.
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:
.
.
.
(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
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)