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Divertikelsjukdom

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Definition:
Divertikulos är ett tillstånd med divertiklar i form av kolonmukosa som hernierar genom muscularis, främst i sigmoideum men också i kolon descendens och ibland i högerkolon. Divertikelsjukdom betecknar divertikulos med symtom.
Förekomst:
Prevalensen divertikulos var 27 % för alla åldrar och 60–80 % >60 års ålder i en stor nederländsk undersökning. Divertikulit utvecklas hos cirka 1–4 % av personer med divertiklar i kolon.
Symtom:
Symtom kan vara ändrade avföringsvanor, vänstersidiga koliksmärtor som lindras vid defekation och gasbildning. Divertikulos är asymtomatiskt hos 80–90 %.
Kliniska fynd:
Oftast inga kliniska fynd. Vid divertikulit föreligger feber och palpationsömhet företrädesvis i nedre vänsterkvadranten. Divertiklar kan ibland leda till tarmblödning.
Diagnostik:
Vid akut divertikulit ses typiska röntgenfynd på DT buk i kombination med stegrade inflammationsparametrar. Vid genomgången förstagångsdivertikulit bör patienten genomgå koloskopi eller DT kolon efter 4–6 veckor för att utesluta koloncancer.
Behandling:
Divertikelsjukdom kräver oftast ingen annan behandling än information. Vid okomplicerad divertikulit rekommenderas tarmvila (alternativt skonkost/flytande kost om patienten har återgått till hemmet). Vid komplicerad divertikulit ges även antibiotika. I vissa fall krävs kirurgi.
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  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet