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

Abstract

Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.

Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

“…Moreover, our study showed that the pandemic changed the morbidity of emergency general surgeries performed. More specifically, the number of digestive surgeries (19.7% vs. 16.4%), hernia repair surgeries (22.6 vs. 18.6%), and of soft tissue infection surgeries (28.3% vs. 26%) decreased, while hepatobiliary surgeries (21.7% vs. 30.5%) and orthopedic surgeries (7.7% vs. 8.5%) increased.On the one hand, a main hypothesis that can explain the decrease in some types of surgery during the pandemic, such as soft tissue infection surgeries, is that patients delayed going to the surgery department to avoid possible COVID-19 infection [21][22][23]. This delay may translate into a more advanced level of disease [22,24].…”

“…More specifically, the number of digestive surgeries (19.7% vs. 16.4%), hernia repair surgeries (22.6 vs. 18.6%), and of soft tissue infection surgeries (28.3% vs. 26%) decreased, while hepatobiliary surgeries (21.7% vs. 30.5%) and orthopedic surgeries (7.7% vs. 8.5%) increased.On the one hand, a main hypothesis that can explain the decrease in some types of surgery during the pandemic, such as soft tissue infection surgeries, is that patients delayed going to the surgery department to avoid possible COVID-19 infection [21][22][23]. This delay may translate into a more advanced level of disease [22,24]. In addition, some authors referred to the management of mild forms of diseases such as cholecystitis, diverticulitis, and appendicitis at home, in order to avoid hospitalization; this fact could explain the discrepancies in the types of emergency surgeries performed during the pandemic [19,25].…”

Actualización sobre fisiopatología y manejo inicial de diverticulitis aguda

“…Al mismo tiempo, la cantidad de presentaciones complicadas aumentaron. Esto debido a consulta médica de forma tardía, posiblemente por miedo de los pacientes a contraer COVID-19 (16). Desde el punto de vista de los proveedores de salud, también se observaron algunas tendencias de manejo influenciadas en respuesta a la pandemia.…”

“…Se reportó preferencia por las terapias conservadoras, para evitar la hospitalización de pacientes. Así, el uso de TAC y drenaje percutáneo aumentaron, con el objetivo de reducir el tratamiento quirúrgico (16). La cirugía de emergencia solamente fue sugerida en pacientes con peritonitis difusa o sepsis, siendo recomendado el procedimiento de Hartmann.…”

Impact of the first COVID-19 surge on the outcomes of diverticulitis

“…They concluded that thresholds for surgery should be higher especially in more vulnerable populations and consideration for postponing non-urgent surgery should be attempted. [ 12 , 13 ] This information raised many questions as to the safety of performing elective surgeries during the first surge, which patients could be safely rescheduled and for how long. Delays in elective surgery have been shown to have a significant economic, emotional, and patient related outcome impact.…”