scholarly journals Diverticulitis

2008 ◽  
Vol 55 (3) ◽  
pp. 97-102 ◽  
Author(s):  
J. Pfeifer
Keyword(s):  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Treatment Modalities ◽  
Perforated Diverticulitis ◽  
Western World ◽  
Common Disease ◽  
Concomitant Treatment ◽  
Wide Range ◽  
Life Threatening

Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann?s procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.

scholarly journals Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis

2020 ◽  
Vol 102 (9) ◽  
pp. 744-747
Author(s):  
Z Abdulazeez ◽  
N Kukreja ◽  
N Qureshi ◽  
S Lascelles
Keyword(s):  
Computed Tomography ◽  
Diverticular Disease ◽  
Flexible Sigmoidoscopy ◽  
Health Care Systems ◽  
Acute Diverticulitis ◽  
Western World ◽  
Routine Surveillance ◽  
New Findings ◽  
Care Systems

Introduction The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure. Materials and methods A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy. Results All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes. Conclusions There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.

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 Minimally Invasive Management of Diverticular Disease

2021 ◽  
Vol 34 (02) ◽  
pp. 113-120
Author(s):  
Andrea Madiedo ◽  
Jason Hall
Keyword(s):  
Minimally Invasive ◽  
Diverticular Disease ◽  
Damage Control ◽  
Primary Anastomosis ◽  
Laparoscopic Approach ◽  
Cost Effective ◽  
Common Disease ◽  
Sigmoid Colectomy ◽  
Oral Antibiotic ◽  
Invasive Approach

AbstractTraditionally, management of complicated diverticular disease has involved open damage control operations with large definitive resections and colostomies. Studies are now showing that in a subset of patients who would typically have undergone an open Hartmann's procedure for Hinchey III/IV diverticulitis, a laparoscopic approach is equally safe, and has better outcomes. Similar patients may be good candidates for primary anastomosis to avoid the morbidity and subsequent reversal of a colostomy.While most operations for diverticulitis across the country are still performed open, there has been an incremental shift in practice toward minimally invasive approaches in the elective setting. The most recent data from large trials, most notably the SIGMA trial, found laparoscopic sigmoid colectomy is associated with fewer short-term and long-term complications, decreased pain, improvement in length of stay, and maintains better cost-effectiveness than open resections. Some studies even demonstrate that robotic sigmoid resections can maintain a similar if not more reduction in morbidity as the laparoscopic approach while still remaining cost-effective.Intraoperative approaches also factor into improving outcomes. One of the most feared complications in colorectal surgery is anastomotic leak, and many studies have sought to find ways to minimize this risk. Factors to consider to minimize incidence of leak are the creation of tension-free anastomoses, amount of contamination, adequacy of blood supply, and a patient's use of steroids. Techniques supported by data that decrease anastomotic leaks include preoperative oral antibiotic and mechanical bowel prep, intraoperative splenic flexure mobilization, low-tie ligation of the inferior mesenteric artery, and use of indocyanine green immunofluorescence to assess perfusion.In summary, the management of benign diverticular disease is shifting from open, morbid operations for a very common disease to a minimally invasive approach. In this article, we review those approaches shown to have better outcomes, greater patient satisfaction, and fewer complications.

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.

Surgical approach of complicated diverticulitis with colovesical fistula: technical note in a particular condition

Open Medicine ◽  
2012 ◽  
Vol 7 (5) ◽  
pp. 578-583 ◽  
Author(s):  
Jacopo Desiderio ◽  
Stefano Trastulli ◽  
Chiara Listorti ◽  
Diego Milani ◽  
Michele Cerroni ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Surgical Approach ◽  
Primary Anastomosis ◽  
Technical Note ◽  
Diagnostic Methods ◽  
Sigmoid Diverticulitis ◽  
Western World ◽  
First Episode ◽  
Internal Fistula ◽  
Abdominal Abscesses

