scholarly journals Management of colonic diverticulitis

BMJ ◽  
2021 ◽  
pp. n72
Author(s):  
Anne F Peery
Keyword(s):  
Gastrointestinal Disease ◽  
Acute Diverticulitis ◽  
Anaerobic Bacteria ◽  
Gastrointestinal Symptoms ◽  
Colon Resection ◽  
Acute Onset ◽  
Colonic Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Primary Resection And Anastomosis

ABSTRACT Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life. A better understanding of prognosis has prompted a shift toward non-operative approaches. The decision to undergo prophylactic colon resection should be individualized to consider the severity of diverticulitis, the patient’s health and immune status, and the patient’s preferences and values, as well as benefits and risks. Because only a section of colon is removed, recurrent diverticulitis remains a risk. Acute diverticulitis with an abscess is treated with antibiotics that cover Gram negative and anaerobic bacteria, with or without percutaneous drainage. Acute diverticulitis with purulent or feculent contamination of the peritoneal cavity is managed with surgery; primary resection and anastomosis is the procedure of choice in stable patients.

Surgical Treatment of Diverticulitis

2019 ◽  
Author(s):  
Tiffany K Weidner ◽  
John T Kidwell ◽  
David A Etzioni
Keyword(s):  
Surgical Treatment ◽  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Sigmoid Resection ◽  
Hartmann Procedure ◽  
Laparoscopic Lavage ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Purulent Peritonitis

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis.  This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis

scholarly journals Management of acute colonic diverticulitis in the general and surgical emergency departments

2021 ◽  
Keyword(s):  
Risk Factors ◽  
Primary Anastomosis ◽  
Current Evidence ◽  
Western World ◽  
Common Disease ◽  
Colonic Diverticulitis ◽  
Elective Resection ◽  
Uncomplicated Diverticulitis ◽  
Select Group ◽  
Recurrent Diverticulitis

Acute left colonic diverticulitis is a very common disease that primarily affects the older population in the Western world. The pathogenesis of acute inflammation of the diverticula may not be as simple as once thought, and the disease cascade could involve a combination of chronic inflammation and altered gut microbiota. Several lifestyle risk factors such as obesity, low-fibre diet, smoking, use of non-steroid anti-inflammatory drugs, inadequate physical activity and others have been associated with a higher risk for diverticulitis. It has been proven that uncomplicated diverticulitis in immunocompetent patients without systemic signs of infection can be treated symptomatically. Outpatient treatment with peroral antibiotics is effective for managing patients with uncomplicated diverticulitis and signs of systemic inflammation. New, less- invasive surgical options have been recognised as appropriate for a select group of patients with complicated diverticulitis. Laparoscopic lavage and drainage are suitable for abscesses where the bowel wall is intact. Resection with primary anastomosis with or without ileostomy is now considered an option for some patients that would historically have to undergo Hartmann’s procedure. The latter still remains the most common operating option even in tertiary referral centres around the world as it is suitable for more complicated cases and critically ill patients. Current evidence does not support routine colonoscopic evaluation for uncomplicated diverticulitis in younger patients without risk factors. Recurrent diverticulitis is now understood to be more benign than was previously thought. Elective resection of the sigmoid colon is therefore no longer a standard treatment for all patients with two or more episodes of acute diverticulitis.

scholarly journals Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

2021 ◽  
Vol 09 (03) ◽  
pp. E331-E337
Author(s):  
Dai Nakamatsu ◽  
Tsutomu Nishida ◽  
Shinji Kuriki ◽  
Li-sa Chang ◽  
Kazuki Aochi ◽  
...  
Keyword(s):  
Detection Rate ◽  
Colorectal Neoplasia ◽  
Acute Diverticulitis ◽  
Colonic Diverticulitis ◽  
Detection Rates ◽  
Positive Group ◽  
Asymptomatic Patients ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Acute Colonic Diverticulitis

Abstract Background and study aims The relationship between acute colonic diverticulitis and colorectal cancer (CRC) is unclear, but colonoscopy is recommended to exclude malignancy. We compared the detection rates for colorectal neoplasia in patients with colonic diverticulitis and asymptomatic patients who had positive fecal immunochemical tests (FITs). Patients and methods In total, 282 patients with acute colonic diverticulitis were hospitalized in our hospital from February 2011 to December 2019. Of them, 143 patients with diverticulitis and 1819 with positive FITs patients during the same period underwent colonoscopy without a prior colonoscopy within 5 years. We retrospectively compared these patients in terms of the invasive CRC rate, advanced neoplasia detection rate (ANDR), adenoma detection rate (ADR), and polyp detection rate (PDR). Results Compared to the diverticulitis group, the FIT-positive group had a significantly higher CRC rate (0 vs 2.7 %, P = 0.0061), ANDR (5.6 vs. 14.0 %, P = 0.0017), ADR (19.6 vs. 53.2 %, P < .0001), and PDR (44.1 vs. 91.0 %, P < .0001). Using 1:1 propensity score matching based on age and sex, we obtained 276 matched patients in both groups. After matching, no difference was found in the CRC rate (0 vs 0.7 %) or ANDR (5.8 vs 7.3 %) between groups, but the ADR and PDR were significantly higher in the FIT-positive group (20.3 vs 43.5 %, P < .0001; 45.7 % vs 86.2 %, P < .0001). Conclusion Patients with acute diverticulitis had lower ADRs and PDRs than patients with positive FITs.

