1
|
Bhatia M, Mattoo A. Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends. Cureus 2023; 15:e43158. [PMID: 37565180 PMCID: PMC10410187 DOI: 10.7759/cureus.43158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Abstract
Diverticular disease is a common surgical condition, especially in the Western world. Its existence is well known in Asian countries as well; however, its impact on Asian health care is not the same as that in Western countries. Diverticular disease has a variable presentation, and its implications can be challenging to manage both for the patient and the medical professionals. Diet and lifestyle are commonly associated with its etiology. In Western countries, much attention is given to diverticular disease, and with the acceptance of colonoscopy as a surveillance investigation, a greater number of people are diagnosed with diverticular disease at an early stage and overall. In acute presentations, a CT scan of the abdomen remains the investigation of choice. The most common presentation of diverticular disease is pain in the abdomen or a change in bowel habits. In most cases, diverticular disease is treated with medical intervention; however, in cases associated with severe complications or advanced stages, surgical modality remains the primary treatment.
Collapse
Affiliation(s)
- Mohit Bhatia
- Surgery Department, Princess Royal University Hospital, King's College, Orpington, GBR
| | - Aastha Mattoo
- Emergency Department, Princess Royal University Hospital, King's College, Orpington, GBR
| |
Collapse
|
2
|
Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes. RADIOLOGIA 2023; 65:32-42. [PMID: 36842784 DOI: 10.1016/j.rxeng.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.
Collapse
|
3
|
Ben Ismail I, Hammami N, Zoghlami A. Laparoscopic sigmoidectomy for recurrent diverticulitis with colouterine fistula. ANZ J Surg 2021; 92:559-560. [PMID: 34255413 DOI: 10.1111/ans.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Imen Ben Ismail
- Department of General Surgery, Trauma Center Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| | - Nada Hammami
- Department of General Surgery, Trauma Center Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| | - Ayoub Zoghlami
- Department of General Surgery, Trauma Center Ben Arous, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
4
|
Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies. Ultrasound Int Open 2021; 6:E76-E86. [PMID: 33728394 PMCID: PMC7954641 DOI: 10.1055/a-1347-5875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/01/2021] [Indexed: 02/08/2023] Open
Abstract
Conventional ultrasound imaging (US) is the first-line investigation in acute
non-traumatic abdominal emergencies, but sometimes it needs further
examinations, such as computed tomography (CT), to reach a certain
diagnosis. Contrast-enhanced ultrasound (CEUS), through injection of
contrast medium, may provide the radiologist with additional information
that could not be investigated with baseline US. It could help reach a
diagnosis and rapidly determine the proper therapy in an emergency setting.
The purpose of this review is to explain and illustrate the various
possibilities and limitations of CEUS in acute non-traumatic abdominal
diseases, in particular acute inflammation, parenchymal infarcts, and
hemorrhages.
Collapse
|
5
|
Hanna MH, Kaiser AM. Update on the management of sigmoid diverticulitis. World J Gastroenterol 2021; 27:760-781. [PMID: 33727769 PMCID: PMC7941864 DOI: 10.3748/wjg.v27.i9.760] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc.) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.
Collapse
Affiliation(s)
- Mark H Hanna
- Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States
| | - Andreas M Kaiser
- Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States
| |
Collapse
|
6
|
Roson Gradaille N, Narbona Díez A, Garriga Farriol MV, Pruna Comella X, Pedraza Gutiérrez S, López Cano M, Badia JM. Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: value of current severity classification schemes. RADIOLOGIA 2021:S0033-8338(21)00028-X. [PMID: 33612278 DOI: 10.1016/j.rx.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.
Collapse
Affiliation(s)
- N Roson Gradaille
- Servicio de Diagnóstico por la imagen, Hospital Universitari Vall d'Hebron, Institut de Diagnòstic per la Imatge (IDI), Barcelona, España.