AbstractBackground: Diverticular disease of the colon is common in the Western world. With the first episode of diverticulitis, most patients will benefit from medical therapy, but in 10% to 20% of cases some complications will develop, such as intra-abdominal abscesses, obstructions, fistulas. In these conditions it is important to define the most appropriate surgical approach. Discussion: The management of diverticular disease has been successful owing to the advances in diagnostic methods, intensive care and surgical experience, but there is debate about the best treatment for some conditions. Fistulas complicating diverticulitis are the result of a localized perforation into adjacent viscera. In particular, the connection between the colon and the urinary tract is a serious anatomical abnormality that must be urgently corrected before a serious urinary infection results. Indications, timing and surgical procedures are determined by the severity of the disease and the patient’s general condition. Summary: Diverticular disease can lead to many complications. One of the most difficult to correct is an internal fistula, such as a colo-vesical fistula. The correct approach in cases where the disorder is clinically suspected has always been controversial, and the guidelines for sigmoid diverticulitis have not established the most appropriate method for diagnosis and treatment. At present, the surgical strategy for these cases requires interruption of the fistula and resection to remove the inflamed colonic segment, with or without primary anastomosis, focusing attention on the construction of the anastomosis to well vascularized and anatomically healthy tissues. It is clear, therefore, that establishing guidelines is difficult, because many pathological situations may be related to diverticulitis, and so, as our experience shows, the surgical approach has to be tailored to the patient’s general and local condition.

scholarly journals EP.FRI.398 Diverticular Disease Patient Presenting with Acute Abdominal Pain, Guidelines and Management

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mahmoud Elnaggar ◽  
Syed Zain Bukhary ◽  
Oladapo Fafemi ◽  
Moustafa Saber
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Iliac Fossa ◽  
Disease Patient ◽  
Western Society ◽  
Perforated Diverticulitis ◽  
Left Iliac Fossa ◽  
Management Algorithm ◽  
Grading Systems ◽  
Hospital Systems

Abstract Aim Diverticular disease of the sigmoid colon is a common condition in Western society, 10-25% will develop an acute episode of diverticulitis, Since Hinchey’s traditional classification for perforated diverticulitis in 1978, several modifications and new grading systems have been presented to display a more contemporary overview of the disease Methods 100 patients diagnosed with acute diverticulitis admitted to the surgical unit in NMUH starting from 1/1/2019 (the first 100 patients were chosen - they attended over a period of 6 months) Data were checked for all patients from the patients' notes and electronic hospital systems for as compared to the: “Acute Diverticulitis Management Algorithm”, provided on the NMUH intranet since April 2015. Results 10% of patients Had pain and tenderness in an abdominal quadrant other than left iliac fossa. Standard investigations including WCC, CRP & erect chest radiograph were done to all patients.  84% of patients were diagnosed with CT scan while the rest were diagnosed clinically.  96% of patients had colonoscopy appointments while 4% had CT colonography appointments. There was no mention of Hinchey grade, despite cases were managed according to this classification. Conclusions There was a good degree of commitment to the management algorithm in some parts, like blood tests and antibiotic prescription, however other parts were not adhered to like the Hinchey's classification documentation for each case. There is a need for more clinical and management related classification system of acute diverticulitis, some classifications were proposed.

scholarly journals Left lower limb fasciitis due to sigmoid colonic perforated diverticulitis: a rare case of colocutaneous fistula

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Alice Rubartelli ◽  
Lorenzo Cocchi ◽  
Nicola Solari ◽  
Ferdinando Cafiero ◽  
Michele Minuto ◽  
...  
Keyword(s):  
Lower Limb ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Rare Event ◽  
Sigmoid Resection ◽  
Sigmoid Diverticulitis ◽  
Perforated Diverticulitis ◽  
Ileal Loop ◽  
Colocutaneous Fistula ◽  
Left Lower Limb

Abstract Up to 25% of patients with acute diverticulitis develop complicated disease. Colocutaneous fistula with lower limb fasciitis secondary to complicated diverticulitis is a rare event. A 71-year-old woman with Class 3 obesity and Type 2 diabetes was admitted to the hospital because of left lower limb fasciitis associated with acute sigmoid diverticulitis complicated by covered perforation. The fasciitis was treated with multiple fasciotomies, antibiotics and hyperbaric oxygen therapy. The patient was readmitted 25 days after discharge because of the formation of a left leg colocutaneous fistula associated with an enterocolic fistula. Patient underwent sigmoid resection with primary anastomosis and ileal loop repair. Three-month follow-up showed fistula healing and absence of symptoms. Fasciitis secondary to acute diverticulitis is a rare clinical scenario. Although our therapeutic strategy was successful, the optimal treatment timing and surgical technique for fasciotomy and colon resection remain to be assessed.

