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Inflammatory Bowel Diseases Jun 2021There has been a historic similarity in the epidemiology and pathophysiology of diverticular disease and inflammatory bowel disease (IBD). Because there are limited to...
BACKGROUND
There has been a historic similarity in the epidemiology and pathophysiology of diverticular disease and inflammatory bowel disease (IBD). Because there are limited to no data on the role of diverticulitis as a potential risk factor for de novo IBD, we aimed to evaluate the role of diverticulitis and complicated diverticulitis as a potential predictor of IBD.
METHODS
We performed a retrospective, single-center study including patients older than age 18 years who were diagnosed with diverticulitis from January 2012 until December 2018 without a prior diagnosis of IBD. These patients were then evaluated for development of IBD. Univariate and multivariate analyses were conducted to compare the characteristics and outcomes between patients who did or did not develop IBD.
RESULTS
A total of 2770 patients were diagnosed with diverticulitis from 2012 until 2018. Of these patients, 17 were diagnosed with IBD, resulting in an incidence rate of 0.23% per patient-year. The incidence rate among patients who required surgery for diverticulitis was 0.44% per patient-year, and patients with complicated diverticulitis had an incidence rate of 0.91% per patient-year. Univariate analysis showed that the need for surgery related to diverticulitis (hazard ratio [HR], 6.27; P = 0.003) and complicated diverticulitis was associated with the development of IBD (HR, 14.71; P < 0.001). Multivariate analysis showed that complicated diverticulitis was the sole factor associated with IBD (HR, 10.34; P < 0.001).
CONCLUSIONS
Patients with diverticulitis are at a higher risk of developing de novo IBD. This risk is highest in patients with complicated diverticulitis.
Topics: Diverticulitis; Humans; Incidence; Inflammatory Bowel Diseases; Retrospective Studies; Risk Factors
PubMed: 33237324
DOI: 10.1093/ibd/izaa299 -
Canadian Journal of Surgery. Journal... Jul 1989Cecal diverticulitis is an uncommon entity. Its operative treatment represents 0.2% of procedures performed for an acute abdomen. The clinical presentation is often...
Cecal diverticulitis is an uncommon entity. Its operative treatment represents 0.2% of procedures performed for an acute abdomen. The clinical presentation is often indistinguishable from acute appendicitis. At operation, it may be confused with cecal carcinoma. The surgeon must be aware of this condition and be prepared to choose the most appropriate treatment. Local excision has been advocated as the treatment of choice. The authors review 18 cases seen over a 10-year period. In no case was the correct diagnosis made preoperatively. Intraoperatively, a correct diagnosis was made in 12 of the 18. Carcinoma was the next most frequent intraoperative diagnosis (four cases). Twelve of the 18 patients were treated by standard or limited right hemicolectomy. One patient died early in the series of sepsis caused by a perforated diverticulum and one patient had a life-threatening complication. Right hemicolectomy appears to be a safe and effective treatment option for cecal diverticulitis.
Topics: Acute Disease; Adult; Aged; Appendicitis; Cecal Diseases; Colectomy; Diagnosis, Differential; Diagnostic Errors; Diverticulitis; Emergencies; Female; Humans; Intraoperative Period; Male; Middle Aged; Retrospective Studies
PubMed: 2736455
DOI: No ID Found -
ANZ Journal of Surgery Oct 2020Acute diverticulitis (AD) is an increasingly common cause of acute hospital admissions. An understanding of its economic burden is necessary to plan resource allocation,...
BACKGROUND
Acute diverticulitis (AD) is an increasingly common cause of acute hospital admissions. An understanding of its economic burden is necessary to plan resource allocation, and for targeting health research funding. The aim of this study is to obtain an accurate estimate of the cost of AD, accounting not only for the initial episode, but all related costs incurred during long-term follow-up.
METHODS
The study captures a cohort of patients who had an initial admission for AD from 1 January 2012-31 December 2012, and their treatment over a 6-year period. Cases were identified from a prospectively maintained database, with AD confirmed by computed tomography scan. The primary outcome was total healthcare cost related to AD.
RESULTS
The study included 170 patients. The total cost was NZD1 956 859 with a median cost per patient of NZD4814. A total of 57% of the cost was incurred for the initial inpatient admission, with the remaining 43% incurred through re-admission, follow-up appointments, investigations and management. Half of the total cost was incurred by 11.8% of the cohort. In multivariate analysis, high cost of care was significantly associated with complicated and recurrent disease, operative intervention and length of stay.
CONCLUSION
This study provides an accurate estimate of the overall cost of AD and its sequelae. There are considerable long-term costs associated with the index episode and a large proportion of the expenditure is incurred by a small group that included those with complicated disease. These findings are important for healthcare resource allocation and for targeting health research funding.