| | - A Narbona Díez
- Servicio de Diagnóstico por la Imagen, Hospital General de Granollers, Granollers, Barcelona, España
| | - M V Garriga Farriol
- Servicio de Diagnóstico por la Imagen, Hospital Universitari Josep Trueta, Institut de Diagnòstic per la Imatge (IDI), Girona, España
| | - X Pruna Comella
- Servicio de Diagnóstico por la Imagen, Hospital General de Granollers, Granollers, Barcelona, España
| | - S Pedraza Gutiérrez
- Servicio de Diagnóstico por la Imagen, Hospital Universitari Josep Trueta, Institut de Diagnòstic per la Imatge (IDI), Girona, España
| | - M López Cano
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J M Badia
- Servicio de Cirugía General y Aparato Digestivo, Hospital General de Granollers, Granollers, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| |
Collapse
|
7
|
Costi R, Annicchiarico A, Morini A, Romboli A, Zarzavadjian Le Bian A, Violi V. Acute diverticulitis: old challenge, current trends, open questions. MINERVA CHIR 2020; 75:173-192. [PMID: 32550727 DOI: 10.23736/s0026-4733.20.08314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute diverticulitis (AD) is an increasing issue for health systems worldwide. As accuracy of clinical symptoms and laboratory examinations is poor, a pivotal role in preoperative diagnosis and severity assessment is played by CT scan. Several new classifications trying to adapt the intraoperative Hinchey's classification to preoperative CT findings have been proposed, but none really entered clinical practice. Treatment of early AD is mostly conservative (antibiotics) and may be administered in outpatients in selected cases. Larger abscesses (exceeding 3 to 5 cm) need percutaneous drainage, while management of stages 3 (purulent peritonitis) and 4 (fecal peritonitis) is difficult to standardize, as various approaches are nowadays suggested. Three situations are identified: situation A, stage 3 in stable/healthy patients, where various options are available, including conservative management, lavage/drainage and primary resection/anastomosis w/without protective stoma; situation B, stage 3 in unstable and/or unhealthy patients, and stage 4 in stable/healthy patients, where stoma-protected primary resection/anastomosis or Hartmann procedure should be performed; situation C, stage 4 in unstable and/or unhealthy patients, where Hartmann procedure or damage control surgery (resection without any anastomosis/stoma) are suggested. Late, elective sigmoid resection is less and less performed, as a new trend towards a patient-tailored management is spreading.
Collapse
Affiliation(s)
- Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Unit of General Surgery, Department of Surgery, Hospital of Vaio, Fidenza, Parma, Italy.,AUSL di Parma, Parma, Italy
| | | | - Andrea Morini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Romboli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alban Zarzavadjian Le Bian
- Service of General, Digestive, Oncologic, Bariatric, and Metabolic Surgery, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris XIII University, Bobigny, France
| | - Vincenzo Violi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Unit of General Surgery, Department of Surgery, Hospital of Vaio, Fidenza, Parma, Italy.,AUSL di Parma, Parma, Italy
| |
Collapse
|
8
|
Frickenstein AN, Jones MA, Behkam B, McNally LR. Imaging Inflammation and Infection in the Gastrointestinal Tract. Int J Mol Sci 2019; 21:ijms21010243. [PMID: 31905812 PMCID: PMC6981656 DOI: 10.3390/ijms21010243] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 02/06/2023] Open
Abstract
A variety of seemingly non-specific symptoms manifest within the gastrointestinal (GI) tract, particularly in the colon, in response to inflammation, infection, or a combination thereof. Differentiation between symptom sources can often be achieved using various radiologic studies. Although it is not possible to provide a comprehensive survey of imaging gastrointestinal GI tract infections in a single article, the purpose of this review is to survey several topics on imaging of GI tract inflammation and infections. The review discusses such modalities as computed tomography, positron emission tomography, ultrasound, endoscopy, and magnetic resonance imaging while looking at up-an-coming technologies that could improve diagnoses and patient comfort. The discussion is accomplished through examining a combination of organ-based and organism-based approaches, with accompanying selected case examples. Specific focus is placed on the bacterial infections caused by Shigella spp., Escherichia coli, Clostridium difficile, Salmonella, and inflammatory conditions of diverticulitis and irritable bowel disease. These infectious and inflammatory diseases and their detection via molecular imaging will be compared including the appropriate differential diagnostic considerations.
Collapse
Affiliation(s)
- Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (A.N.F.); (M.A.J.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Meredith A. Jones
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (A.N.F.); (M.A.J.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Bahareh Behkam
- Department of Mechanical Engineering, Virginia Tech University, Blacksburg, VA 24061, USA;
| | - Lacey R. McNally
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (A.N.F.); (M.A.J.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
- Correspondence:
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW While few diseases are limited solely to the elderly, diverticular disease is clearly more prevalent with increasing age and therefore the aim of this review is to focus on the clinical implications of diverticular disease in the elderly. RECENT FINDINGS Diverticulitis in the elderly is best managed with an individualized treatment approach including considerations for selective antibiotic usage even in uncomplicated disease. Furthermore, due to the increased prevalence of ischemic colitis in the elderly and the similarities in presentation with diverticular hemorrhage, there needs to be a high index of suspicion and appropriate evaluation for ischemic colitis in patients with hematochezia, particularly if they have abdominal pain. The elderly are a vulnerable population where the index of suspicion for complications of diverticular disease should be high.
