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Advances in Surgery Sep 2020
Review
Topics: Anastomotic Leak; Colectomy; Diverticulitis, Colonic; Humans; Laparoscopy; Laparotomy; Peritonitis; Postoperative Complications; Reoperation
PubMed: 32713424
DOI: 10.1016/j.yasu.2020.04.001 -
The Journal of Trauma and Acute Care... Jul 2024Acute colonic diverticulitis is a common disease treated by acute care surgeons. Acute uncomplicated colonic diverticulitis involves thickening of the colon wall with... (Review)
Review
Acute colonic diverticulitis is a common disease treated by acute care surgeons. Acute uncomplicated colonic diverticulitis involves thickening of the colon wall with inflammatory changes and less commonly requires the expertise of a surgeon; many cases may be treated as an outpatient with or without antibiotics. Complicated diverticulitis involves phlegmon, abscess, peritonitis, obstruction, stricture, and/or fistula and usually requires inpatient hospital admission, treatment with antibiotics, and consideration for intervention including operative management. This review will discuss what the acute care surgeon needs to know about diagnosis and management of acute colonic diverticulitis.
Topics: Humans; Diverticulitis, Colonic; Acute Disease; Anti-Bacterial Agents
PubMed: 38509056
DOI: 10.1097/TA.0000000000004304 -
Arquivos de Gastroenterologia 2021Diverticulitis is an acute inflammatory process that affects individuals with diverticular disease. Given the sharp increase in the diagnostic rate of such a... (Review)
Review
BACKGROUND
Diverticulitis is an acute inflammatory process that affects individuals with diverticular disease. Given the sharp increase in the diagnostic rate of such a pathological process, there was also an increased interest in elucidating the possible causes related to the development of this clinical condition. Among the main factors investigated, diet excels, the object of study of this integrative literature review.
METHODS
After searching the virtual health library and PubMed databases, five prospective cohort studies were selected that best answered the guiding question: "Is there a relationship between diet and the incidence of diverticulitis?".
RESULTS
It was observed that the high intake of red meat and the low intake of dietary fiber were the most strongly associated dietary factors with the incidence of this inflammatory process.
CONCLUSION
Therefore, it is evident that choosing healthy eating habits can considerably reduce the incidence of diverticulitis and, consequently, potentially more serious complications directly related to it.
Topics: Diet; Dietary Fiber; Diverticulitis; Feeding Behavior; Humans; Prospective Studies
PubMed: 34705977
DOI: 10.1590/S0004-2803.202100000-66 -
Revista Espanola de Enfermedades... Sep 2023Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male...
Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male patient diagnosed with colonic diverticulosis. He presented to the emergency department with symptoms of acute abdomen and was diagnosed by CT scan with a 13x14 cm giant diverticulum showing signs of complication. Given the findings, an urgent surgical intervention was decided, and diverticulectomy at the diverticular neck was performed using an endostapler. The etiology of giant diverticula is related to a mechanism of one-way valve at the diverticular neck. Diagnosis poses a challenge as the clinical presentation is nonspecific. The imaging modality of choice is CT scan, which reveals a large cystic image dependent on the sigmoid colon. Definitive treatment is surgical, either by resecting the affected segment including the lesion or by performing a simple diverticulectomy in uncomplicated cases.
Topics: Male; Humans; Aged; Colon, Sigmoid; Diverticulum, Colon; Diverticulum; Tomography, X-Ray Computed; Diagnosis, Differential; Diverticulitis
PubMed: 37539515
DOI: 10.17235/reed.2023.9804/2023 -
Praxis Apr 2022
Topics: Anti-Bacterial Agents; Diverticulitis; Diverticulitis, Colonic; Humans; Hyperplasia
PubMed: 35414252
DOI: 10.1024/1661-8157/a003811 -
JPMA. the Journal of the Pakistan... Nov 2020To evaluate the treatment options applied to solitary caecal diverticulitis patients, and to explore the possibility of non-operative treatments.
OBJECTIVE
To evaluate the treatment options applied to solitary caecal diverticulitis patients, and to explore the possibility of non-operative treatments.
METHODS
The retrospective study was conducted a tertiary referral centre, and comprised data of patients who presented with acute abdominal pain and were diagnosed either preoperatively or intraoperatively as cases of solitary caecal diverticulitis between January 2009 and December 2017. Data on demographics, physical examination findings, laboratory results, treatment modalities and outpatient clinical records was noted, and analysed analysed using SPSS 21.
RESULTS
Of the 580 patients whose medical records were reviewed, 11(1.89%) were diagnosed as cases of solitary caecal diverticulitis. Of them, 6(54.5%) patients were treated conservatively, and 5(45.4%) surgically. The disease recurred in 1(9%) patient who was treated conservatively. Among those treated surgically, 1(20%) patient had hemicolectomy, and the rest had appendectomy and/or diverticulectomy and drainage procedures. There were no major complications during the follow- up.
CONCLUSIONS
With accurate diagnosis during preoperative period, the spread of the pathology helps to choose the best suitable surgical technique. Appendectomy should be performed to avoid future diagnostic confusion.
