Acute Colonic Diverticulitis: Diagnostic Evidence, Demographic and Clinical Features in ree Practice Settings

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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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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EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis

British Journal of Surgery ◽

10.1093/bjs/znab312.004 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

Neil J Smart ◽

Andrew Maw

Keyword(s):

Hospital Stay ◽

Conservative Management ◽

Emergency Surgery ◽

Lower Risk ◽

Length Of Hospital Stay ◽

Colonic Diverticulitis ◽

Co Morbidity ◽

Male Patients ◽

The Right ◽

Acute Colonic Diverticulitis

Abstract Aims To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis Methods We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data. Results Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P<0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P<0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P<0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P<0.0001) while more patients in the left-sided group had stage II (OR:0.19,P<0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P<0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,<0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02). Conclusions Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.

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CLINICAL CHARACTERISTICS AND FETO-MATERNAL OUTCOMES IN PREGNANT WOMEN WITH COVID -19 INFECTIONS

10.36106/ijsr/6704051 ◽

2021 ◽

pp. 30-32

Author(s):

Gulshan Bano ◽

Anubha Prashad ◽

Rakhee Soni ◽

Mohammed Mishal

Keyword(s):

Pregnant Women ◽

Cesarean Delivery ◽

Clinical Features ◽

Clinical Characteristics ◽

Maternal Outcomes ◽

Hypertensive Disorder ◽

Co Morbidity ◽

Hypertensive Disorder Of Pregnancy ◽

The Mean ◽

In Pregnancy

Background and objectives:-COVID-19 is ongoing pandemic, caused by novel Corona Virus. There is very scarce information is available about clinical features and feto-maternal outcomes of COVID-19 in pregnancy. Therefore, this study was aimed to determine clinical characteristics and feto-maternal outcomes of pregnant women with COVID-19. Methods- In this retrospective study, we included all pregnant women admitted with COVID-19 over three months. Clinical features, laboratory ndings and feto-maternal outcomes were assessed.Results:-The mean age of the patients was 24 years. Hypertensive disorder of pregnancy was most common associated co-morbidity. Majority of patients (81%) were asymptomatic. Lymphocytopenia was seen in 58% of the patients and 47% had elevated levels of CRP. All patients who presented in rst trimester had spontaneous abortion. There is relatively higher rate of preterm birth (21%) and cesarean delivery(43%). All the neonates were tested negative for COVID-19. Conclusion;- There is relatively higher rate of cesarean delivery. Overall feto-maternal outcome was good and there was no evidence of vertical transmission.

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Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis

Scientific Reports ◽

10.1038/s41598-020-60397-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Kil-yong Lee ◽

Jaeim Lee ◽

Youn Young Park ◽

Younglim Kim ◽

Seong Taek Oh

Keyword(s):

Clinical Features ◽

Colonic Diverticulitis ◽

Acute Colonic Diverticulitis

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A three-step approach to patients with suspected acute diverticulitis in the emergency department: An interdisciplinary algorithm proposal

Emergency Care Journal ◽

10.4081/ecj.2018.7339 ◽

2018 ◽

Vol 14 (2) ◽

Cited By ~ 1

Author(s):

Ciro Paolillo ◽

Massimo Sartelli ◽

Vittorio Miele ◽

Luca Ansaloni ◽

Massimo Valentino ◽

...

Keyword(s):

Older Patients ◽

Clinical Characteristics ◽

Multidisciplinary Approach ◽

Acute Abdominal Pain ◽

Acute Diverticulitis ◽

Atypical Presentation ◽

Emergency Physicians ◽

Colonic Diverticulitis ◽

High Index Of Suspicion ◽

Acute Colonic Diverticulitis

Patients with acute abdominal pain due to acute colonic diverticulitis are a frequent cause of hospital admission. Diverticuar disease increases with age. In Western populations, diverticular disease is diagnosed in 50% individuals over 70 years and 80% over 85 years of age. The identification of patients with acute diverticulitis is a considerable challenge, since numerous other acute abdominal conditions mimic its clinical characteristics. Another problem is the atypical presentation in older patients. A high index of suspicion in the setting of a compatible history and physical examination serves as the cornerstone of early diagnosis. The purpose of this review is to underline the importance of an intimately integrate multidisciplinary approach between emergency physicians, radiologists and surgeons.

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Free abdominal gas on computed tomography in the emergency department: aetiologies and association between amount of free gas and mortality

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0057 ◽

2020 ◽

Vol 102 (8) ◽

pp. 581-589

Author(s):

N Tau ◽

I Cohen ◽

Y Barash ◽

E Klang

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Mortality Rates ◽

Common Source ◽

Clinical Implications ◽

Colonic Diverticulitis ◽

Common Cause ◽

Free Gas ◽

Peptic Disease ◽

All Cause Mortality

Introduction Free abdominal gas is an important finding with major clinical implications. However, data on the aetiologies and prognosis of patients with free gas are scarce. Our primary aim was to describe the sources of free abdominal gas on emergency department (ED) computed tomography (CT). The secondary aim was to evaluate the association between the amount of free gas and all-cause mortality. Methods All patients who underwent CT in the ED between February 2012 and February 2019 with free abdominal gas were included in the study. A scoring system was used to assess the amount of free gas: small – gas bubbles; medium – any gas pocket ≤2cm in diameter; large – any gas pocket >2cm. Data were collected from laboratory and clinical assessment regarding the source of free gas and all-cause mortality. Results A total of 372 patients had free abdominal gas. Colonic diverticulitis was the most common aetiology among those with a small or medium amount of free gas (81/250 [32.4%] and 12/71 [16.9%] respectively). For patients with a large amount of gas, peptic disease was the most common aetiology (11/51 [21.6%]). Three-quarters of the patients (280/372, 75.2%) had the source of free gas identified during ED admission. Ninety-day mortality rates were 7.2%, 9.9% and 21.6% for patients with small, medium and large amounts of gas respectively (p=0.007). Conclusions Colonic diverticulitis was the most common source of free abdominal gas and peptic disease was the most common cause of a large amount of free gas. Mortality rates correlated with the amount of gas and were significantly higher in patients with a large amount.

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Cognitive impairment in patients with atrial fibrillation: What is the importance of anticoagulant therapy?

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.956 ◽

2018 ◽

Vol 88 (2) ◽

Author(s):

Giovanni Capobianco

Keyword(s):

Atrial Fibrillation ◽

Cognitive Impairment ◽

Clinical Features ◽

Anticoagulant Therapy ◽

Clinical Characteristics ◽

Elder Patients ◽

Geriatric Unit ◽

Co Morbidity

Atrial fibrillation represents one of the most significant aging markers and its prevalence increases with age, reaching 11.1% in men and 9.1% in women aged over 85 years. Fragility is nowadays defined according to two different phenotypes: the biologic-physiologic phenotype developed by L. Fried and Baltimora School and the clinic-multidimensional phenotype, proposed by Rockwood and Halifax School. If the clinical characteristics of elder patients hospitalized in acute geriatric unit care are considered, differences appear in the clinical features, in co-morbidity, in therapy and prognosis.

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