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Surgery Feb 2023
Topics: Humans; Anti-Bacterial Agents; Diverticulitis; Diverticulitis, Colonic; Acute Disease; Treatment Outcome
PubMed: 35660023
DOI: 10.1016/j.surg.2022.04.047 -
Nederlands Tijdschrift Voor Geneeskunde 2012The NHG practice guideline on 'Diverticulitis' provides general practitioners with directions on the diagnosis and treatment of uncomplicated and complicated... (Review)
Review
The NHG practice guideline on 'Diverticulitis' provides general practitioners with directions on the diagnosis and treatment of uncomplicated and complicated diverticulitis. Diverticulitis is primarily a clinical diagnosis which can be supported by assessment of CRP. Uncomplicated diverticulitis is strongly suspected if the patient reports the development of persistent sharp, stabbing pain in the lower left abdomen within a couple of days; if there is pressure or rebound tenderness only in the lower left abdomen; and if there are no alarm signals. Alarm signals of complicated diverticulitis are: guarded muscle response, signs of intestinal obstruction, locally palpable resistance, rectal loss of blood, hypotension, and high fever. The policy for uncomplicated diverticulitis is waiting without specific measures, provided that the general practitioner monitors the course actively. There is no indication for antibiotics in patients with uncomplicated diverticulitis. Patients with signs of complicated diverticulitis or with persisting symptoms should be referred.
Topics: C-Reactive Protein; Diverticulitis; General Practice; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Societies, Medical; Watchful Waiting
PubMed: 22296900
DOI: No ID Found -
International Surgery 2001We report a case of a female patient with a picture of "atypical appendicitis," with 3 days of abdominal pain, localized to the right lower quadrant with no nausea,... (Review)
Review
We report a case of a female patient with a picture of "atypical appendicitis," with 3 days of abdominal pain, localized to the right lower quadrant with no nausea, vomiting, diarrhea, or anorexia. On examination she was febrile to 38.4 degrees C, had tenderness at McBurney's point, and a leukocyte count of 11,200. A computerized axial tomography (CAT) scan was obtained showing changes consistent with appendicitis. On laparoscopic exploration the patient was found to have cecal masses. Definitive surgical treatment was deferred until after adequate evaluation of the colon. Postoperative colonoscopy demonstrated cecal diverticulitis. Management of cecal diverticulitis found during laparotomy for presumed appendicitis has included right hemicolectomy, ileocolic resection or appendectomy, and conservative treatment with antibiotics. The laparoscopic approach in a patient with an equivocal history and physical examination allows for definitive workup of inflammatory cecal masses found during surgery for appendicitis.
Topics: Abdominal Pain; Adult; Appendicitis; Cecal Diseases; Colonoscopy; Diagnosis, Differential; Diverticulitis; Female; Humans; Tomography, X-Ray Computed
PubMed: 11996078
DOI: No ID Found -
Diseases of the Colon and Rectum Apr 2023A 58-year-old man with a previous history of hypertension presented to the emergency department because of acute left lower quadrant pain. Neither nausea nor vomiting...
A 58-year-old man with a previous history of hypertension presented to the emergency department because of acute left lower quadrant pain. Neither nausea nor vomiting was described. At physical examination, he had tenderness to palpation in the left lower quadrant with no signs of peritonitis. The patient's body temperature and heart rate were unremarkable (37.2°C/86 beats per minute). Laboratory blood tests showed minimal leukocytosis (13,000 cells/mm 3 ) with no other relevant findings. An abdominal CT was performed, which confirmed the clinical suspicion of acute uncomplicated diverticulitis (AUD). It was described as the presence of a sigmoid thickening and phlegmon in an area with several diverticula, but no free air, fluid, or abscesses were identified ( Fig. 1 ). After the administration of painkillers, the patient remained completely asymptomatic, with good pain control and no fever, so he was recommended conservative outpatient treatment without antibiotics. One week after the AUD episode, the patient was checked, and he confirmed that the resolution had been uneventful and he had been asymptomatic, confirming that the outpatient treatment was successful. The patient asked for any measures that he could follow to prevent further episodes and showed interest in surgical treatment options.
Topics: Male; Humans; Middle Aged; Diverticulitis; Abscess; Abdominal Pain; Fever; Peritonitis
PubMed: 36735723
DOI: 10.1097/DCR.0000000000002750 -
International Journal of Colorectal... May 2021Recent data shows a significantly increased risk of diverticulosis among smokers. There is limited data on the association between tobacco smoking and diverticulitis. We...
BACKGROUND
Recent data shows a significantly increased risk of diverticulosis among smokers. There is limited data on the association between tobacco smoking and diverticulitis. We aim to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of diverticulitis patients based on tobacco smoking status.
METHODS
A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016 and 2017) and the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of diverticulitis and smoking. We assessed all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of tobacco smokers vs. nonsmokers with diverticulitis.
