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The New England Journal of Medicine Jan 2019
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 30702244
DOI: 10.1056/NEJMc1815667 -
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 -
The Surgical Clinics of North America Oct 2018Acute diverticulitis is a common condition that has been increasing in incidence in the United States. It is associated with increasing age, but the pathophysiology of... (Review)
Review
Acute diverticulitis is a common condition that has been increasing in incidence in the United States. It is associated with increasing age, but the pathophysiology of acute diverticulitis is still being elucidated. It is now believed to have a significant contribution from inflammatory processes rather than being a strictly infectious process. There are still many questions to be answered regarding the optimal management of acute diverticulitis because recent studies have challenged traditional practices, such as the routine use of antibiotics, surgical technique, and dietary restrictions for prevention of recurrence.
Topics: Acute Disease; Diverticulitis; Emergency Service, Hospital; Humans
PubMed: 30243445
DOI: 10.1016/j.suc.2018.06.006 -
Current Problems in Surgery May 2021
Review
Topics: Diverticulitis; Elective Surgical Procedures; Humans; Patient Selection
PubMed: 33933211
DOI: 10.1016/j.cpsurg.2020.100876 -
Presse Medicale (Paris, France : 1983) Dec 2017Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively... (Review)
Review
Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.
Topics: Algorithms; Diverticulitis; Humans; Jejunal Diseases
PubMed: 29133083
DOI: 10.1016/j.lpm.2017.08.009 -
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 -
MMW Fortschritte Der Medizin Nov 2021
Review
Topics: Acute Disease; Diverticulitis; Diverticulitis, Colonic; Humans; Retrospective Studies
PubMed: 34767222
DOI: 10.1007/s15006-021-0408-4 -
Ugeskrift For Laeger Jul 2021Diverticulitis is a complication to the common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics. Risk factors for... (Review)
Review
Diverticulitis is a complication to the common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics. Risk factors for diverticulitis, however, may suggest, that the condition is inflammatory rather than infectious. The evidence on antibiotic treatment for uncomplicated acute diverticulitis suggests, that antibiotics have no effect on complications, emergency surgery, recurrence, elective colonic resections and long-term complications. The evidence is based on three randomised clinical trials on the need for antibiotics, which is summarised in this review.
Topics: Acute Disease; Anti-Bacterial Agents; Diverticulitis; Diverticulitis, Colonic; Diverticulum; Humans; Recurrence
PubMed: 34356008
DOI: No ID Found -
Journal of Visceral Surgery Aug 2023Diverticular disease, including diverticulitis, begins when the patient becomes symptomatic. Sigmoid diverticulitis corresponds to inflammation/infection of a... (Review)
Review
INTRODUCTION
Diverticular disease, including diverticulitis, begins when the patient becomes symptomatic. Sigmoid diverticulitis corresponds to inflammation/infection of a diverticulum of the sigmoid colon. Among diverticulosis patients, 4.3% develop diverticulitis, a frequent pathology that can entail major functional disorders. Following sigmoid diverticulitis, few studies have assessed functional disorders and quality of life, a multidimensional concept comprising physical, psychological and mental dimensions, as well as social relations.
OBJECTIVE
The purpose of this work is to report current published data on the quality of life of patients having had sigmoid diverticulitis.
RESULTS
Following uncomplicated sigmoid diverticulitis, long-term quality of life does not substantially differ between patients having undergone antibiotic therapy and those having only received symptomatic treatment. As for patients having experienced recurrent events, their quality of life seems improved by elective surgery. Following Hinchey I/II sigmoid diverticulitis, elective surgery seems to improve quality of life, notwithstanding a 10% risk of postoperative complications. Following sigmoid diverticulitis, while emergency surgery seems not to have greater impact on quality of life than elective surgery, the surgical technique employed in an emergency setting seems to have an impact, particularly with regard to the physical and mental components of quality of life.
CONCLUSION
Assessment of quality of life is of fundamental importance in diverticular disease and should orient operative indications, particularly in an elective context.
Topics: Humans; Colon, Sigmoid; Quality of Life; Laparoscopy; Diverticulitis; Elective Surgical Procedures; Diverticulum; Diverticulitis, Colonic; Sigmoid Diseases
PubMed: 37385843
DOI: 10.1016/j.jviscsurg.2023.06.003 -
Journal of Clinical Gastroenterology 2008The term "diverticulitis" indicates the inflammation of a diverticulum or diverticula, which is accompanied by detectable or microscopical perforation. Diverticulitis is... (Review)
Review
The term "diverticulitis" indicates the inflammation of a diverticulum or diverticula, which is accompanied by detectable or microscopical perforation. Diverticulitis is a common condition with an estimated incidence of 25%. At present, elective sigmoid resection is recommended after 2 episodes of uncomplicated diverticulitis to prevent the serious complications of recurrent colonic diverticulitis. This guideline has been based on the assumption that recurrent episodes (2 or more) of diverticulitis will lead to complicated diverticulitis and higher mortality. The data to support this assumption are based on only a few small studies. Advances in diagnostic modalities, medical therapy, and surgical techniques over the past 2 decades have changed both the management and outcomes of diverticulitis. Many authors have shown that patients treated nonoperatively have a low risk of recurrent disease and would be expected to do well without elective colectomy.
Topics: Adult; Aged; Aged, 80 and over; Colon, Sigmoid; Diverticulitis; Diverticulitis, Colonic; Female; Humans; Male; Middle Aged; Prevalence; Secondary Prevention; Sigmoid Diseases
PubMed: 18936650
DOI: 10.1097/MCG.0b013e3181886ee4