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

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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Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly

Medicina ◽

10.3390/medicina58010029 ◽

2021 ◽

Vol 58 (1) ◽

pp. 29

Author(s):

Gennaro Perrone ◽

Mario Giuffrida ◽

Elena Bonati ◽

Gabriele Luciano Petracca ◽

Antonio Tarasconi ◽

...

Keyword(s):

Conservative Treatment ◽

Elderly Patients ◽

Conservative Management ◽

Acute Diverticulitis ◽

The Elderly ◽

Complicated Diverticulitis ◽

First Episode ◽

Colonic Diverticulitis ◽

Acute Colonic Diverticulitis

Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65–74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 ± 6.8 years (range 65–92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88%). Average white cells count was 10.04 ± 5.05 × 109/L in the early elderly group and 11.24 ± 7.89 in the late elderly group. CRP was elevated in 29 (78.3%) cases in early elderly and in 23 late elderly patients (67.6%). A CT scan of the abdomen was performed in every case (100%). Almost all patients were treated with bowel rest and antibiotics (95.7%). Average length of stay was 7.74 ± 7.1 days (range 1–48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 ± 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6%). New episodes of acute diverticulitis were reported in 20 patients (28.1%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities.

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

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.234.acdd ◽

2014 ◽

Vol 23 (4) ◽

pp. 379-386 ◽

Cited By ~ 6

Author(s):

Rajan Iyer ◽

George F. Longstreth ◽

Li-Hao Chu ◽

Wansu Chen ◽

Linnette Yen ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Clinical Features ◽

Clinical Characteristics ◽

Past History ◽

Colonic Diverticulitis ◽

Co Morbidity ◽

Objective Evidence ◽

Multiple Variables ◽

Acute 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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EP.FRI.1040 Management of Acute Colonic Diverticulitis According to The WSES (World Society of Emergency Surgery) Classification in a Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab312.150 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Lorraine Hickey ◽

Paul Goldsmith

Keyword(s):

Acute Diverticulitis ◽

White Cell Count ◽

Colonic Diverticulitis ◽

C Reactive Protein ◽

Single Centre ◽

Ct Guided ◽

Reactive Protein ◽

Tertiary Centre ◽

Acute Colonic Diverticulitis

Abstract Aims Debate remains regarding management of complicated diverticulitis. The WSES acute diverticulitis working group published in 2015 a CT-guided classification of left colon acute diverticulitis, divided into uncomplicated (Stage 0) and complicated (Stage 1a-4). Using this classification, we reviewed our management of CT-proven acute colonic diverticulitis. Methods A single-centre retrospective review of management of CT-proven acute colonic diverticulitis over 12 months based on the WSES classification. Results 24 males and 31 females presented (median age=56, IQR 45-68). Median white cell count=12 (IQR 10-16) and median C-reactive protein=88 (IQR 41-157). Based on CT, 25 (45.5%) patients =stage 0, 14 (25.5%) =stage 1a, 6 (11%) =stage 1b, 4 (7%) =stage 2a, 6 (11%) =stage 2b, and none staged 3/4. 15% (8/55) patients had an operation, remainder were conservatively managed. 2 patients had laparoscopic washout/drainage (stages 1b and 2b). 6 patients had Hartmanns (x1 stage 1a, x1 stage 1b, x4 stage 2b). Median length of stay=5 days (IQR 4-8). There was 1 related reattendance declining readmission (stage 1a managed conservatively) and 2 readmissions (1 stage 0 managed conservatively, other initially stage 1a managed conservatively but on readmission staged 2b proceeding to Hartmanns). 30-day mortality included 3 deaths (stages 1b/2a/2b all managed conservatively). Conclusions Hartmanns resection is advocated as treatment of choice for complicated acute diverticulitis, particularly for Stage 2b or above.

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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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The Best Choice of Treatment for Acute Colonic Diverticulitis with Purulent Peritonitis Is Uncertain

BioMed Research International ◽

10.1155/2014/380607 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Line Hupfeld ◽

Jakob Burcharth ◽

Hans-Christian Pommergaard ◽

Jacob Rosenberg

Keyword(s):

Randomized Trials ◽

Standard Treatment ◽

Peritoneal Lavage ◽

Acute Diverticulitis ◽

Fecal Peritonitis ◽

Colonic Diverticulitis ◽

Intestinal Perforations ◽

Purulent Peritonitis ◽

Choice Of Treatment ◽

Acute Colonic Diverticulitis

Severe stages of acute, colonic diverticulitis can progress into intestinal perforations with peritonitis. In such cases, urgent treatment is needed, and Hartmann’s procedure is the standard treatment for cases with fecal peritonitis. Peritoneal lavage may be an alternative to resection for acute diverticulitis with purulent peritonitis, but ongoing randomized trials are awaited to clarify this.

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Clinical Analysis of 123 Cases of Acute Colonic Diverticulitis

10.21203/rs.3.rs-32188/v1 ◽

2020 ◽

Author(s):

Zhi Chen ◽

Bing Zhang ◽

dan wu ◽

Ye Jin

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Recurrence Rate ◽

Sigmoid Diverticulitis ◽

Colonic Diverticulitis ◽

Abdominal Drainage ◽

Significant Difference ◽

Operation Group ◽

Length Of Hospitalization ◽

Acute Colonic Diverticulitis

Abstract Objective: To study the characteristics of acute colonic diverticulitis and the differences between different treatment options.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including operation group (n = 30) and non-operation group (n = 93). The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of acute colonic diverticulitis were compared between the operation group and the non-operation group.Results:111 cases of Caecal and ascending colonic diverticulitis (proportion 90.2%, male to female ratio 2.26: 1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%); 3 cases of transverse colonic diverticulitis; 3 cases of descending colonic diverticulitis; 6 cases of Sigmoid diverticulitis (proportion 4.9%, male: female 1: 1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 Days, recurrence rate 0%).30 patients received surgical treatment, including 15 cases of abdominal drainage, 14 cases of colonic diverticulectomy and repair, and 1 case of sigmoidectomy. There was a statistically significant difference in the length of hospitalization between the operative group and the non- operative group (P = 0.018), and the length of hospitalization was longer in the operative group. There was no significant difference in the recurrence rate between the operative group and the non-operative group of colonic diverticulitis (P = 0.595). Colonic diverticulitis usually relapsed within 1 year. The total recurrence rate was 4.1%.Conclusions: The right-sided colonic diverticulitis is more common in young and middle-aged. There is a higher incidence in males. The effect of non-operative treatment of acute diverticulitis is better than that of surgical treatment. Resection and repair of the diverticulum or abdominal drainage can be used in patients with acute uncomplicated diverticulitis.

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