Complicated Diverticulitis

Chapman, Jennifer R.; Davies, Michael M.; Wolff, Bruce G.; Dozois, Eric J.; Tessier, Deron J.; Harrington, Jeffrey R.; Larson, Dirk

doi:10.1097/01.sla.0000184843.89836.35

Cited by 270 publications

(91 citation statements)

References 26 publications

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“…Furthermore, a high rate of patients who presented with perforation (45%, 98/218) presented with this as the initial event of the disease. These findings were similar to those reported in other recent studies [6, 7]. In this series, acute phlegmon was the most frequent presentation of complicated diverticular disease found, as described [8].…”

Section: Discussionsupporting

confidence: 93%

“…In our experience, this latter surgical approach was performed in two patients. In agreement with several reports [6, 8, 18], we found that almost all fistulas were amenable to resection and primary anastomosis.…”

Section: Discussionsupporting

confidence: 93%

“…Our overall morbidity rate of 30% was similar to that described in other studies [6, 8], whereas our major morbidity rate was lower than that reported in a previous study [16]. Considering only patients who underwent surgical treatment, the postoperative morbidity rate obtained in this study was clearly higher to that mentioned in several reports [7, 9, 15].…”

Section: Discussionsupporting

confidence: 88%

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Presentation, Management and Outcome of Acute Sigmoid Diverticulitis Requiring Hospitalization

et al. 2007

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Aim: This study was conducted to assess the presentation, management, and outcomes of patients with acute sigmoid diverticulitis requiring hospitalization. Methods: From 1986 to 2005, the medical records of 265 patients treated for acute sigmoid diverticulitis requiring hospitalization were retrospectively analyzed. Data were collected with regard to patient’s demographics, clinical characteristics, presentations of acute diverticulitis, treatment, morbidity, and mortality. Results: Only 47 patients (17.7%) had a previous diverticulitis episode. Of the 265 patients, 166 (62.6%) were managed without operation, and 99 (37.4%) underwent surgery. Overall and major morbidity in the whole series were 30.2 (80/265) and 15.5% (40/265), respectively; whereas among the patients with surgical management, were 72.7 (72/99), and 35.3% (35/99), respectively. Overall and postoperative mortality rates were 2.6 (7/265) and 6.1% (6/99), respectively. Older age, steroid use, perforation, and co-morbidities were significantly associated with unfavorable outcomes. Conclusions: It was concluded that surgery for acute sigmoid diverticulitis requiring hospitalization carries important morbidity and mortality. To achieve improvements in outcome, a selective therapeutic approach should be considered, choosing the best surgical procedure for each complication of diverticular disease.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

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Presentation, Management and Outcome of Acute Sigmoid Diverticulitis Requiring Hospitalization

et al. 2007

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“…The difference could lie in the moment of endoscopy or surgery. Some find surgery mandatory after a first recurrence while others follow a more liberated policy [35]. Furthermore, additional or more adequate treatment may alter the disease and lead to less recurrences [36], thus reducing the chance for chronic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies

Meurs-Szojda

Droste

Kuik

et al. 2008

Int J Colorectal Dis

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Background and aims There are conflicting data concerning the association between diverticular disease and colorectal carcinoma (CRC). This study was performed to determine the prevalence and association of diverticulosis, diverticulitis, polyps, and CRC. Materials and methods In a cross-sectional, retrospective study, we analyzed the colonoscopy reports of complete colonoscopies and patho-histological results of all patients referred for colonoscopy in a period of 3 months in 18 hospitals in The Netherlands. Diverticulosis was defined as three or more diverticula present and diverticulitis as diverticulosis with inflammation. Polyps were also coded according to localization and size. Advanced neoplastic lesions were defined as polyps ≥10 mm in diameter and/or villous architecture and/or adenomas with high grade dysplasia and/or invasive cancer. Actual and previous described CRC were registered. Results A total of 4,241 patients were included in the study [1,996 (47%) male], mean age of 59 and range 18-95. Diverticula, diverticulitis, and polyps were seen in 1,052 (25%), 75 (2%), and 1,282 (30%) patients, respectively. No association was found between patients with polyps and those with and without diverticulosis (p=0.478). Invasive adenocarcinoma and adenomas ≥10 mm were most frequently observed. CRC was present in 372 (9%) patients. Negative relation between diverticulosis and CRC and invasive adenocarcinoma was observed. No association was found between polyps and CRC and patients with diverticulitis and CRC. In conclusion, there is no relation between patients with diverticulosis and higher incidence of polyps or CRC when using age-stratified analysis. No increased risk for polyps or CRC was found in patients with diverticulitis.

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“…Furthermore, new insights into the natural history of diverticular disease have shown that once it is treated conservatively for an uncomplicated episode, recurrent disease will follow a rather mild course [4,5]. Together, these two aspects have resulted in a more conservative policy for the treatment of diverticular disease [6].…”

mentioning

confidence: 99%

Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial

et al. 2010

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Background The short-term results of the Sigma trial show that laparoscopic sigmoid resection (LSR) used electively for diverticular disease offers advantages over open sigmoid resection (OSR). This study aimed to compare the overall mortality and morbidity rates after evaluation of the clinical outcomes at the 6-month follow-up evaluation. Methods In a prospective, multicenter, double-blind, parallel-arm, randomized control trial, eligible patients were randomized to either LSR or OSR. The short-term results and methodologic details have been published previously. Follow-up evaluation was performed at the outpatient clinic 6 weeks and 6 months after surgery. Results In this trial, 104 patients were randomized for either LSR or OSR, and the conversion rate was 19.2%. The LSR approach was associated with short-term benefits such as a 15.4% reduction in the major complications rate, less pain, and a shorter hospital stay at the cost of a longer operating time. At the 6-month follow-up evaluation, no significant differences in morbidity or mortality rates were found. Two patients died of cardiac causes (overall mortality, 3%). Late complications (7 LSR vs. 12 OSR; p = 0.205) consisted of three incisional hernias, five small bowel obstructions, four enterocutaneous fistulas, one intraabdominal abscess, one retained gauze, two anastomotic strictures, and three recurrent episodes of diverticulitis. Nine of these patients underwent additional surgical interventions. Consideration of the major morbidity over the total follow-up period (0-6 months) shows that the LSR patients experienced significantly fewer complications than the OSR patients (9 LSR vs. 23 OSR; p = 0.003). The Short Form-36 (SF-36) questionnaire showed significantly better quality of life for LSR at the 6-week follow-up assessment. However, at the 6-month follow-up assessment, these differences were decreased. Conclusions The late clinical outcomes did not differ between LSR and OSR during the 30-day to 6-month followup period. Consideration of total postoperative morbidity shows a 27% reduction in major morbidity for patients undergoing laparoscopic surgery for diverticular disease.Keywords Diverticular disease Á Diverticulitis Á Sigmoid resection Á Laparoscopic Laparoscopic surgery for the treatment of diverticular disease has gained popularity over the past two decades. Particularly in an elective setting, laparoscopic sigmoid resections (LSRs) have shown beneficial effects on postoperative outcomes [1,2]. Traditionally, elective open sigmoid resections (OSRs) have been associated with high postoperative complication rates and a mortality rate of

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Complicated Diverticulitis

Cited by 270 publications

References 26 publications

Presentation, Management and Outcome of Acute Sigmoid Diverticulitis Requiring Hospitalization

Presentation, Management and Outcome of Acute Sigmoid Diverticulitis Requiring Hospitalization

Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies

Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial

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