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Journal of Digestive Diseases May 2016Acute diverticulitis has been traditionally associated with worse outcome in young patients, indicating a more aggressive surgical approach is required for them. The aim...
OBJECTIVE
Acute diverticulitis has been traditionally associated with worse outcome in young patients, indicating a more aggressive surgical approach is required for them. The aim of this study was to assess whether acute diverticulitis was more virulent in young patients.
METHODS
A retrospective, cross-sectional study included all patients who were admitted for a first episode of acute diverticulitis between January 2004 and December 2013. The patients were divided into two groups (≤50 years and >50 years) based on their age. Patients' characteristics, clinical and surgical data were recorded and analyzed.
RESULTS
Overall, 636 patients were included in the database, including 177 (27.8%) in the younger group and 459 in the elder group. There were no significant differences between the groups in disease complexity, peritonitis, laboratory work-up, vital signs on presentation, bowel obstruction or the presence of fistula and abscess in need of drainage. Younger patients had more free extra-luminal air on computed tomography (CT) scan (P = 0.03). Surgical data, including the intra-operative modified Hinchey score and the need for emergency and additional surgery did not significantly differ between the two groups. Young patients had more readmissions (P = 0.01) due to acute diverticulitis, diverticular complications and elective surgery. Length of hospital stay (P = 0.0001) was longer and postoperative complications were more common in the elder patients.
CONCLUSIONS
The clinical presentation of acute diverticulitis does not seem to be worse in the young population. Younger patients tend to have a more severe presentation on CT scan and more readmissions, but this did not translate to a more severe disease course.
Topics: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Disease Progression; Diverticulitis; Female; Humans; Length of Stay; Male; Middle Aged; Patient Readmission; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; Young Adult
PubMed: 27106275
DOI: 10.1111/1751-2980.12350 -
Ultraschall in Der Medizin (Stuttgart,... Aug 2007
Topics: Diverticulitis; Humans; Incidence; Ultrasonography
PubMed: 17680516
DOI: 10.1055/s-2007-963368 -
Scandinavian Journal of Gastroenterology Jun 2013To compare patients younger and older than 50 years with diverticulitis with regard to complications, disease recurrence and to the need for surgery. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To compare patients younger and older than 50 years with diverticulitis with regard to complications, disease recurrence and to the need for surgery.
MATERIAL AND METHODS
A literature review and meta-analysis was conducted according to the PRISMA guidelines. MEDLINE, Embase and the Cochrane databases were searched for longitudinal cohort studies comparing patients younger and older than 50 years with diverticulitis.
RESULTS
Eight studies were included with a total of 4.751 (male:female 1:0.66) patients younger and 18.328 (male:female 1:1.67) older than 50 years of age. The risk of developing at least one recurrent episode was significantly higher among patients younger than 50 years (pooled RR 1.73; 95% CI 1.40-2.13) with an estimated cumulative risk of 30% compared with 17.3% in older patients. The risk of requiring surgery during hospitalization for a primary episode of diverticulitis was equal in both age groups (pooled RR 0.99; 95% CI 0.74-1.32) and estimated at approximately 20%. Patients younger than 50 years more frequently required urgent surgery during hospitalization for a subsequent recurrent episode (pooled RR 1.46; 95% CI 1.29-1.66); the cumulative risk was 7.3% in younger and 4.9% in patients older than 50 years.
CONCLUSION
Patients younger than 50 years only differ substantially in risk for recurrent disease from patients older than 50 years of age. Although the relative risk for requiring urgent surgery for recurrent disease was higher in younger patient, one should consider that the absolute risk difference is relatively small (7.3% vs. 4.9%).
Topics: Abdominal Abscess; Age Factors; Diverticulitis; Emergency Treatment; Female; Fistula; Humans; Male; Middle Aged; Recurrence; Risk
PubMed: 23330633
DOI: 10.3109/00365521.2012.758765 -
American Family Physician Feb 2023
Topics: Humans; Diverticulitis; Diverticulitis, Colonic; Acute Disease; Diagnosis, Differential
PubMed: 36791429
DOI: No ID Found -
Journal of Gastrointestinal Surgery :... Mar 2021
Topics: Clostridioides; Clostridium Infections; Diverticulitis; Fecal Microbiota Transplantation; Humans
PubMed: 33006061
DOI: 10.1007/s11605-020-04812-2 -
The American Surgeon Nov 2008Diverticulitis is classified as uncomplicated or complicated, i.e., associated with perforation, fistula, or obstruction. CT allows more reliable characterization of an... (Review)
Review
Diverticulitis is classified as uncomplicated or complicated, i.e., associated with perforation, fistula, or obstruction. CT allows more reliable characterization of an acute attack of diverticulitis. Medical management is reserved for uncomplicated diverticulitis and the initial phase of treatment of diverticulitis associated with abscess formation. Percutaneous abscess drainage is a major advance, which permits one-stage resection in a majority of cases. Diverticulitis associated with free perforation can be selectively managed with resection and primary anastomosis, although a Hartmann resection is likely to be performed. A fistula associated with diverticulitis can usually be managed with a one-stage resection. Obstruction can be managed selectively with resection with on-table bowel preparation, primary anastomosis, and proximal diversion. Laparoscopic techniques permit successful performance of elective resections most of the time. Hand assistance is of particular value when the patient has dense fibrosis.
