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Journal of Medical Radiation Sciences Sep 2022Appendiceal diverticulitis, a frequently underdiagnosed entity, differs from typical appendicitis by the presence of an inflamed appendiceal diverticulum. Appendiceal...
Appendiceal diverticulitis, a frequently underdiagnosed entity, differs from typical appendicitis by the presence of an inflamed appendiceal diverticulum. Appendiceal diverticulitis is a surgical emergency which has an increased risk of perforation compared to typical appendicitis. We will discuss a surgically and pathologically confirmed case of complicated appendiceal diverticulitis and its management implications.
Topics: Appendicitis; Appendix; Diagnosis, Differential; Diverticulitis; Humans
PubMed: 35194966
DOI: 10.1002/jmrs.573 -
The New England Journal of Medicine Jan 2019
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 30699324
DOI: 10.1056/NEJMc1815667 -
The New England Journal of Medicine Jan 2019
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 30702245
DOI: 10.1056/NEJMc1815667 -
JAMA Surgery Jun 2024Care of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated... (Review)
Review
IMPORTANCE
Care of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated diverticulitis. The latest pathophysiology, advances in diagnosis, and prevention strategies are also reviewed.
OBSERVATIONS
Treatment is moving to the outpatient setting, physicians are forgoing antibiotics for uncomplicated disease, and the decision for elective surgery for diverticulitis has become preference sensitive. Furthermore, the most current data guiding surgical management of diverticulitis include the adoption of new minimally invasive and robot-assisted techniques.
CONCLUSIONS AND RELEVANCE
This review provides an updated summary of the best practices in the management of diverticulitis to guide colorectal and general surgeons in their treatment of patients with this common disease.
Topics: Humans; Diverticulitis; Diverticulitis, Colonic; Anti-Bacterial Agents; Elective Surgical Procedures; Robotic Surgical Procedures
PubMed: 38630452
DOI: 10.1001/jamasurg.2023.8104 -
The Surgical Clinics of North America Jun 2024Diverticulosis and diverticulitis remain common diagnoses in western countries, and the incidence continues to rise. Diverticulitis accounts for roughly one-third of... (Review)
Review
Diverticulosis and diverticulitis remain common diagnoses in western countries, and the incidence continues to rise. Diverticulitis accounts for roughly one-third of admissions to acute care hospitals annually, with even more patients being treated as outpatients due to improved understanding of risk stratification and the natural history of disease progression. Thus, having a thorough understanding of the etiology of the disease in conjunction with computed tomography findings and patient presentation can help dictate the appropriate treatment.
Topics: Humans; Diverticulitis; Tomography, X-Ray Computed; Diverticulitis, Colonic
PubMed: 38677818
DOI: 10.1016/j.suc.2023.12.001 -
Journal of Gastrointestinal Surgery :... Oct 2017Diverticulitis has become increasingly more common in the 20 century and is now one of the most frequent indications for gastrointestinal tract-related hospitalizations.... (Review)
Review
Diverticulitis has become increasingly more common in the 20 century and is now one of the most frequent indications for gastrointestinal tract-related hospitalizations. The spectrum of clinical presentation can vary widely from mild, uncomplicated disease that can be managed as an outpatient, to complicated diverticulitis with peritonitis and sepsis. Historically, all patients with diverticulitis were managed with, at a minimum, a course of antibiotics, with many patients undergoing urgent or emergent surgery with a sigmoid colectomy, end colostomy, and oversewn rectosigmoid "Hartmann's" stump. However, the treatment paradigm has shifted away from more aggressive surgical management over the years, with recent literature supporting the notion that nonoperative management may lead to equivalent or even superior outcomes in many circumstances. Therefore, the purpose of this review is to summarize and interpret the existing literature on the management of uncomplicated and complicated left-sided diverticulitis in 2017.
Topics: Diverticulitis, Colonic; Humans
PubMed: 28547631
DOI: 10.1007/s11605-017-3404-3 -
JAMA Sep 2016
Topics: Diverticulitis; Diverticulum; Humans
PubMed: 27623476
DOI: 10.1001/jama.2016.3592 -
International Journal of Colorectal... Oct 2022Elective sigmoid resection is proposed as a treatment for symptomatic diverticular disease for the possible improvement in quality of life achievable. Albeit encouraging...
