A clinical and radiological comparison of sigmoid diverticulitis episodes 1 and 2

Gervaz, Pascal; Platon, Alexandra; Widmer, Lucien; Ambrosetti, P.; Poletti, Pierre–Alexandre

doi:10.1111/j.1463-1318.2011.02642.x

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…Uncomplicated diverticulitis follows a rather indolent course. Approximately one‐third of patients experience a recurrence, but only about 10 per cent with recurrence have complicated disease.…”

Section: Resultsmentioning

confidence: 99%

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

McDermott

Collins

Heeney

et al. 2014

Journal of British Surgery

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Background: The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.Methods: A literature review was performed on the electronic databases MEDLINE from PubMed, Embase and the Cochrane Library for publications in English. The keywords 'diverticulitis', 'diverticular' were searched for the past decade (to September 2013).Results: Diverticulitis occurs frequently in the Western world, but only one in five patients develops complications (such as abscess and perforation) during the first acute presentation. The reported perforation rate is 3·5 per 100 000 population. Based on recent data, including the AVOD and DIVER trials, antibiotic therapy for mild episodes may be unnecessary and outpatient management reasonable in most patients. Antibiotics and admission to hospital is required for complicated diverticulitis confirmed on imaging and for patients with sepsis. Diverticular abscesses (about 5 per cent of patients) may require percutaneous drainage if antibiotics alone fail. Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma. However, the collective, published worldwide experience is limited to fewer than 800 patients, and results from ongoing randomized trials (LapLAND, SCANDIV, DILALA and LADIES trials) are needed to inform better decision-making. Conclusion:The treatment of diverticulitis continues to evolve with a trend towards a more conservative and minimally invasive management approach. Judicious use of antibiotics in uncomplicated cases, greater application of laparoscopic techniques, and primary resection and anastomosis are of benefit in selected patients.

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Section: Resultsmentioning

confidence: 99%

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

McDermott

Collins

Heeney

et al. 2014

Journal of British Surgery

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“…Recently, Gervaz et al29 have found that in 35% of patients who had a recurrence after an initial uncomplicated sigmoiditis the diverticulitis will involve another segment of the left colon. Knowing that 93% of acute diverticulitis involve the sigmoid and the descending colon, this finding is very important to guide elective surgery that should ideally remove all the segments affected with diverticulitis 30…”

Section: Present Role Of Ct Scanmentioning

confidence: 99%

Acute left-sided colonic diverticulitis: clinical expressions, therapeutic insights, and role of computed tomography

Ambrosetti¹

2016

CEG

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The diagnostic approach of patients with suspected acute diverticulitis remains debated. On the one hand, a scoring system with the best predictive value in diagnosing acute diverticulitis has been developed in order to reduce the use of computed tomography (CT) scan, while, on the other hand, patients with a high probability of acute diverticulitis should benefit from CT scan from a clinical viewpoint, ensuring that they will receive the most appropriate treatment. The place and classification of CT scan for acute diverticulitis need to be reassessed. If the management of uncomplicated acute diverticulitis, abscess, and fecal peritonitis is now well codified, urgent surgical or medical treatment of hemodynamically stable patients presenting with intraperitoneal air or fluid without uncontrolled sepsis is still under discussion. Furthermore, the indications for laparoscopic lavage are not yet well established. It is known for years that episode(s) of acute uncomplicated diverticulitis may induce painful recurrent bowel symptoms, known as symptomatic uncomplicated diverticular disease and irritable bowel syndrome-like diverticular disease. These two clinical expressions of diverticular disease, that may darken quality of life, are treated medically aimed at symptom relief. The possible place of surgery should be discussed. Clinical and CT scan classifications should be separated entities.

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“…Despite the fact that the use of advanced technology, such as high speed CT, enable earlier and more accurate diagnosis [3], the number of publications mentioning a rise in the progression and rate of complicated diverticulitis have recently increased [4]. The prevalence of complicated diverticulitis is 10%, and while its mortality rate is 6% for Hinchey III, it is 35% for Hinchey IV [5,2,6]. We evaluated 1000 patients who presented to the emergency service with acute abdomen.…”

Section: Introductionmentioning

confidence: 99%

Complicated Diverticulitis Rates in Acute Abdominal Cases

Turan¹,

Çeliker²,

Zengin³

et al. 2019

JSTR

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Background: The location of diverticulitis, the frequency of the concomitant findings, and the severity of diverticulitis were detected in the abdominal CTs of the patients who presented to the emergency service with complaint of acute abdomen due to complicated diverticulitis. The necessity of CT evaluation was emphasized using classification. Aims: The aim of this study is to raise awareness about the fact that the abdominal CTs should be evaluated by classification in order to guide a physician encountering a patient with complicated diverticulitis who presented with acute abdomen for the first time to the correct treatment option. Study Design: The present study protocol was reviewed and approved by the Recep Tayyip Erdoğan University Local Ethics Committee (approval No. 40465587-40). Informed consent was submitted by all subjects when they were enrolled. The approval of and the permission for study from the training and research hospital management was received. The data of the patients over the age of 35 who presented to the emergency service of our hospital from 2014-2016 with the complaint of acute abdomen was retrospectively evaluated. The medical information of the patients kept in the system records was reviewed. Methods: The contrast abdominal CTs of 1000 patients were examined. 56 patients with diverticular disease were divided into two groups; non-complicated and complicated diverticulitis. The group with complicated diverticulitis was classified by two radiologists using modified Hinchey classification. The data obtained was statistically analyzed using the Pearson Chi-Square Test. Results: Diverticular disease was detected in 5.6 of 1000 patients, 2.3% of which was non-complicated, while 3.3% was complicated. Of the patients with complicated diverticulitis, 2.1% were classified as having Hinchey Ia, 0.4% Hinchey Ib, 0.2% Hinchey II, 0.3% Hinchey III, and 0.3% Hinchey IV diverticulitis. Of the patients with diverticular disease, 58.8% developed complicated diverticulitis, 18.2% of whom developed Hinchey III-IV diverticulitis requiring inpatient conservative and surgical treatment. Descenden and sigmoid colon involvement was seen primarily (60.9%). Of the six patients with possibility

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A clinical and radiological comparison of sigmoid diverticulitis episodes 1 and 2

Abstract: The majority of patients who develop recurrence do so in a similar mode and location. However, 10% develop complicated diverticulitis and in 35% of patients recurrent diverticulitis occurs at a different location.

Cited by 16 publications

References 19 publications

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

Acute left-sided colonic diverticulitis: clinical expressions, therapeutic insights, and role of computed tomography

Complicated Diverticulitis Rates in Acute Abdominal Cases

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