Topics: Age Factors; Colectomy; Diverticulitis; Humans; Laparoscopy; Patient Selection; Risk Factors; Severity of Illness Index
PubMed: 19062658
DOI: No ID Found -
European Journal of Trauma and... Oct 2023The management of recurrent diverticulitis after initial non-operative treatment remains controversial. Recurrences after medical treatment have been described up to 36%...
BACKGROUND
The management of recurrent diverticulitis after initial non-operative treatment remains controversial. Recurrences after medical treatment have been described up to 36% but only 3 to 5% develop complicated disease.
AIM
To investigate the effectiveness of conservative treatment during a prolonged follow-up after first episode of complicated diverticulitis.
METHODS
This retrospective single-center study describes the conservative management and outcomes of 207 with complicated acute colonic diverticulitis treated at Parma University Hospital from 1 January 2012 until 31 December 2019. The follow-up was performed until December 2020. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis.
RESULTS
We enrolled 207 patients (118 males, 89 females). The mean age was 59 ± 14.5 years. CT scan of the abdomen was always performed. Almost all patients were treated with bowel rest and antibiotics (98.5%). Percutaneous drainage of abscessed diverticulitis was performed 12 times (5.7%). Average follow-up was 48 ± 28.8 months. 79 patients had new episodes of diverticulitis (38.1%) and 23 patients had high severity new episodes (11.1%). 11 patients underwent surgery (7.7%). Lower CT-Stages showed a higher recurrence rate (P = 0.002). Grade III diverticulitis showed a lower recurrence rate (P = 0.007). Patients with chronic NSAID use showed a higher incidence of high severity new episodes (P = 0.039). No recurrence rate differences were noted among patients with or without home therapy (P > 0.05).
CONCLUSIONS
Non-operative treatment is an effective and safe option in selected patients with complicated diverticulitis. The recurrence's severity is generally lower than the previous episodes and this can justify the conservative management.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Diverticulitis, Colonic; Conservative Treatment; Treatment Outcome; Retrospective Studies; Diverticulitis
PubMed: 35262746
DOI: 10.1007/s00068-022-01922-1 -
International Journal of Surgical... Jun 2009Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare.... (Review)
Review
Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare. Appendiceal diverticulosis is usually an incidental finding and clinically asymptomatic. When symptomatic, it is usually complicated by acute or chronic diverticulitis with or without acute appendicitis. It presents with atypical abdominal signs and symptoms, mostly in adult males. Appendiceal diverticulitis is a distinct entity with several clinical and pathological differences from acute appendicitis. It has a more rapid progression to perforation and a higher rate of mortality. Therefore, appendiceal diverticulitis should be considered in the clinical differential diagnosis, especially in adult males with chronic abdominal pain. Appendiceal diverticulosis demonstrates a significant association with obstructing or incidental appendiceal neoplasms. It may play an important role in the development of pseudomyxoma peritonei, which is associated with appendiceal mucinous tumors. Therefore, meticulous gross examination and thorough histological examination of the entire appendicectomy specimen are essential. When discovered either by preoperative radiological investigations or during an exploratory operation, prophylactic appendicectomy is advocated to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm.
Topics: Appendix; Cecal Diseases; Diagnosis, Differential; Diverticulitis; Diverticulum; Humans
PubMed: 19233860
DOI: 10.1177/1066896909332728 -
Digestive Diseases and Sciences Sep 2020
Topics: Adult; Diverticulitis; Diverticulitis, Colonic; Hospitalization; Humans; Obesity, Morbid
PubMed: 32382900
DOI: 10.1007/s10620-020-06307-1 -
JAAPA : Official Journal of the... Jul 2022Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical...
Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical presentation and treatment options vary considerably, leaving uncertainty about optimal management. Traditionally, surgery was recommended to prevent complications, persistent symptoms, and recurrent episodes. Improvements in the understanding of the disease's natural history, diagnostic imaging, and long-term outcomes have prompted changes to diagnosis and treatment guidelines.
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 35762951
DOI: 10.1097/01.JAA.0000832644.97318.f3