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American Family Physician May 2013Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess,... (Review)
Review
Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation. Patients with acute diverticulitis may present with left lower quadrant pain, tenderness, abdominal distention, and fever. Other symptoms may include anorexia, constipation, nausea, diarrhea, and dysuria. Initial laboratory studies include a complete blood count, basic metabolic panel, urinalysis, and measurement of C-reactive protein. Computed tomography, the most commonly performed imaging test, is useful to establish the diagnosis and the extent and severity of disease, and to exclude complications in selected patients. Colonoscopy is recommended four to six weeks after resolution of symptoms for patients with complicated disease or for another indication, such as age-appropriate screening. In mild, uncomplicated diverticulitis, antibiotics do not accelerate recovery, or prevent complications or recurrences. Hospitalization should be considered if patients have signs of peritonitis or there is suspicion of complicated diverticulitis. Inpatient management includes intravenous fluid resuscitation and intravenous antibiotics. Patients with a localized abscess may be candidates for computed tomography-guided percutaneous drainage. Fifteen to 30 percent of patients admitted with acute diverticulitis require surgical intervention during that admission. Laparoscopic surgery results in a shorter length of stay, fewer complications, and lower in-hospital mortality compared with open colectomy. The decision to proceed to surgery in patients with recurrent diverticulitis should be individualized and based on patient preference, comorbidities, and lifestyle. Interventions to prevent recurrences of diverticulitis include increased intake of dietary fiber, exercise, cessation of smoking, and, in persons with a body mass index of 30 kg per m(2) or higher, weight loss.
Topics: Acute Disease; Anti-Bacterial Agents; Colonoscopy; Contraindications; Diverticulitis; Female; Humans; Male; Risk Factors; Tomography, X-Ray Computed
PubMed: 23668524
DOI: No ID Found -
Critical Care Nursing Clinics of North... Mar 2018Diverticular disease accounts for approximately 300,000 hospitalizations per year in the United States, resulting in 1.5 million days of inpatient care. Diverticulitis... (Review)
Review
Diverticular disease accounts for approximately 300,000 hospitalizations per year in the United States, resulting in 1.5 million days of inpatient care. Diverticulitis is defined as an inflammation of the diverticulum, which can be asymptomatic or symptomatic. This disease is the third most common gastrointestinal illness that requires hospitalization and the leading indication for elective colon resection. Abdominal pain is the most common complaint in patients with acute diverticulitis. The pain can be described as cramping, constant, and persistent for several days. Medical management is most often provided with antibiotics and clear liquid diet.
Topics: Acute Disease; Anti-Bacterial Agents; Diverticulitis; Hospitalization; Humans; Inflammation; United States
PubMed: 29413216
DOI: 10.1016/j.cnc.2017.10.006 -
Surgical Endoscopy Sep 2019Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to...
BACKGROUND
Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management.
METHODS
Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement.
RESULTS
A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members' online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis.
CONCLUSION
This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice.
Topics: Acute Disease; Diverticulitis; Endoscopy, Gastrointestinal; Evidence-Based Practice; Humans; Patient Care Management; Patient Selection
PubMed: 31250244
DOI: 10.1007/s00464-019-06882-z -
International Journal of Colorectal... May 2018The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world.
PURPOSE
Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.
METHODS
PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs.
RESULTS
A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6-9%, I 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%.
CONCLUSION
Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.
Topics: Abscess; Acute Disease; Digestive System Surgical Procedures; Diverticulitis; Drainage; Emergencies; Humans; Inpatients; Outpatients; Patient Readmission
PubMed: 29532202
DOI: 10.1007/s00384-018-3015-9 -
The New England Journal of Medicine Jan 2019
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 30702245
DOI: 10.1056/NEJMc1815667 -
The New England Journal of Medicine Jan 2019
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 30699324
DOI: 10.1056/NEJMc1815667 -
Advances in Surgery Sep 2021
Review
Topics: Diverticulitis; Diverticulitis, Colonic; Humans; Laparoscopy
PubMed: 34389099
DOI: 10.1016/j.yasu.2021.05.004 -
American Family Physician Dec 2020Learn more about the benefits and harms of antibiotics for uncomplicated diverticulitis. (Review)
Review
Learn more about the benefits and harms of antibiotics for uncomplicated diverticulitis.
Topics: Acute Disease; Anti-Bacterial Agents; Diverticulitis; Drug Administration Schedule; Female; Humans; Male; Watchful Waiting
PubMed: 33252904
DOI: No ID Found -
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 -
Digestive Diseases and Sciences Apr 2022Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years,... (Review)
Review
Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years, especially in patients under 50 years old. Historically, acute diverticulitis in younger patients was felt to represent a separate entity, being more virulent and associated with a higher rate of recurrence. Accordingly, young patients were often managed differently to older counterparts. Our understanding of the natural history of this condition has evolved, and current clinical practice guidelines suggest age should not alter management. The purpose of this review is to evaluate the changing epidemiology of acute diverticulitis, consider potential explanations for the observed increased incidence in younger patients, as well as review the natural history of acute diverticulitis in the younger population.
Topics: Acute Disease; Diverticulitis; Diverticulitis, Colonic; Hospitalization; Humans; Incidence; Middle Aged; Recurrence
PubMed: 33786702
DOI: 10.1007/s10620-021-06956-w