RESULTS
We identified 442,273 diverticulitis patients, of whom 96,864 were tobacco smokers, and 345,409 were nonsmokers. Between the two groups, in-hospital mortality was not significant (OR 1.09, 95% CI 0.38-2.6; P = 0.98). Tobacco smokers with diverticulitis have higher odds of lower gastrointestinal bleeding (LGIB) (OR 1.6, 95% CI 1.4-3.8; P = 0.01), peritonitis (OR 1.5, 95% CI 1.9-3.3; P = 0.00), intestinal obstruction (OR 1.6, 95% CI 2.8-7.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05-4.4; P = 0.03), and shock requiring vasopressor (OR 1.5, 95% CI 1.2-2.2; P = 0.00). In tobacco smokers with complicated diverticulitis, there were higher odds of LGIB (OR 1.4, 95% CI 1.2-1.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05-4.4; P = 0.03), and colectomy (OR 1.2, 95% CI 1.1-1.2; P = 0.00). In-hospital mortality was not significant in smokers with complicated diverticulitis (OR 1.2, 95% CI 0.78-1.9; P = 0.3).
CONCLUSIONS
In this propensity-matched analysis, there was no difference in in-hospital mortality between tobacco smokers vs. nonsmokers with diverticulitis. Smoking has been associated with an increased incidence of complications in diverticulitis with a higher length of hospital stay and resource utilization.
Topics: Diverticulitis; Humans; Inpatients; Length of Stay; Retrospective Studies; Tobacco Smoking
PubMed: 33415450
DOI: 10.1007/s00384-020-03805-6 -
Medicina 2023Meckel's diverticulum corresponds to the aberrant involution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric...
Meckel's diverticulum corresponds to the aberrant involution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric border of the terminal ileum. It is the most common structural anomaly of the gastrointestinal tract, it is almost always asymptomatic and its diagnosis is usually incidental, however the complication with diverticulitis is an unusual condition. We describe the case of a 65-year-oldman, who was admitted from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computerized tomography of the abdomen with intra venous contrast was performed, which was interpreted as complicated Meckel's diverticulitis, being corroborated during the surgical act and confirmed by pathological anatomy. Meckel's diverticulitis is a rare entity, however it is important to recognize it within the differential diagnoses of acute abdomen, which will allow prompt intervention and a favorable outcome.
Topics: Male; Humans; Meckel Diverticulum; Abdomen, Acute; Tomography, X-Ray Computed; Diverticulitis; Diagnosis, Differential
PubMed: 37582139
DOI: No ID Found -
The American Journal of Gastroenterology Mar 1998Four cases of acute ileal diverticulitis are presented wherein early diagnosis helped avoid emergent surgery. All patients did well initially with conservative medical...
Four cases of acute ileal diverticulitis are presented wherein early diagnosis helped avoid emergent surgery. All patients did well initially with conservative medical management. Acute ileal diverticulitis, although uncommon, should be suspected when the clinical presentation indicates an inflammatory condition of the lower right abdomen. Surgery, when required for recurrent disease, can be reserved for the interval between acute episodes.
Topics: Acute Disease; Aged; Diverticulitis; Female; Humans; Ileal Diseases; Male; Middle Aged; Radiography
PubMed: 9517656
DOI: 10.1111/j.1572-0241.1998.00452.x -
Lancet (London, England) May 2023
Topics: Humans; Abscess; Conservative Treatment; Diverticulitis; Colectomy; Diverticulitis, Colonic; Acute Disease
PubMed: 37244691
DOI: 10.1016/S0140-6736(23)00771-7 -
Updates in Surgery Mar 2016The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated... (Review)
Review
Elective colonic resection after acute diverticulitis improves quality of life, intestinal symptoms and functional outcome: experts' perspectives and review of literature.
The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated episode of acute diverticulitis remains controversial. Although both the impact of symptomatic disease and occurrence of its complications are extensively studied, there is no consensus about the role of elective colonic resection in the management of symptomatic recurrent diverticulitis. In this study, the database of ERIC, the Web of Science, EMBASE, and MEDLINE were searched for the English-language published articles about the functional outcomes and symptomatic improvement in patients after elective surgery for diverticular disease. A majority of clinical trials showed that elective surgery following a successful conservative treatment of acute diverticulitis resulted in significantly better social and functional well-being. In addition, elective surgery greatly reduces the potential events of disease recurrence, thus decreasing financial burden on the national health services. However, to obtain the best functional outcome surgical intervention must be individualized and tailored to meet every single patient's specific indigenous symptomatology.
Topics: Acute Disease; Colectomy; Colon; Defecation; Diverticulitis; Elective Surgical Procedures; Humans; Laparoscopy; Quality of Life; Recurrence; Treatment Outcome
PubMed: 27015932
DOI: 10.1007/s13304-016-0349-0 -
Diseases of the Colon and Rectum May 2020Diverticulitis is separated into complicated and uncomplicated, based on the patient's presentation at the time of his or her initial attack of acute diverticulitis.
BACKGROUND
Diverticulitis is separated into complicated and uncomplicated, based on the patient's presentation at the time of his or her initial attack of acute diverticulitis.