scholarly journals Development and validation of a diverticular clinical score for symptomatic uncomplicated diverticular disease after acute diverticulitis in a prospective patient cohort

2020 ◽  
Vol 13 ◽  
pp. 175628482091321
Author(s):  
Adi Lahat ◽  
Herma H Fidder ◽  
Shomron Ben-Horin
Keyword(s):  
Diverticular Disease ◽  
Inflammatory Markers ◽  
Global Assessment ◽  
Validation Cohort ◽  
Acute Diverticulitis ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Therapeutic Decisions ◽  
Wide Range ◽  
Uncomplicated Diverticular Disease

Background: Following an attack of acute diverticulitis (AD), many patients continue to suffer from a complex of symptoms, titled ‘symptomatic uncomplicated diverticular disease (SUDD)’. To date, there is no validated clinical score for standardized assessment of patients with SUDD, thereby hampering the interpretation of observational studies and the conductance of clinical trials. We aimed to develop a validated SUDD clinical score. Methods: Data from previous prospective study of patients after AD was used to devise the score’s first version. Validation was first performed using a focus group of patients after AD SUDD who underwent a structured cognitive personal interview. Thereafter, the diverticular clinical score (DICS) was applied for a second validation cohort. DICS scores of validation cohort were compared with physicians’ global assessment for disease severity and inflammatory markers. Results: In DICS second validation using 48 patients prospectively recruited after AD SUDD, a correlation matrix demonstrated strong correlation between total questionnaire’s score and the presence of elevated inflammatory markers ( ρ = 0.84). Mean score in patients with elevated inflammatory markers compared with those without inflammation was 17.8 versus 6.2, respectively, p < 0.001. Cronbach’s α for measuring internal consistency was 0.91. DICS discriminated accurately between patients with/without active disease, as gauged by the physicians global assessment (area under the curve receiver operating characteristic = 0.989). Conclusions: Patients suffering from post-AD SUDD exhibit a wide range of symptoms. The newly developed DICS accurately and reproducibly quantitates SUDD-related symptom severity. The DICS may prove useful for monitoring SUDD in clinical practice and in research settings, as well as facilitating patient stratification and therapeutic decisions.

Selecting a PRO-CTCAE based subset for patient reported symptom monitoring during lung cancer treatment (Preprint)

2020 ◽  
Author(s):  
Evalien Veldhuijzen ◽  
Iris Walraven ◽  
Jose Belderbos
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Treatment Modalities ◽  
European Organization ◽  
Specific Patient ◽  
Symptom Monitoring ◽  
Lung Cancer Patients ◽  
Wide Range ◽  
Patient Reported

BACKGROUND The Patient Reported Outcomes Version of the Common Terminology Criteria of Adverse Events (PRO-CTCAE) item library covers a wide range of symptoms relevant for oncology care. To enable implementation of PRO-CTCAE-based symptom monitoring in clinical practice, there is a need to select a subset of items relevant for specific patient populations. OBJECTIVE The aim of this study was to develop a PRO-CTCAE subset relevant for patients with lung cancer. METHODS The PRO-CTCAE-based subset for lung cancer patients was generated using a mixed methods approach based on the European Organization for Research and Treatment of Cancer (EORTC) guidelines for developing questionnaires, consisting of a literature review and semi-structured interviews with both lung cancer patients and health care practitioners (HCPs). Both patients and HCPs were queried on the relevance and impact of all PRO-CTCAE items. Results were summarized and, after a final round of expert review, a selection of clinically relevant items for lung cancer patients was made. RESULTS A heterogeneous group of lung cancer patients (n=25) from different treatment modalities and HCPs (n=22) participated in the study. A final list of eight relevant PRO-CTCAE items was created: decreased appetite, cough, shortness of breath, fatigue, constipation, nausea, sadness, and pain (general). CONCLUSIONS Based on literature and both professional and patient input, a subset of PRO-CTCAE items has been identified for use in lung cancer patients in clinical practice. Future work is needed to confirm the validity and effectiveness of this PRO-CTCAE lung cancer subset internationally, and in the real-world clinical practice setting.

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