Recurrence and virulence of colonic diverticulitis in immunocompromised patients

Biondo, Sebastiano; Borao, Jaime López; Kreisler, Esther; Golda, Thomas; Millán, Mónica; Frago, Ricardo; Fraccalvieri, Doménico; Guardiola, Jordi; Jaurrieta, Eduardo

doi:10.1016/j.amjsurg.2011.09.027

Cited by 90 publications

(122 citation statements)

References 25 publications

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“…This statement has been challenged by a study on 166 immunosuppressed patients that showed that they had a significantly higher mortality rate than nonimmunosuppressed patients, but only during the first episode of the disease, and that patients who required emergency surgery for AD had no previous history of diverticular disease [141]. Therefore, no firm conclusions can be drawn about the need of elective, prophylactic sigmoidectomy in immunocompromised patients.…”

Section: What Are the Actual Indications For Elective Surgery?mentioning

confidence: 88%

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options.

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Section: What Are the Actual Indications For Elective Surgery?mentioning

confidence: 88%

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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“…There were four studies that reported mortality following emergent and elective surgery separately, within the same cohort, and these were used for a comparative analysis between these two clinical situations. [4][5][6][7] There were 493 patients in the emergent surgery group and 199 patients in the elective surgery group. The mortality in the emergent surgery group was 9.78% (95% CI 4.13-21.43) and in the elective surgery group mortality was 1.93% (95% CI 0.…”

Section: Post-operative Mortalitymentioning

confidence: 99%

Mortality and complications following surgery for diverticulitis: Systematic review and meta‐analysis

2016

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Background: The surgical treatment of diverticulitis is in a state of evolution. Clinicians across many disciplines need to counsel patients regarding surgical choices. Objectives: A systematic review and meta-analysis was conducted to determine the mortality and complication rates following surgery for diverticulitis in both the emergent and elective setting. Methods: We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published from 1980 to 2012. The primary outcome of interest was the point estimate of mortality, following surgery for diverticulitis. Results: Of the 289 citations reviewed, we included 59 studies. Overall, the point estimate for mortality was 3.05%, with a 95% confidence intereval (CI) of 1.73-5.32 and p < 0.001. Mortality following emergent surgery was 10.64% (95% CI 7.95-14.11; p < 0.001), versus 0.50% (95% CI 0.46-0.54; p < 0.001) following elective operations. A laparoscopic approach had an estimated mortality of 0.75% (95% CI 0.35-1.58; p < 0.001), compared to an open surgical approach, which had a mortality of 4.69% (95% CI 2.29-9.36, p < 0.001). The mortality following a resection with primary anastomosis was 1.96% (95% CI 1.22-3.13; p < 0.001) and for the Hartmann's procedure was 14.18% (95% CI 9.83-20.03; p < 0.001). A comparative analysis found that the risk of post-operative mortality was significantly higher following emergent surgery, compared to elective surgery (odds ratio (OR): 6.12 with 95% CI 1.62-23.10; p ¼ 0.008; Q ¼ 2.56, p ¼ 0.46 and I 2 ¼ 0); the open approach, compared to a laparoscopic approach (OR: 36.43 with 95% CI 9.94-133.6; p ¼ 0.13; and Q ¼ 2.79, p ¼ 0.25 and I 2 ¼ 28.26); and for Hartmann's procedure, compared to primary anastomosis without diversion (OR: 25.45 with 95% CI 15.13-42.81, p < 0.001; and Q ¼ 23.34, p ¼ 0.14 and I 2 ¼ 27.16). The overall reported post-operative complication rate was 32.64% (95% CI 27.43-38.32; p < 0.00). The overall surgical and medical complication rates were 18.96% and 13.93%, respectively. Conclusions: Urgent surgical treatment of diverticulitis has a significant complication rate. Even elective surgery has a significant complication rate that needs to be considered when doing the clinical decision-making for recurrent diverticulitis.

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“…The most severe recurrences occurred in the first 6 months. The authors concluded that the risk of recurrence and need for emergency operation is similar to immunocompetent patients [ 3 ].…”

Section: Discussionmentioning

confidence: 98%

“…One retrospective study in the literature examined the recurrence and virulence of diverticulitis in immunocompromised patients from 1994 to 2008 [ 3 ]. They reviewed 156 immunosuppressed patients including patients on chronic steroids, immunosuppressant medications (e.g., azathioprine, methotrexate), solid organ transplant recipients, extracolonic active malignant neoplasm, chemotherapy, emphysema, arthritis, pulmonary fibrosis, and congenital or acquired immunodeficiency syndrome patients, who were admitted with radiographically proven diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown a significantly higher rate of complicated diverticulitis, as well as increased morbidity and mortality associated with acute diverticulitis in the transplant population compared with immunocompetent patients [ 1,2 ]. Solid organ transplant patients with acute diverticulitis have also been reported to present with more severe grades of peritonitis and also undergo significantly more Hartmann operations compared with immunocompetent patients [ 3 ]. In a systematic review of sigmoid diverticulitis in transplant patients and those on chronic corticosteroid therapy, Hwang et al [ 4 ] calculated an overall mortality of 25% in this population for acute sigmoid diverticulitis.…”

Section: Introductionmentioning

confidence: 92%

See 1 more Smart Citation

Elective Colectomy for Diverticulitis in Transplant Patients: Is It Worth the Risk?

Lee

Skube

Melton

et al. 2017

Journal of Gastrointestinal Surgery

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Recurrence and virulence of colonic diverticulitis in immunocompromised patients

Cited by 90 publications

References 25 publications

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

Mortality and complications following surgery for diverticulitis: Systematic review and meta‐analysis

Elective Colectomy for Diverticulitis in Transplant Patients: Is It Worth the Risk?

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