Management of diverticulitis

Janes, Simon; Meagher, Allan; Frizelle, Frank

doi:10.1136/bmj.332.7536.271

Cited by 66 publications

(42 citation statements)

References 36 publications

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“…Laparoscopic colonic resection to remove the diseased segment of the colon but not all diverticula is the recommended procedure 2 . By reviewing the literature, laparoscopic colectomy proves to be safe comparing to open procedures in terms of morbidity and mortality 9,10,13 . The authors had a morbidity rate of 11.7%, a mortality rate of 0.48% and two anastomotic fistulae, which are comparable to the rate in the literature which ranges from 0-5.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Especially for the cases of diverticulitis, considerable progress has been made in terms of diagnosis and management. Accurate CT scan diagnosis and radiological interventional techniques are now largely available 2 , as well as effective antimicrobial agents 10 . Finally, as the surgical resection of the involved colon is the only means of definitely eradicate this condition, the elective laparoscopic colectomy has emerged as a safe and interesting choice among the options of treatment 6,15,16 .…”

Section: Introductionmentioning

confidence: 99%

“…Although recently challenged about its progressiveness 7,8 , the natural history of diverticulitis is assumed to be that of recurrence over time for at least one third of the patients 3,10 . The fear of complications from this benign and prevalent disease has motivated medical and surgical societies to produce guidelines and consensus conferences on the subject 11,14 .…”

Section: Introductionmentioning

confidence: 99%

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Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

Pinto

Fallatah

Espalieu

et al. 2010

ABCD, arq. bras. cir. dig.

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-Background -The increased prevalence of diverticular disease has made its most appropriate management a matter of constant debate. Especially for the cases of diverticulitis, considerable progress has been made in terms of diagnosis and management.The surgical resection of the involved colon is the only means of definitely eradicate this condition and so, the elective laparoscopic colectomy has emerged as a safe and interesting choice among the options of treatment. Aim -To analyze the outcomes of the laparoscopic left colectomy for diverticular disease performed over a 17-year period at a single institution. Methods -Between April 1990 and May 2007, a total of 205 consecutive left laparoscopic colectomies were retrospectively reviewed. Data obtained included the pre-operative workup, indications for surgery, operative results, complications and follow-up. Univariate and multivariate statistical analyzes were performed in an effort to identity risk factors for adverse outcomes in the series. Results -Indications were for non-complicated acute diverticulitis (80%), acute or chronic complicated diverticulitis (18.05%) and bleeding diverticular disease (1.95%). The conversion rate was 5.85% (12 cases). The median operative time was 180 (100-420) min with a hospital stay of 7 (5-44) days. The mean length of the resected specimen was 29.12 (+8.2) cm. Most cases (88.3%) had an unremarkable postoperative course but complications occurred in 24 (11.7%) patients. In order of frequency, these were: paralytic ileus (n=6), pelvic collections (n=4), bowel obstructions (n=4) and fistulas (n=2), among others. A re-operation was necessary in eight cases and there was one death (0.48%). Median follow-up was 26.5 (1-156) months with a satisfying result seen in 179 (87.32%) of the patients. In 18 (8.78%) cases, persistent symptoms of functional colonic disorders were noted. There were 7 (3.41%) anastomotic stenosis in witch two needed a re-operation. The recurrence rate was 1.95% (4 cases). Age and intraoperative complications were identified as risk factors for conversion. The presence of associated lesions was significantly correlated with the persistence of functional colonic symptoms during the follow-up. ConclusionsThe laparoscopic left colectomy is safe and effective in comparison to all other modalities of management for diverticular disease. Precise diagnosis and respect of the current indications are essential to achieve such results.RESUMO -Racional -O aumento da prevalência de doença diverticular tornou o seu manuseio mais adequado uma questão de debate constante. Especialmente para os casos de diverticulite, progresso considerável tem sido feito em termos de diagnóstico e tratamento. A ressecção cirúrgica do cólon envolvido é a única maneira de erradicar definitivamente essa condição e, portanto, a colectomia laparoscópica eletiva surgiu como uma opção segura e interessante entre as várias formas de tratamento. Objetivo -Analisar os resultados das colectomias laparoscópicas esquerdas para a doença diverticula...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

Pinto

Fallatah

Espalieu

et al. 2010

ABCD, arq. bras. cir. dig.

