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O

.



Cruveilhier 1849.
1914.

.

,
.
:

.
E .
.

.
.



Ehlers-Danlos, Marfans,


20

.
.


.
; .
NSAIDS
.
.
50% > 50 .
5-10% > 45 .
80% > 85 .
20% .
20% < 50 .



(93-100%).

(57-100%).
(69-83%).
: .
.

(, ,
, ).
(, ,
).
.
: .
.
.
.
.
.
< 40
40% .

()
.
.
.

CT Scan


.
:
.
.
.
.
.
.
.
.

H CT 2-21%.



. .
:
.
.
.
.
.
.
.


.


:
.
.



:
.
.
.

,

:

, , , .

1978 HINCHEY
4 .
HINCHEY (1978)

75%

25%

V:

(Hinchey EJ et al. Adv Surg 1978; 12:85-10)


.
.
.
(K, , , ,
).
.

-
.
.
1,4% .

.
(Dis Colon and Rectum 2007; 50(9): 1460-1464)


( WORLD GASTROENTEROLOGY ORGANISATION
(WGO) 2007).


( )

per os.
(Bacteroides fragilis,
Peptostreptococcus
Clostridium
organisms).
(Escherichia coli and Klebsiella, Proteus, Streptococcus, and
Enterobacter organisms).
Ciprofloxacin (500mg 2) 7-10 .
Metronidazole (250mg 3) 7-10 .

( 2-3 ) .

IV
Ciprofloxacin 3 , Metronidazole.
.
CT scan 48-72h.
per os 14 .
.

4-6
.

.
.
3-4 CT
scan.

< 5cm .
> 5cm.
.
.
.

.
Hartmann.
3 .
.

Hartmann vs
Constantinides . 963
1984-2004 Hartmann
.
:
Hinchey >2
14,4% (Hartmann) 14,1%
Hinchey <2

15,1% (Hartmann) 4,9%

(Constantinides VA et al. Dis Colon Rectum 2006; 49: 966-81)

80 ,

.
(Herzog T et al. Acta Chir Belg 2011; 111: 378-83)

2%
.
:

(70%)
, , , ,
.
CT scan .
(25%)
.
.
, ,

, .


.
.
(
).
.

stent .

.

.

-

, .
5-25% .
.
.
SSAT (Society for Surgery of the Alimentary Tract)

:

2 .
< 40 .
.
.
.

.

1 < 50
.
(Chautens RC et al. Dis Colon Rectum 2002; 45: 962-66)
1 < 50
.
(Janes S et al. Dis Colon Rectum 2009; 52: 1008-16)
1
.
(Broderick Villa et al. Arch Surg 2005; 140: 576-571)
2 .
(Janes S et al. Br J Surg 2005; 92: 133-42)
2 .
(Makela JT et al. Hepatogastroenterology 2007; 54:1412-6)


(Aids, ,
)

:
.
(43% 14%).
.

(39% 2%).

.


:
.
.
3
.
(Thaler K et al. Dis Colon Rectum 2003; 46: 385-88)

T


.


.
.
11% (2002-2007).
.

, , ,
.
.
2,8% - 5,7% .
11,8% .
(Masoomi H et al. Arch Surg 2011; 146: 200-6)
(Masoomi H et al. World J Surg 2011; 35: 2143-8)
(El Zarrol Elgazwi K et al. JSLS 2010; 14: 469-475)
(Jones OM et al. Ann Surg 2008; 248: 1092-7)
(Royds J et al. Colorectal Dis 2011; In press)

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