Topics: Appendicitis; Cecal Diseases; Diagnosis, Differential; Diverticulitis; Humans; Retrospective Studies
PubMed: 33341831
DOI: 10.5455/JPMA.12674 -
Journal of Gastrointestinal and Liver... Sep 2019Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal and extraintestinal diseases, and are increasingly considered a... (Review)
Review
Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal and extraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation. However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorly investigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associated microbiota composition and functionality across different stages of diverticular disease. We also explore the influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possible relevance of these associations for the pathogenesis of diverticula. We overview the current treatments of diverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty and the need for future studies. Although no conclusive remarks on the relationship between microbiota and diverticular disease can be made, preliminary data suggest that abdominal symptoms are associated with reduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, and overgrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the early stages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiome in the pathogenesis of diverticular disease and its progression towards more severe forms.
Topics: Animals; Bacteria; Diverticulitis; Diverticulum; Dysbiosis; Feces; Gastrointestinal Microbiome; Host-Pathogen Interactions; Humans; Intestinal Mucosa; Risk Factors
PubMed: 31517330
DOI: 10.15403/jgld-277 -
Clinical Gastroenterology and... Feb 2022The etiology of diverticulitis is poorly understood. The long-held belief that constipation and low-fiber diet are risk factors for diverticulosis has recently been...
OBJECTIVE
The etiology of diverticulitis is poorly understood. The long-held belief that constipation and low-fiber diet are risk factors for diverticulosis has recently been challenged by studies that suggest that more frequent bowel movements predispose to diverticulosis. We aim to prospectively explore the association between bowel movement frequency and incident diverticulitis.
DESIGN
We studied participants of the Nurses' Health Study (NHS) and Health Professional Follow-up Study (HPFS). Participants' medical history, lifestyle factors and diet were used in Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios(HRs) and 95% confidence intervals(CI).
RESULTS
In the NHS during over 24 years of follow-up encompassing 1,299,922 person-years, we documented 5,214 incident cases of diverticulitis, and in the HPFS over 14 years encompassing 368,661 person-years of follow-up, we documented 390 incident cases of diverticulitis. We observed an inverse association between the frequency of bowel movements and risk of diverticulitis. In the NHS, compared with women who had daily bowel movements, those with more than once daily bowel movements had a HR of 1.30 (95% CI, 1.19, 1.42) and those with less frequent bowel movements had a HR of 0.89 (95% CI, 0.82, 0.95; p-trend < 0.0001). In the HPFS, the corresponding HRs were 1.29 (95% CI, 1.04, 1.59) and 0.61 (95% CI, 0.36, 1.03; p-trend = 0.003). The association between bowel movements and diverticulitis was not modified by categories of age, BMI, physical activity, laxative use or fiber intake.
CONCLUSION
More frequent bowel movements appear to be a risk factor for subsequent diverticulitis both in men and women. Further studies are needed to understand the potential mechanisms that may underlie this association.
Topics: Constipation; Defecation; Diverticulitis; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Risk Factors
PubMed: 33418133
DOI: 10.1016/j.cgh.2021.01.003 -
Deutsches Arzteblatt International Aug 2020Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in Germany. The disease has a number of subtypes, each of which has an appropriate treatment. In this article, we present the current surgical indications and optimal timing of surgery for diverticular disease.
METHODS
This review is based on publications that were retrieved by an extensive, selective search in Medline and the Cochrane Library (1998-2018) for studies and guidelines with information on the indications for surgery in diverticular disease.
RESULTS
Studies of evidence grades 2 to 4 were available. Patients receiving a diagnosis of freely perforated diverticulitis and peritonitis (Classification of Diverticular Disease [CDD] type 2c) should be operated on at once. Covered perforated diverticulitis with a macroabscess (>1 cm, CDD type 2b) may be an indication for elective surgery after successful conservative treatment. New evidence from a randomized, controlled trial suggests that elective surgery should also be considered for patients with chronic recurrent diverticulitis (CDD type 3b). The decisive factor in such cases is the impairment of the quality of life for the individual patient. Elective surgery is indicated in chronic recurrent diverticulitis with complications (fistulae, stenoses). Asymptomatic diverticulosis (CDD type 0) and uncomplicated diverticulitis (CDD type 1) are not surgical indications. Likewise, in diverticular hemorrhage (CDD type 4), surgery is only indicated in exceptional cases, when conservative treatment fails.
CONCLUSION
The surgical indication and the proper timing of surgery depend on the type of disease that is present. Future studies should more thoroughly investigate the effect of surgery on the quality of life in patients with the various types of diverticular disease.
Topics: Adult; Aged; Aged, 80 and over; Diverticulitis; Elective Surgical Procedures; Germany; Humans; Middle Aged; Quality of Life; Retrospective Studies
PubMed: 33161943
DOI: 10.3238/arztebl.2020.0591 -
Advances in Surgery Sep 2021
Review
Topics: Diverticulitis; Diverticulitis, Colonic; Humans; Laparoscopy
PubMed: 34389099
DOI: 10.1016/j.yasu.2021.05.004