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“…Besides, CT is helpful for the percutaneous drainage of abscess. [10,11] Recently, a study reported that multi-detector CT has become the best imaging modality to evaluate patients presenting with right lower quadrant abdominal pain or suspected acute cecal pathology. [12] MRI can be a valuable alternative to CT in young or pregnant patients who have suspected appendicitis and an uncertain US result.…”

Section: Discussionmentioning

confidence: 99%

Solitary caecum diverticulitis mimicking acute appendicitis

Hot

Eğin

Gökçek

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.Key words: Acute abdomen; cecum diverticulitis; diverticular disease of the colon.seen in 10-20% of the patients according to complications like inflammation, perforation, hemorrhage and rarely intestinal obstruction. [5,6] Acute appendicitis is the most common false diagnosis for CD.[5] In fact, patients who have CD suffer from prolonged complaints accompanied by intermittent or chronic symptoms. The pain of CD begins from the right side of the abdomen or at right lower quadrant rather than periumblical region and remains, vomiting is not common. Preoperative diagnosis is difficult, and CD should be kept in mind for patients with right lower quadrant pain. [7] This study aimed to present our experience in the surgical management of ten cases of CD over an 8-year period. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room. CASE SERIESA retrospective analysis of the surgical treatment of acute diverticulitis of the caecumperformed between November 2005 and November 2013 within the Emergency Surgical Department of the Okmeydanı Training and Research Hospital was carried out. Patients who received only medical therapy were excluded from the study. Patients were identified from the hospital's operating records based on the final postoperative diagnosis. The search revealed ten patients that underwent surgery for diverticular disease of the caecum.In all cases, the correct diagnosis of diverticulitis was confirmed by histopathological examination. The data collected

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“…Zwar werden sozioökonomische Faktoren wie eine ballaststoffarme Ernährung in westlichen Län-dern mit hohem Lebensstandard und höherer Lebenserwartung als wesentliche Faktoren der Divertikelentstehung verdächtigt [1], doch ist dies keine zwingende Voraussetzung für die Ausbildung der Erkrankung. Wenig präzise und therapeutisch nutzbar ist auch die Feststellung, dass der Pathogenese ein Missverhältnis zwischen intraluminalem Druck und Wanddicke des Kolons zugrunde liegt [2]. Somit bleibt die Therapie an der Symptomatik und dem Verlauf des Krankheitsbilds orientiert.…”

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Indikation zur chirurgischen Therapie der Sigmadivertikulitis aus der Sicht des Chirurgen*

Junghans¹,

Schwenk²

2006

Visc Med

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The management of sigmoid diverticulitis has changed during the last years. There is no doubt that immediate surgery is needed in case of perforation into the abdominal cavity as well as purulent and feculent peritonitis. Furthermore elective surgery is recommended in ‘complicated’ diverticulitis with an abscess, stenosis or fistula, and in chronic recurrent diverticulitis with persistent symptoms caused by the inflammation. In contrast to the opinion of most of German surgeons, the international literature proposes a conservative approach with a ‘wait and see’ strategy in case of ‘uncomplicated’ acute diverticulitis with perisigmoidal inflammation diagnosed by CT scan. These patients should be individually treated in consideration of age, co-morbidities, inflammation-related symptoms, and number and severity of the inflammation.

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Management of diverticulitis

Cited by 66 publications

References 36 publications

Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

Solitary caecum diverticulitis mimicking acute appendicitis

Indikation zur chirurgischen Therapie der Sigmadivertikulitis aus der Sicht des Chirurgen*

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