PURPOSE
Elective sigmoid resection is proposed as a treatment for symptomatic diverticular disease for the possible improvement in quality of life achievable. Albeit encouraging results have been reported, recurrent diverticulitis is still a concern deeply affecting quality of life. The aim of this study is to determine the rate of recurrent diverticulitis after elective sigmoid resection and to look for possible perioperative risk factors.
METHODS
Patients who underwent elective resection for DD with at least a 3-year follow-up were included. Postoperative recurrence was defined as left-sided or lower abdominal pain, with CT scan-confirmed findings of diverticulitis.
RESULTS
Twenty of 232 (8.6%) patients developed CT-proven recurrent diverticulitis after elective surgery. All the 20 recurrent diverticulitis were uncomplicated and did not need surgery. Eighty-five percent of the recurrences occurred in patients with a preoperative diagnosis of uncomplicated DD, 70% in patients who had at least 4 episodes of diverticulitis, and 70% in patients with a history of diverticulitis extended to the descending colon. Univariate analysis showed that recurrence was associated with diverticulitis of the sigmoid and of the descending colon (p = 0.04), with a preoperative diagnosis of IBS (p = 0.04) and with a longer than 5 years diverticular disease (p = 0.03). Multivariate analysis was not able to determine risks factors for recurrence.
CONCLUSION
Our study showed that patients with a preoperative diagnosis of IBS, diverticulitis involving the descending colon, and a long-lasting disease are more likely to have recurrent diverticulitis. However, these variables could not be assumed as risk factors.
Topics: Colon, Sigmoid; Diverticular Diseases; Diverticulitis; Diverticulitis, Colonic; Elective Surgical Procedures; Humans; Irritable Bowel Syndrome; Quality of Life; Recurrence
PubMed: 36048197
DOI: 10.1007/s00384-022-04248-x -
The American Journal of Emergency... Feb 2024Acute diverticulitis is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency medicine clinicians to be aware of the... (Review)
Review
INTRODUCTION
Acute diverticulitis is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
OBJECTIVE
This paper evaluates key evidence-based updates concerning acute diverticulitis for the emergency clinician.
DISCUSSION
Diverticulitis is a complication of diverticulosis and most commonly affects the sigmoid and descending colon in Western countries. History and examination can suggest the diagnosis, with abdominal pain and tenderness in the left lower quadrant being the most common symptom and sign, respectively. Change in bowel habits and fever may also occur. Laboratory testing may demonstrate leukocytosis or an elevated C-reactive protein. Imaging options can include computed tomography (CT) of the abdomen and pelvis with intravenous contrast, magnetic resonance imaging (MRI), or ultrasound (US), though most classification systems for diverticulitis incorporate CT findings. While the majority of diverticulitis cases are uncomplicated, complications may affect up to 25% of patients. Treatment of complicated diverticulitis requires antibiotics and surgical consultation. Antibiotics are not required in select patients with uncomplicated diverticulitis. Appropriate patients for supportive care without antibiotics should be well-appearing, have pain adequately controlled, be able to tolerate oral intake, be able to follow up, have no complications, and have no immunocompromise or severe comorbidities.
CONCLUSIONS
An understanding of literature updates can improve the ED care of patients with acute diverticulitis.
Topics: Humans; Diverticulitis, Colonic; Diverticulitis; Colon, Sigmoid; Tomography, X-Ray Computed; Anti-Bacterial Agents
PubMed: 37956503
DOI: 10.1016/j.ajem.2023.10.051 -
International Journal of Colorectal... Mar 2021Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a... (Review)
Review
PURPOSE
Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a spectrum of pathological processes with varying clinical manifestations. The purpose of this review was to update the reader on modern evidence-based treatment strategies for acute diverticulitis.
METHODS
A literature search of the PUBMED database was performed using the keywords 'diverticulosis', 'diverticular disease' and 'diverticulitis'. Only articles published in the English language were included.
RESULTS
Evidence-based treatment strategies for acute diverticulitis have evolved over time. Data have questioned the need for antibiotic therapy for Hinchey I disease and the role of percutaneous abscess drainage for Hinchey II. Clinical trials have demonstrated laparoscopic lavage is an appropriate option for select patients with Hinchey III disease and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease.
CONCLUSION
Risk-adapted treatment strategies and operative decision-making for acute diverticulitis are increasingly based on a combination of patient and disease factors.
Topics: Anastomosis, Surgical; Diverticulitis; Diverticulitis, Colonic; Drainage; Humans; Laparoscopy; Surgical Stomas
PubMed: 33156365
DOI: 10.1007/s00384-020-03788-4