Collapse
Affiliation(s)
- Mona Rezapour
- Division of Gastroenterology and Hepatology, University of Miami, Miami, FL, USA
| | - Neil Stollman
- Alta Bates Summit Medical Center, East Bay Center for Digestive Health, 300 Frank H Ogawa Plaza, Suite 450, Oakland, CA, 94612, USA.
| |
Collapse
|
10
|
Okhotnikov OI, Yakovleva MV, Shevchenko NI, Grigoriyev SN, Pakhomov VI. [X-ray-surgery of diverticular disease complicated by abscess formation]. Khirurgiia (Mosk) 2018:35-40. [PMID: 29953098 DOI: 10.17116/hirurgia2018635-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Show the possibility of an alternative use of interventional radiology techniques in complex treatment of patients with inflammatory complications of the diverticular disease of the colon. MATERIAL AND METHODS In 2012-2016, there were 87 patients under our supervision with complicated diverticular disease. In 57 (65.5%) cases were diagnosed infiltrate, in 24 (27.6%) cases - abscess of paracolon area (Ib-II type by Hinchey), in 6 (6.9%) cases (III-IV type according Hinchey) generalized peritonitis have been identified. RESULTS Emergency laparotomy was performed in 13 patients. Abscesses of paracolon (Ib-II type by Hinchey) area were diagnosed sonographically during the initial examination in 17 patients. 26 percutaneous drainage of diverticulogenous abscesses of different localizations self-locking drainage #8Fr 'pig tail' was carried out under the combined ultrasonic and X-ray control in this group of patients. The technical success of percutaneous drainaging of the abscesses was achieved in all manipulations. 13 patients had a single drainaging, and for diverticular disease - disease-free during the observation period of 1 year to 5 years. Resection of the colon in a planned manner after percutaneous drainage of recurrent abscess of paracolon area was performed in 4 patients. Complications related with the technique of installing drainage were not reported, mortality in the group of drained patients was absent. CONCLUSION Ultrasound examination of patients with suspected inflammatory complications of diverticular disease - a necessary and sufficient method for initial diagnosis of the disease. Percutaneous drainage of diverticulogenous abscesses (Hinchey Ib-II) is represented by the pragmatic 'first line' choice in patients with complicated diverticular disease, that allows to treat the pathology steadfastly in most of the cases.
Collapse
Affiliation(s)
- O I Okhotnikov
- Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia
| | - M V Yakovleva
- Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia; Chair of Surgical Diseases of Kursk State Medical University, Healthcare Ministry of the Russian Federation, Kursk, Russia
| | - N I Shevchenko
- Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia
| | - S N Grigoriyev
- Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia
| | - V I Pakhomov
- Department of X-ray surgical diagnosis and treatment #2 of Kursk Regional Clinical Hospital, Kursk, Russia
| |
Collapse
|
11
|
|
12
|
The value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis. Jpn J Radiol 2017; 35:358-365. [DOI: 10.1007/s11604-017-0646-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
|
13
|
Woodbridge L, Wylie P. Current Issues in Computed Tomography Colonography. Semin Ultrasound CT MR 2016; 37:331-8. [DOI: 10.1053/j.sult.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
14
|
Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc 2016; 91:1094-104. [PMID: 27156370 DOI: 10.1016/j.mayocp.2016.03.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/12/2016] [Accepted: 03/14/2016] [Indexed: 02/08/2023]
Abstract
Diverticular disease is a common condition that is associated with variable presentations. For this review article, we performed a review of articles in PubMed through February 1, 2016, by using the following MeSH terms: colon diverticula, colonic diverticulitis, colonic diverticulosis, colonic diverticulum, colonic diverticula, and diverticula. Diverticula are structural alterations within the colonic wall that classically form "pockets" referred to as diverticula. Diverticula form from herniation of the colonic mucosa and submucosa through defects in the circular muscle layers within the colonic wall. Often this is at the sites of penetrating blood vessels in the colon. Diverticular disease is extremely common, which resulted in 2,682,168 outpatient visits and 283,355 hospitalization discharges for diverticulitis or diverticulosis in 2009. Diverticulosis is one of the most common detected conditions found incidentally on colonoscopy. Risk factors for the development of diverticulitis include obesity, smoking, nonsteroidal anti-inflammatory drugs, corticosteroids, and opiates. In contrast, fiber may be protective, but recent studies have questioned the role of fiber in developing diverticular disease. Most patients with diverticulosis will be asymptomatic, but a subset of patients may develop nonspecific abdominal pain (isolated or recurrent), diverticulitis, or segmental colitis associated with diverticulosis. Classically, the treatment of diverticulitis has included antibiotics for all patients. More recent evidence indicates that in mild to even moderate uncomplicated diverticulitis, antibiotics may not be as necessary as initially believed. In more complicated diverticulitis, intravenous antibiotics and surgery may be necessary. Once a patient has had an attack of diverticulitis, increasing fiber may help prevent future attacks. Other modalities such as 5-aminosalicylate products, antibiotics, and probiotics are still of unclear benefit in preventing future episodes of diverticulitis. Similarly, even when patients develop recurrent episodes of diverticulitis, surgery may not be necessary as a prophylactic treatment.