OBJECTIVE
The aim of this study was to identify risk factors for persistent complex diverticulitis, defined as an abscess, fistula, or stricture, at the time of elective surgery, and to characterize outcomes in this patient population.
DESIGN
This was a retrospective review of 2010 to 2016 in the American College of Surgeons National Surgical Quality Improvement Project database.
SETTINGS
Individuals diagnosed with diverticulitis who underwent elective surgery were included.
PATIENTS
A total of 1502 patients underwent elective surgery for diverticulitis, of which 559 (37%) patients had a surgical indication of persistent complex diverticulitis.
INTERVENTIONS
We performed logistic regression analysis to identify risk factors for complex diverticulitis and evaluated a new prediction model.
MAIN OUTCOME MEASURES
The predictive factors of persistent complex diverticulitis for elective colon resection were measured.
RESULTS
The patients with complex diverticulitis were older (p < 0.001), had worse functional status (p < 0.001), more comorbidities (diabetes mellitus and hypertension), and a higher Charlson Comorbidity Index (2.7 vs 1.6, p < 0.001). They were more likely to have a history of tobacco or alcohol use (p < 0.001) and to be malnourished. Interestingly, patients found to have persistent complex diverticulitis did not have more episodes than patients with uncomplicated cases did (p = 0.67). Surgical time was longer in complex diverticulitis, and the patients were more likely to require diverting stomas and concurrent resections of adjacent structures. The area under the curve from the test set was (0.75; 95% CI, 0.72-0.78), sensitivity and specificity were 0.890 (95% CI, 0.870-0.891) and 0.450 (95% CI, 0.410-0.490).
LIMITATIONS
The study was limited by its retrospective review and observational bias.
CONCLUSIONS
Patients undergoing elective surgery for complex diverticulitis did not have more episodes. Instead, complex diverticulitis may be a reflection of a complicated patient, suggesting that complicated patients should have a different algorithm of care at the time of their initial presentation with diverticulitis to prevent the development of complex disease. See Video Abstract at http://links.lww.com/DCR/B183. ¿PODEMOS PREDECIR DIVERTICULITIS QUIRÚRGICAMENTE COMPLEJA EN CASOS ELECTIVOS?: La diverticulitis se divide en complicada y sin complicaciones, según la presentación del paciente en el momento de su ataque inicial de diverticulitis aguda.El objetivo de este estudio fue identificar los factores de riesgo para la diverticulitis compleja persistente, definida como un absceso, fístula o estenosis, en el momento de la cirugía electiva, y caracterizar los resultados en esta población de pacientes.Esta fue una revisión retrospectiva del 2010-2016 en la base de datos del Proyecto de Mejora de la Calidad Quirúrgica Nacional del Colegio Estadounidense de Cirujanos.Se incluyeron individuos diagnosticados con diverticulitis que se sometieron a cirugía electiva.1502 pacientes fueron sometidos a cirugía electiva por diverticulitis, de los cuales 559 (37%) pacientes tenían una indicación quirúrgica de diverticulitis compleja persistente.Realizamos un análisis de regresión logística para identificar los factores de riesgo de diverticulitis compleja y evaluamos un nuevo modelo de predicción.Se midieron los factores predictivos de diverticulitis compleja persistente para la resección de colon electiva.Los pacientes con diverticulitis compleja eran mayores (p <0,001), tenían un peor estado funcional (p <0,001), más comorbilidades (diabetes e hipertensión) y un índice de comorbilidad de Charlson más alto (2,7 frente a 1,6, p <0,001). Tenían más probabilidades de tener antecedentes de consumo de tabaco o alcohol (p <0.001) y estar desnutridos. Curiosamente, los pacientes con diverticulitis compleja persistente no tuvieron más episodios que los pacientes sin complicaciones (p = 0,67). El tiempo quirúrgico fue más largo en la diverticulitis compleja y era más probable que requirieran estomas para desvio y resecciones concurrentes de estructuras adyacentes. El área bajo la curva de prueba fue (0.75, intervalo de confianza del 95% 0.72-0.78), la sensibilidad y la especificidad fueron 0.890 (intervalo de confianza del 95%; 0.870-0.891) y 0.450 (intervalo de confianza del 95%; 0.410-0.490), respectivamente.El estudio estuvo limitado por su revisión retrospectiva y sesgo observacional.Los pacientes sometidos a cirugía electiva por diverticulitis compleja no tuvieron más episodios. En cambio, la diverticulitis compleja puede ser un reflejo de un paciente complicado, lo que sugiere que los pacientes complicados deben tener un algoritmo de atención diferente al momento de su presentación inicial con diverticulitis para prevenir el desarrollo de una enfermedad compleja. Consulte Video Resumen en http://links.lww.com/DCR/B183. (Traducción-Dr. Yesenia Rojas-Kahlil).
Topics: Adult; Aged; Colectomy; Diverticulitis; Elective Surgical Procedures; Female; Humans; Logistic Models; Male; Middle Aged; Patient Selection; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; Risk Factors
PubMed: 32032203
DOI: 10.1097/DCR.0000000000001600