsigmoïdiens avec une sensibilité de 95 %. Depuis les dernières recommandations établies en 2006, de nombreuses publications sur le traitement radiologique interventionnel de cette complication sont disponibles. Le niveau de preuve des essais reste faible (C) ; mais les conclusions sont toujours en faveur de cette approche lorsqu’elle est comparée à la chirurgie plus morbide. D’ailleurs, les données épidémiologiques montrent que le recours à l’acte de radiologie est en constante augmentation aux dépens de la chirurgie en urgence. Le taux d’échec du drainage varie de 15 à 30 % et la présence d’une fistule digestive explique la plupart des échecs. Dans ces cas, la chirurgie de rattrapage est nécessaire et reste morbide. Les complications représentent 2,5 % des cas, liées à des perforations digestives sur le trajet du drain et des complications hémorragiques en cas de drainage transglutéal.

Mots clés

Abcès Diverticulite Tomodensitométrie abdominale Drainage radiologique 

Imaging and drainage of complicated Hinchey II diverticulitis

Abstract

Pericolic abscess is a significant complication of colonic diverticulitis that occurs in 15 to 40% of the cases. CT-scan is the gold standard for the diagnosis with 95% of positive predictive value. Since the last ten years, amount of publications have reported experiences of CT-guided drainage of pericolic abscesses. Despite a retrospective design, series always conclude that this minimally invasive approach is effective in improving management of complicated diverticulitis. Cohort studies demonstrated a significant increase of abscesses drainages and decrease in emergency surgery. Failure of drainage occurs in 15 to 30% of the cases, usually due to recurrent abscess and colonic fistula. Complications occur in 2,5% with small bowel injury and hemorrhage.

Keywords

Abscess Diverticulitis CT-scan CT-guided drainage 

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Copyright information

© Lavoisier 2017

Authors and Affiliations

  • A. David
    • 1
  • O. Morla
    • 1
  • F. Douane
    • 1
  • J. Meyer
    • 1
  • E. Frampas
    • 1
  1. 1.Service central de radiologie et imagerie médicaleHôtel-Dieu, CHU de NantesNantesFrance

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