Outcomes of colonic diverticulitis according to the reason of immunosuppression

Biondo, Sebastiano; Trenti, Loris; Elvira, Jordi; Kreisler, Esther

doi:10.1016/j.amjsurg.2016.01.038

Cited by 37 publications

(38 citation statements)

References 20 publications

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“…In this large population-based cohort of AUD patients, immunosuppressive treatment was found to be associated with an increased risk of complications as has also been reported by others [ 6 , 10 ]. Hence, patients receiving immunosuppressive treatment should be monitored closely.…”

Section: Discussionsupporting

confidence: 81%

Low risk of complications in patients with first-time acute uncomplicated diverticulitis

Chabok

Andreasson

Nikberg

2017

Int J Colorectal Dis

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PurposeFirst-time acute uncomplicated diverticulitis (AUD) has been considered to have an increased risk of complication, but the level of evidence is low. The aim of the present study was to evaluate the risk of complications in patients with first-time AUD and in patients with a history of diverticulitis.MethodsThis paper is a population-based retrospective study at Västmanland’s Hospital, Västerås, Sweden, where all patients were identified with a diagnosis of colonic diverticular disease ICD-10 K57.0–9 from January 2010 to December 2014. The records of all patients were surveyed and patients with a computed tomography (CT)-verified AUD were included. Complications defined as CT-verified abscess, perforation, colonic obstruction, fistula, or sepsis within 1 month from the diagnosis of AUD were registered.ResultsOf 809 patients with AUD, 642 (79%) had first-time AUD and 167 (21%) had a previous history of AUD with no differences in demographic or clinical characteristics. In total, 16 (2%) patients developed a complication within 1 month irrespective of whether they had a previous history of diverticulitis (P = 0.345). In the binary logistic regression analysis, first-time diverticulitis was not associated with increased risk of complications (OR 1.58; CI 0.52–4.81). The rate of antibiotic therapy was about 7–10% during the time period and outpatient management increased from 7% in 2010 to 61% in 2014.ConclusionsThe risk for development of complications is low in AUD with no difference between patients with first-time or recurrent diverticulitis. This result strengthens existing evidence on the benign disease course of AUD.

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Section: Discussionsupporting

confidence: 81%

Low risk of complications in patients with first-time acute uncomplicated diverticulitis

Chabok

Andreasson

Nikberg

2017

Int J Colorectal Dis

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“…Among immunocompromised patients, chronic corticosteroid users have the highest risk of emergency surgery and of recurrence, especially in the first year after a diverticulitis attack. There should be a low threshold for abdominal CT in their follow-up, to search for persistent fluid collections or pericolic inflammation, in which case elective surgery may be indicated [197] (Data S5; 5.5a).…”

Section: Should Immunocompromised and Young Patients Be Treated Diffementioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

184

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…Independent predictors of mortality for NSTI have been identified including: age older than 75 years, severe peripheral vascular disease, hospital-acquired NSTI, multifocal NSTI, and septic shock at admission [1]. In immunocompromised patients, such as long-term corticosteroid use, the post-operative mortality rate for diverticulitis surgery can be as high as 31.6% [4]. Lack of early symptoms in the disease presentation hinders timely diagnosis and treatment [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Complicated Sigmoid Diverticulitis Presenting as Severe Necrotizing Soft Tissue Infection

AlghamdiMahmoud

KhadarooRachel

FathimaniKamran

2017

Surgical Infections Case Reports

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Background: Necrotizing soft tissue infection is a rare and aggressive medical and surgical emergency characterized by intense and severe tissue destruction, rapid onset systemic toxicity, and high mortality. Diverticulitis is a common complication of diverticular disease. However, its presentation as necrotizing soft tissue infection is rare. It is always important to identify the precipitating cause of necrotizing soft tissue infection to assist in appropriate treatment and risk stratification. Case Presentation: The patient was an 84-year-old female with a history of hypertension and chronic obstructive pulmonary disease with long-term steroid dependency. She presented to the emergency department with abdominal tenderness, left abdominal wall cellulitis, crepitus, and septic shock. Abdominal and pelvic computed tomography findings showed intra-abdominal abscess secondary to perforated sigmoid diverticulitis with abdominal wall abscess and necrotizing soft tissue infection of abdominal wall, chest wall, groin, and back. After intravenous fluid resuscitation and antibiotics, the patient underwent urgent laparotomy. She was found to have a large abdominal wall abscess, perforated sigmoid diverticulitis, and extensive necrosis of the torso extending from the groin to chest wall including the back. Conclusion: Abdominal wall necrotizing soft tissue infection is an uncommon complication of perforated diverticulitis. In an elderly immunocompromised patient with septic shock, perforated diverticulitis, and necrotizing soft tissue infection, the prognosis is poor.

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Outcomes of colonic diverticulitis according to the reason of immunosuppression

Cited by 37 publications

References 20 publications

Low risk of complications in patients with first-time acute uncomplicated diverticulitis

Low risk of complications in patients with first-time acute uncomplicated diverticulitis

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Complicated Sigmoid Diverticulitis Presenting as Severe Necrotizing Soft Tissue Infection

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