scholarly journals Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1288
Author(s):  
Marilia Carabotti ◽  
Francesca Falangone ◽  
Rosario Cuomo ◽  
Bruno Annibale
Keyword(s):  
Systematic Review ◽  
Diverticular Disease ◽  
Dietary Habits ◽  
Acute Diverticulitis ◽  
High Quality ◽  
Eligibility Criteria ◽  
Diverticular Bleeding ◽  
Recurrent Diverticulitis ◽  
Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

scholarly journals Neutrophil to Lymphocyte Count Ratio Has a Close Association With Severe Acute Colonic Diverticulitis in Patients Undergoing Surgical Treatment

2017 ◽  
Vol 102 (11-12) ◽  
pp. 514-521
Author(s):  
TaeHoon Kim ◽  
Tong Moon ◽  
Jin Yoon ◽  
SangSu Park ◽  
YongSeog Jang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Management ◽  
Lymphocyte Count ◽  
Acute Diverticulitis ◽  
White Blood Cells ◽  
Colonic Diverticulitis ◽  
Count Ratio ◽  
Co Morbidity ◽  
Acute Colonic Diverticulitis

Objective: To investigate the diagnostic potential of neutrophil-to-lymphocyte count ratio (NLCR) for acute diverticulitis. Summary of Background Data: We evaluated NLCR in patients with acute colonic diverticulitis who were treated with conservative and surgical treatments. Methods: A total of 205 patients who underwent surgical treatment or conservative management of acute diverticulitis between 2012 and 2016 were reviewed. Patients' age; sex; hospital days; co-morbidity; complication; period of use of antibiotics; treatment method; body temperature; and initial laboratory results such as neutrophil count, lymphocyte count, NLCR, and serum levels of C-reactive protein (CRP) were assessed. Results: The median ages of the conservative and surgical treatment groups were 46 and 68 years, respectively. Median CRP and glucose levels were high in acute colonic diverticulitis patients who underwent surgical treatment (P &lt; 0.001, P &lt; 0.001). Albumin level was low in the surgical treatment group (P &lt; 0.001). NLCR was significantly different in both groups (conservative management vs surgical treatment, 4.1 mg/L versus 8.5 mg/L; P &lt; 0.001). Median white blood cells was 11.36 × 109/L in the conservative management group and 14.0 × 109/L in the surgical treatment group, with no significance (P = 0.071). Multivariate analysis revealed that NLCR &gt;10.21 [odds ratio (OR) = 5.613, P = 0.022]; CRP &gt;17.23 mg/L (OR = 4.241, P = 0.006); and albumin ≤3.5 (OR = 4.192, P = 0.036) were significant for acute colonic diverticulitis patients. Conclusion: NLCR, CRP, and albumin levels were significantly associated with acute colonic diverticulitis in the surgical treatment group, and NLCR was the most powerful predictive marker of severe acute colonic diverticulitis.

SP1.1.16Endoscopic evaluation after acute colonic diverticulitis: Review of literature

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hazim A. Eltyeb ◽  
Sriram Subramonia
Keyword(s):  
Colorectal Cancer ◽  
Confidence Interval ◽  
Acute Diverticulitis ◽  
Significant Risk ◽  
Acute Attack ◽  
Current Evidence ◽  
Colonic Diverticulitis ◽  
Endoscopic Evaluation ◽  
Medical Societies ◽  
Meta Analyses

Abstract Aim To compare the current evidence for routine endoscopic evaluation of the colon after an episode of acute diverticulitis against existing guidelines in the United Kingdom. Methodology A systematic literature search of Medline, Embase and Cochrane databases was performed using keywords “Diverticular disease”, “Diverticulitis”, “acute”, “Colorectal Cancer” and “endoscopy”. Recommendations from guidelines of specialist medical societies were reviewed. Available literature was explored to assess the risk of colorectal cancer in patients presenting with acute diverticulitis. Results The most recent UK guideline (Royal College of Surgeons Commissioning guide 2014 supported by ACPGBI) recommends the routine evaluation of colonic lumen after resolution of an acute attack of diverticulitis. More recent guidelines from specialist medical societies (European Society of Coloproctology 2020, World Society of Emergency Surgery 2020, European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons 2018) do not recommend routine endoscopic evaluation after recovery from uncomplicated colonic diverticulitis. Two meta-analyses as well as three large cohort studies showed no significant risk of colorectal cancer ((1.22% (95% confidence interval 0.63-1.97) and (0.7%; confidence interval 0.3%−1.4%)) following uncomplicated acute diverticulitis. Conclusion Existing UK guidance on routine colonic luminal evaluation after resolution of acute diverticulitis should be revised based on current evidence.

