Diverticulitis in Transplant Patients and Patients on Chronic Corticosteroid Therapy: A Systematic Review

Abstract

Our study summarizes evidence that patients with transplants or patients on chronic corticosteroid therapy 1) have a rate of acute diverticulitis that is higher than the baseline population and 2) a mortality rate with acute diverticulitis that is high. Further research is needed to define whether these risks constitute a mandate for screening and prophylactic sigmoid colectomy.

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

“…In the literature the mortality rate of acute cases of diverticulitis treated on an inpatient basis is between 0 % and 13 %, while it is significantly higher at 8 -24 % in cases of complicated diverticulitis and in patients under immunosuppresive therapy [21]. In principle, the mortality rate is higher in the first year after a complicated case of diverticulitis with a 2.5-fold increase after fistula formation and even a 4.5-fold increase after perforation being described.…”

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“…Abdominal pain (96%), fever with or without chills (69%), and abdominal tenderness (80%) are the more common symptoms. [22][23][24] Other more rare symptoms include diarrhea, constipation, nausea, vomiting, and rectal bleeding. 22,23 All of our patients presented with abdominal pain, 40% had fever, and 30% had abdominal tenderness.…”

“…In the literature, pneumoperitoneum is found in approximately 80% of patients with IP. 24,25 However, a computed tomography scan should be required to establish the diagnosis. 25 Perforation occurs more often in the sigmoid colon but can also occur in the midsigmoid region, cecum, transverse colon, and descending colon.…”

Failure to Use Ultrasound Is a Glaring Shortcoming

“…Sie ist bei komplizierter Divertikulitis oder bei Patienten unter immunsuppressiver Therapie deutlich höher (8-24,3%; [144]. Eine notfallmäßige operative Intervention wird bei 2 -62% der Patienten erforderlich.…”

“…Konsensusstärke: Starker Konsens, Empfehlungsstärke: Offene Empfehlung Kommentar zu Statement 6.5 Die Inzidenz einer akuten Divertikulitis ist bei transplantierten Patienten und bei solchen die chronisch Glucokorticoide einnehmen bei praeexistierender Divertikulose hoch und hat mit 25% eine wesentlich höhere Letalität als in der Normalbevölkerung [144]. Die betroffene Risikogruppe hat auch ein bis 5-fach erhöhtes Risiko, eine Perforation zu entwickeln, und spricht schlechter auf eine medikamentöse Therapie an [144,154,320] [272,326].…”