Operations for Colonic Diverticulitis

Background & Aims: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.Methods: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.Results: Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while ≥1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01).Conclusion: There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.Abbreviations: AD: acute colonic diverticulitis; BMI: body mass index; CT: computed tomography; ED: emergency department; IBS: irritable bowel syndrome; ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification; IP: inpatient; KPSC: Kaiser Permanente Southern California; OP: outpatient.

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

Endoscopy International Open ◽

10.1055/a-1333-1108 ◽

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.

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Emergency laparoscopic Hartmann’s procedure for Hinchey IV left colonic diverticulitis ‐ video‐vignette

Colorectal Disease ◽

10.1111/codi.15610 ◽

2021 ◽

Author(s):

Sante Capitano ◽

Daniele Scoglio ◽

Luigi Boccia

Keyword(s):

Hartmann’S Procedure ◽

Colonic Diverticulitis ◽

Hartmann's Procedure ◽

Video Vignette

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A case report of colouterine fistula due to colonic diverticulitis: a rare complication

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00301-3 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Shweta Pandey ◽

Saurabh Maheshwari ◽

Uddandam Rajesh ◽

Darshan Singh Grewal ◽

Vibhuti Maria

Keyword(s):

Case Report ◽

Rare Complication ◽

Colonic Diverticulitis ◽

Colouterine Fistula

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Management of colonic diverticulitis

BMJ ◽

10.1136/bmj.n72 ◽

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.

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Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

BMC Gastroenterology ◽

10.1186/s12876-021-01672-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kil-yong Lee ◽

Jaeim Lee ◽

Youn Young Park ◽

Seong Taek Oh

Keyword(s):

Computed Tomography ◽

Colon Cancer ◽

Detection Rate ◽

Primary Outcome ◽

Advanced Adenoma ◽

Secondary Outcome ◽

Colonic Diverticulitis ◽

Right Colon ◽

Colon Diverticulitis

Abstract Background Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, we aimed to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. Methods Patients with uncomplicated right colon diverticulitis (modified Hinchey stage Ia) diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment were included. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved retrospectively from patients’ medical records. Results The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases) and advanced adenoma (> 10 mm in diameter; or exhibiting a > 25% villous component or severe dysplasia), including colon cancer, was observed in 9 patients (2.7%). Conclusions In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.

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Recurrent Left Colonic Diverticulitis Episodes: More Severe Than the Initial Diverticulitis?

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(09)79279-7 ◽

2009 ◽

Vol 2009 ◽

pp. 171-173

Author(s):

J.L. Rombeau

Keyword(s):

Colonic Diverticulitis

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

International Surgery ◽

10.9738/intsurg-d-17-00120.1 ◽

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 < 0.001, P < 0.001). Albumin level was low in the surgical treatment group (P < 0.001). NLCR was significantly different in both groups (conservative management vs surgical treatment, 4.1 mg/L versus 8.5 mg/L; P < 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 >10.21 [odds ratio (OR) = 5.613, P = 0.022]; CRP >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.

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