Diverticulitis in California from 1995 to 2006: Increased Rates of Treatment for Younger Patients

2009 ◽  
Vol 75 (10) ◽  
pp. 981-985 ◽  
Author(s):  
David A. Etzioni ◽  
Rebecca R. Cannom ◽  
Glenn T. Ault ◽  
Robert W. Beart ◽  
Andreas M. Kaiser
Keyword(s):  
Health Planning ◽  
Acute Diverticulitis ◽  
Age Groups ◽  
Surgical Care ◽  
The United States ◽  
Colon Resection ◽  
Younger Patients ◽  
Younger Age ◽  
National Trends ◽  
Procedure Codes

Colonic diverticular disease is responsible for over 300,000 admissions and expenditures exceeding $2.7 billion/year. There is recent evidence that rates of treatment for diverticulitis have increased in the United States over the last decade. We hypothesize that these national trends of increasing rates of hospitalizations for diverticulitis would be found in an analysis of a single-state discharge database. Data from the Office of Statewide Health Planning and Development were used to analyze treatment for diverticulitis in California from 1995 to 2006. For each hospitalization, surgical care was determined based on procedure codes for left colon resection and/or colostomy. Overall numbers of admissions for acute diverticulitis increased throughout the 12-year study period with an estimated annual percentage of change (EAPC) of 2.1 per cent (P < 0.001). Rates of admissions increased most rapidly in patients 20 to 34-years-old (EAPC = 8.6%, P < 0.001) and 35 to 49 years old (EAPC = 5.7%, P < 0.001). Elective colectomies had an EAPC of 2.1 per cent (P < 0.001), which was also most dramatic in younger age groups. Between 1995 and 2006 we found significant increases in both the rates of hospitalization for diverticulitis and rates of elective surgical treatment in California. These increases are entirely due to higher rates of care for younger patients.

scholarly journals Minimal short-term effect of dietary 2'-fucosyllactose on bacterial colonisation, intestinal function and necrotising enterocolitis in preterm pigs

2016 ◽  
Vol 116 (5) ◽  
pp. 834-841 ◽  
Author(s):  
Malene S. Cilieborg ◽  
Stine B. Bering ◽  
Mette V. Østergaard ◽  
Michael L. Jensen ◽  
Łukasz Krych ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Human Milk ◽  
Gastrointestinal Disease ◽  
Anaerobic Bacteria ◽  
Postnatal Period ◽  
Necrotising Enterocolitis ◽  
Preterm Neonates ◽  
Intestinal Immunity ◽  
Digestive Function ◽  
Brush Border Enzyme

AbstractHuman milk decreases the risk of necrotising enterocolitis (NEC), a severe gastrointestinal disease that occurs in 5–10 % of preterm infants. The prebiotic and immune-modulatory effects of milk oligosaccharides may contribute to this protection. Preterm pigs were used to test whether infant formula enriched with α1,2-fucosyllactose (2'-FL, the most abundant oligosaccharide in human milk) would benefit gut microbial colonisation and NEC resistance after preterm birth. Caesarean-delivered preterm pigs were fed formula (Controls, n 17) or formula with 5 g/l 2'-FL (2'-FL, n 16) for 5 d; eight 2'-FL pigs (50 %) and twelve Controls (71 %) developed NEC, with no difference in lesion scores (P=0·35); 2'-FL pigs tended to have less anaerobic bacteria in caecal contents (P=0·22), but no difference in gut microbiota between groups were observed by fluorescence in situ hybridisation and 454 pyrosequencing. Abundant α1,2-fucose was detected in the intestine with no difference between groups, and intestinal structure (villus height, permeability) and digestive function (hexose absorption, brush border enzyme activities) were not affected by 2'-FL. Formula enrichment with 2'-FL does not affect gut microbiology, digestive function or NEC sensitivity in pigs within the first few days after preterm birth. Milk 2'-FL may not be critical in the immediate postnatal period of preterm neonates when gut colonisation and intestinal immunity are still immature.

scholarly journals Multislice Computed Tomography Imaging of Diverticultis Complication: Colovenous Fistula

2010 ◽  
Vol 10 (2) ◽  
pp. 118-120
Author(s):  
Maija Radzina ◽  
Andris Laganovskis ◽  
Mara Tirane ◽  
Ligita Zvaigzne ◽  
Peteris Prieditis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diverticular Disease ◽  
Multislice Computed Tomography ◽  
Gastrointestinal Disease ◽  
Rare Complication ◽  
Acute Diverticulitis ◽  
Computed Tomography Imaging ◽  
Tomography Imaging ◽  
Complicated Form ◽  
Radiological Studies

Multislice Computed Tomography Imaging of Diverticultis Complication: Colovenous FistulaAcute colon pathology as diverticulitis is a frequent and important gastrointestinal disease, but the clinical diagnosis is often difficult to state. Several radiological studies have been used to assist in the diagnosis of acute diverticulitis (e.g. barium enema, ultrasound, and computed tomography (CT). Colovenous fistula is a rare complication of diverticulitis. We have analyzed MSCT imaging role in evaluation of such complicated form of diverticular disease.

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