Atypical diverticular disease

Horgan, Alan; McConnell, Elizabeth J.; Wolff, Bruce G.; The, S.; Paterson, Craig

doi:10.1007/bf02234790

Cited by 111 publications

(82 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If complicated diverticulitis is established, there is an indication for surgery. Patients with persistent, chronic symptoms with signs of inflammation (‘smouldering diverticulitis') but no evidence of a complication can also benefit from surgery [100,101]. …”

Section: Outpatient/inpatient Treatment Conservative/surgical Treatmentmentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

View full text Add to dashboard Cite

Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

show abstract

Section: Outpatient/inpatient Treatment Conservative/surgical Treatmentmentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

View full text Add to dashboard Cite

show abstract

“…Acute or chronic inflammatory changes were present in 76% of resected specimens. Complete resolution of symptoms occurred in 77%, with 88% becoming pain free [6]. SCAD is a nonspecific localized inflammatory process; its pathogenesis and relationship with inflammatory bowel disease are still unclear.…”

Section: Clinical Presentationmentioning

confidence: 99%

Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

View full text Add to dashboard Cite

Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25–35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2–14% and a risk of stoma and related death of 0–2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them.

show abstract

“…Smoldering diverticulitis is a surgically coined phrase for patients with sustained symptomatic diverticulitis, in whom diverticulitis remained obscure at CT, sometimes also barium enema and / or colonoscopy until sigmoidal resection was performed (histological diagnosis) [28]. The …”

Section: Macropathology and Pathogenesis ▼mentioning

confidence: 99%

Statement of the Section Internal Medicine of the DEGUM – Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis

2015

Ultraschall in Med

View full text Add to dashboard Cite

This paper reviews and interprets the role of ultrasonography in view of the recently published Guideline on diverticular disease of the Consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) implying a new classification of diverticular disease (CDD). Qualified US is not only equipotent to qualified CT and frequently effectual for diagnosis but considers relevant legislation for radiation exposure protection. Unsurpassed resolution allows detailed resolution thereby allowing to differentiate and stratify the relevant types of diverticular disease. Subsequently, US is considered the first choice of imaging in diverticular disease. Vice versa, CT has definite indications in unclear / discrepant situations ? or insufficient US-performance.

show abstract

Atypical diverticular disease

Abstract: We conclude that the diagnosis and presentation of atypical smoldering diverticular disease is an uncommon and poorly defined entity. However, sigmoid resection in this subgroup of patients is safe and is associated with resolution of symptoms in the majority of cases.

Cited by 111 publications

References 9 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Clinical Presentation and Risks

Statement of the Section Internal Medicine of the DEGUM – Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis

Contact Info

Product

Resources

About