Hospital Presentations of Acute Diverticulitis During COVID-19 Pandemic may be More Likely to Require Surgery due to Increased Severity: A Single-Centre Experience

Abstract

Background The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in fewer emergency presentations of many acute medical and surgical conditions. The purpose of this study was to assess the severity of disease at presentation and quantify the change in number of presentations during this period. Methods This retrospective study includes all patients diagnosed with acute diverticulitis on abdominopelvic computerised tomography (CT) between March 1, 2020 and June 30, 2020, compared to the same period in 2019. Follow up scans on the index admission were excluded. Hinchey grade was assessed for all CT scans. Inflammatory markers were analysed, along with outcome measures including length of stay and mortality. Results Acute diverticulitis was diagnosed in 52 CT scans in the acute pandemic period – a decrease of 51.4%. Average age at presentation was unchanged (63.3 ± 14.3 vs. 62.8 ± 13.8, P = .848). The number of Hinchey II, III and IV presentations were significantly higher in the acute pandemic period (28.8% vs. 11.2%, P = .005) and significantly more emergency operations were carried out (7.69% vs. .93%, P = .04). Mortality was not significantly increased, nor were serum levels of C-reactive protein, white cell count and lactate. Discussion During the COVID-19 pandemic, fewer patients presented and were diagnosed with acute diverticulitis. A significantly greater proportion presented at a more advanced stage and required emergency surgery, suggesting late presentation. Our findings support the need for maintaining acute surgical services and the provision of early radiological and surgical input in patients presenting with signs and symptoms of acute diverticulitis in future pandemics.

The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis

“…More severe symptoms due to delayed access to hospital care have been reported in the pediatric population [4] and acute coronary syndrome cases [10,35]. Increased disease severity has also been described for abdominal conditions, with an increase of complicated cases among patients with diverticulitis [22,24,25] and acute appendicitis [23,36]. Cano-Valderaama [32] reported a statistically significant increase of time from symptom onset to ED presentation among patients with acute surgical conditions, leading to higher Sequential Organ Failure Assessment (SOFA) scores, lower laparoscopic interventions, higher morbidity, and longer lengths of stay, while Tartaglia et al reported a higher percentage of patients requiring ICU admission during the pandemic [37].…”

“…Moreover, these kinds of urgent conditions often lead to surgical resection of the involved organ, enabling an assessment of the pathological findings to investigate whether and to what extent COVID-19-induced delays have really increased disease severity. Previous retrospective observational studies [21][22][23] reported a reduction of ED admissions for abdominal surgical emergencies during the COVID-19 infection waves, also suggesting an increase of disease severity at presentation based on clinical [24] and radiological [21][22][23][24][25] data, but an analysis and correlation with pathological findings is still missing.…”

The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review

“…The initial search produced 135 potentially relevant articles. After 85 articles were screened for relevance of titles and abstracts, 50 full text articles were further assessed for eligibility and 25 were excluded ( Supplementary Table S1 ); thus, 25 trials were included in the review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Their characteristics are reported in Table 1 , Table 2 , Table 3 and Table 4 .…”

“…One of these diseases is colonic diverticular disease, with a variable spectrum from asymptomatic diverticulosis to acute diverticulitis up to peritonitis and abscess formation [ 7 ]. Compared to previous years, during the COVID-19 pandemic we have observed an increase in severe forms of diverticulitis in the emergency rooms [ 9 ], often with complications such as abdominal abscesses or purulent/fecal peritonitis [ 36 , 39 ].…”

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

“…Welle im Jahr 2020 in London ebenfalls ein Rückgang von Patientenvorstellungen um ca. 50 % berichtet mit einem Trend hin zu komplizierteren Typen mit Abszess oder Perforation [ 15 ].…”