Uncomplicated Diverticulitis, More Complicated than We Thought

Boostrom, Sarah Y.; Wolff, Bruce G.; Cima, Robert R.; Merchea, Amit; Dozois, Eric J.; Larson, David W.

doi:10.1007/s11605-012-1924-4

Cited by 62 publications

(47 citation statements)

References 14 publications

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“…If complicated diverticulitis is established, there is an indication for surgery. Patients with persistent, chronic symptoms with signs of inflammation (‘smouldering diverticulitis') but no evidence of a complication can also benefit from surgery [100,101]. …”

Section: Outpatient/inpatient Treatment Conservative/surgical Treatmentmentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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Section: Outpatient/inpatient Treatment Conservative/surgical Treatmentmentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

View full text Add to dashboard Cite

show abstract

“…Another possible factor is the uncommon subclinical or silent, smoldering variant of diverticulitis that has been recently recognized and which may be exacerbated by direct trauma from the colonoscope. This lowgrade chronic variant of diverticulitis has been noted at elective surgical resection of the sigmoid colon after repeated acute diverticulitis episodes, 24 or on occasion during screening colonoscopy in asymptomatic patients, 25 as well as on CT examinations performed for reasons unrelated to the colon. In such cases, optical colonoscopy may be incomplete due to preexisting subclinical inflammation and stricture formation, most often in the sigmoid region.…”

Section: Acute Diverticulitismentioning

confidence: 88%

Complications of Optical Colonoscopy

Daly¹,

Lu²,

Pickhardt³

et al. 2014

Radiologic Clinics of North America

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“…These patients do not have complicated diverticulitis yet suffer severely with symptoms. Boostrom et al [43] showed that operating on chronic smoldering diverticulitis can benefit up to 90% of patients while Horgan et al [25] found that 77% of patients with smoldering diverticulitis achieved complete resolution of their chronic pain after sigmoid resection. Operating on smoldering diverticulitis is for treatment of symptoms and not to reduce the recurrence rate, unlike the general trend where patients undergo surgery to prevent recurrent diverticulitis after nonoperative treatment of an episode of complicated diverticulitis.…”

Section: Treatmentmentioning

confidence: 99%

Recurrent Acute Diverticulitis: When to Operate?

et al. 2018

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Objective: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life. Methods: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. The literature was thoroughly searched for major studies tackling this topic. Furthermore, studies reporting on decision making based on quality of life were included. Risks of developing recurrent diverticulitis and the potential need of surgery were identified. Relevant surgical details that would decrease recurrence were also denoted. Results: Surgery has been the mainstay of treatment for quite some time. However, the paradigms of treatment have changed over the last few years, especially when long-term population studies confirmed that not all patients require surgical treatment with its associated risk of morbidity. Conclusion: Treatment now has to be patient-tailored with special attention to the subgroup of high-risk patients. These patients must be adequately selected, identifying the impact of the disease on the quality of life and weighing in the risks of the surgical intervention.

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Uncomplicated Diverticulitis, More Complicated than We Thought

Cited by 62 publications

References 14 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Complications of Optical Colonoscopy

Recurrent Acute Diverticulitis: When to Operate?

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