Résumé
La diverticulose colique est une affection fréquente dans les pays industrialisés dont la prévalence augmente avec l’âge. La diverticulite correspond à une inflammation et à la survenue d’une infection au niveau du diverticule et de la région péridiverticulaire. La prise en charge médicale d’un patient atteint de diverticulite peut être ambulatoire, mais l’hospitalisation est nécessaire en cas d’intolérance alimentaire, de poussée sévère, en cas de complications décelées sur la tomodensitométrie ou en l’absence de réponse au traitement ambulatoire. Le traitement médical est essentiellement basé sur une antibiothérapie à large spectre, couvrant à la fois les flores aérobies et anaérobies, pour une durée de sept à dix jours qui peut être adaptée selon l’évolution. L’absence d’amélioration des signes infectieux en moins de trois jours doit conduire à rechercher, par tomodensitométrie, une complication qui peut nécessiter un geste invasif tel qu’un drainage percutané ou la chirurgie. Les données de la littérature ne permettent de recommander ni de régime alimentaire, ni de traitement médicamenteux, en prévention d’une première poussée ou d’une récidive de diverticulite chez un patient ayant une diverticulose colique.
Abstract
Diverticulosis is a common colonic disease in industrialized societies and its prevalence increases with age. Acute diverticulitis is defined by diverticular and peridiverticular inflammation and infection. For most patients, outpatient therapy is possible and hospitalization is only indicated if the patient is unable to eat, suffers from an acute attack, has complications or if symptoms fail to improve despite adequate outpatient therapy. The treatment of acute uncomplicated diverticulitis usually consists of broad-spectrum antibiotics covering both aerobic and anaerobic bacteria. Antimicrobial therapy is given for 7 to 10 days but the duration of the treatment can be longer if there are complications. If there is no clinical improvement within 2 or 3 days, repeat CT imaging is appropriate, as this may reveal an abscess, phlegmon or fistula, which might necessitate percutaneous drainage or surgery. The published literature does not support the recommendation of any prophylactic diet or medical treatment for reducing the risk of first or recurrent diverticulitis in patients with diverticulosis.
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Dupas, J.L. Traitement médical de la diverticulite sigmoïdienne. Colon Rectum 3, 16–19 (2009). https://doi.org/10.1007/s11725-009-0137-9
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DOI: https://doi.org/10.1007/s11725-009-0137-9