Topics: Cost of Illness; Diverticulitis; Health Care Costs; Hospitalization; Humans; Longitudinal Studies; Retrospective Studies
PubMed: 32808421
DOI: 10.1111/ans.16234 -
Clinical Gastroenterology and... Jan 2021
Topics: Diet; Diverticulitis; Humans; Inflammation; Risk Factors
PubMed: 32109629
DOI: 10.1016/j.cgh.2020.02.040 -
Current Surgery 2004
Review
Topics: Adult; Aged; Anti-Bacterial Agents; Colectomy; Colonoscopy; Contrast Media; Diverticulitis; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Laparotomy; Male; Middle Aged; Minimally Invasive Surgical Procedures; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 15276340
DOI: 10.1016/j.cursur.2003.08.009 -
Journal of Gastroenterology and... Sep 2007There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option.... (Comparative Study)
Comparative Study Review
There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option. We performed a systematic review of the available evidence regarding the outcomes after medical and surgical treatment of diverticulitis from studies published after 1980 and indexed in the PubMed database. We included original studies that reported comparative data for at least one outcome in medically- and surgically-treated patients with transverse or left colon diverticulitis. The main outcomes of interest were mortality, morbidity, and recurrence of diverticulitis after medical or surgical treatment. There were 21 studies fulfilling our inclusion criteria out of 1360 initially identified as possibly relevant. More patients were treated conservatively in the included studies compared to emergency surgery (24 862 vs 6504). Emergency surgery was the main option for patients with severe complications of diverticular disease, including peritonitis. In most studies, in-hospital mortality for patients treated surgically was generally higher than that of patients treated medically, whereas there were insufficient comparative data regarding mortality during follow up. However, readmission to the hospital due to diverticular disease during follow up was more common in the group of patients treated conservatively compared to those treated surgically (4358/23 446 [18.6%]vs 22/359 [6.1%]). Conservatively-treated patients, with a first or second episode of diverticulitis, required surgery for recurrent disease during follow up in a maximum of 45% of cases, with larger studies reporting percentages lower than 11%. It should be emphasized that medical and surgical treatments have not ever been compared in a randomized controlled trial in patients with diverticulitis (without generalized peritonitis that is a surgical emergency). Although medical treatment results in more readmissions due to recurrence, it may be reasonable to avoid surgical therapy in the vast majority of patients with acute diverticulitis. It is unclear what the best treatment option is for younger patients (<50 years), namely whether elective surgery should be considered with the first episode of diverticulitis.
Topics: Diverticulitis; Humans; Treatment Outcome
PubMed: 17716342
DOI: 10.1111/j.1440-1746.2007.05118.x -
The American Journal of Nursing Oct 1954
Topics: Diverticulitis; Humans
PubMed: 13197450
DOI: No ID Found -
Therapeutische Umschau. Revue... 2020Update: Management of colonic diverticulitis Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of...
Update: Management of colonic diverticulitis Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of Diverticular Disease" (CDD) to grade the severity of disease. This classification is based on imaging by CT scan or ultrasound. The CDD system divides patients into categories with a common therapeutic strategy. Acute uncomplicated diverticulitis is treated by oral or intravenous antibiotics. For the majority of patients with uncomplicated diverticulitis, antibiotic therapy might be omitted in favor of a solely symptomatic therapy. Acute diverticulitis complicated by a relevant abscess or a perforation is treated by interventional drainage or surgical therapy. Resection with primary anastomosis replaces more and more resection with end colostomy (Hartmann's procedure). For patients with sepsis, the concept of damage control surgery has been introduced. The indication for elective surgery after conservative treatment of diverticulitis shall be dictated by the degree of the patient's symptoms, rather than the number of conservatively treated episodes of diverticulitis. Persisting complications, as fistulas and stenosis, represent an indication for elective colonic resection.
Topics: Anti-Bacterial Agents; Diverticulitis; Diverticulitis, Colonic; Drainage; Elective Surgical Procedures; Humans
PubMed: 32772693
DOI: 10.1024/0040-5930/a001170 -
ANZ Journal of Surgery Nov 2019
Topics: Aged, 80 and over; Diagnosis, Differential; Diverticulitis; Humans; Ileal Diseases; Male
PubMed: 30353982
DOI: 10.1111/ans.14911 -
BMJ Case Reports Apr 2019We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain...
We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain with CT imaging concerning for a duodenal mass or abscess in the juxtapapillary region of the second part of the duodenum. Upper endoscopy showed a non-bleeding duodenal diverticulum with purulent discharge consistent with diverticulitis. She underwent endoscopic disimpaction with irrigation and received a 14 day course of antibiotics, after which she presented for follow-up 1 month after discharge without complications. This case highlights the rarity of juxtapapillary duodenal diverticulitis, its nonspecific clinical presentation and imaging findings and the importance of early diagnosis and management to prevent severe complications including perforation.
Topics: Abdominal Pain; Aged, 80 and over; Anti-Bacterial Agents; Diverticulitis; Duodenal Diseases; Endoscopy; Female; Humans; Nausea; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome; Vomiting
PubMed: 30981989
DOI: 10.1136/bcr-2019-229259