Collapse
MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Dietary Fiber/standards
- Diverticulitis, Colonic/diagnosis
- Diverticulitis, Colonic/epidemiology
- Diverticulitis, Colonic/etiology
- Diverticulitis, Colonic/therapy
- Diverticulosis, Colonic/diagnosis
- Diverticulosis, Colonic/epidemiology
- Diverticulosis, Colonic/etiology
- Diverticulosis, Colonic/therapy
- Female
- Geography
- Humans
- Male
- Middle Aged
- Prevalence
- Protective Factors
- Risk Factors
- Sex Distribution
Collapse
Affiliation(s)
- Joseph D Feuerstein
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Kenneth R Falchuk
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
De Cecco CN, Ciolina M, Annibale B, Rengo M, Bellini D, Muscogiuri G, Maruotti A, Saba L, Iafrate F, Laghi A. Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC). Eur Radiol 2016; 26:639-45. [PMID: 26105021 DOI: 10.1007/s00330-015-3866-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to evaluate the prevalence of colonic diverticula according to age, gender, distribution, disease extension and symptoms with CT colonography (CTC). METHODS The study population included 1091 consecutive patients who underwent CTC. Patients with diverticula were retrospectively stratified according to age, gender, clinical symptoms and colonic segment involvement. Extension of colonic diverticula was evaluated using a three-point quantitative scale. Using this data, a multivariate regression analysis was applied to investigate the existence of any correlation among variables. RESULTS Colonic diverticula were observed in 561 patients (240 men, mean age 68 ± 12 years). Symptomatic uncomplicated diverticular disease (SUDD) was present in 47.4% of cases. In 25.6% of patients ≤40 years, at least one diverticulum in the colon was observed. Prevalence of right-sided diverticula in patients >60 years was 14.2% in caecum and 18.5% in ascending colon. No significant difference was found between symptomatic and asymptomatic patients regarding diverticula prevalence and extension. No correlation was present between diverticula extension and symptoms. CONCLUSION The incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding, with their prevalence increasing with patient age. SUDD does not seem to be related to diverticula distribution and extension. KEY POINTS Incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding. SUDD does not seem to be related to diverticula distribution and extension.
Collapse
Affiliation(s)
- Carlo Nicola De Cecco
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Maria Ciolina
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
| | - Bruno Annibale
- Department of Digestive and Liver Disease, University of Rome "Sapienza" - Sant'Andrea Hospital, Via di Grottarossa 1035, Rome, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
| | - Giuseppe Muscogiuri
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
| | - Antonello Maruotti
- Department of Public Institutions, Economy and Society, University "Roma Tre", Rome, Italy
- Southampton Statistical Sciences Research Institute & School of Mathematics, University of Southampton, Southampton, UK
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza" - Polo Pontino, Via Franco Faggiana, 34, 04100, Latina, Italy.
| |
Collapse
|
16
|
Ambrosetti P. Acute left-sided colonic diverticulitis: clinical expressions, therapeutic insights, and role of computed tomography. Clin Exp Gastroenterol 2016; 9:249-57. [PMID: 27574459 PMCID: PMC4993273 DOI: 10.2147/ceg.s110428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The diagnostic approach of patients with suspected acute diverticulitis remains debated. On the one hand, a scoring system with the best predictive value in diagnosing acute diverticulitis has been developed in order to reduce the use of computed tomography (CT) scan, while, on the other hand, patients with a high probability of acute diverticulitis should benefit from CT scan from a clinical viewpoint, ensuring that they will receive the most appropriate treatment. The place and classification of CT scan for acute diverticulitis need to be reassessed. If the management of uncomplicated acute diverticulitis, abscess, and fecal peritonitis is now well codified, urgent surgical or medical treatment of hemodynamically stable patients presenting with intraperitoneal air or fluid without uncontrolled sepsis is still under discussion. Furthermore, the indications for laparoscopic lavage are not yet well established. It is known for years that episode(s) of acute uncomplicated diverticulitis may induce painful recurrent bowel symptoms, known as symptomatic uncomplicated diverticular disease and irritable bowel syndrome-like diverticular disease. These two clinical expressions of diverticular disease, that may darken quality of life, are treated medically aimed at symptom relief. The possible place of surgery should be discussed. Clinical and CT scan classifications should be separated entities.
Collapse
Affiliation(s)
- Patrick Ambrosetti
- Department of Surgery, Clinique Générale Beaulieu, Geneva, Switzerland
- Correspondence: Patrick Ambrosetti, Department of Surgery, Clinique Générale Beaulieu, Ch Beau-Soleil, 1205 Geneva, Switzerland, Tel +41 22 830 0520, Fax +41 22 830 2343, Email
| |
Collapse
|
17
|
Flor N, Maconi G, Sardanelli F, Lombardi MA, Colombo B, Di Leo G, Falleni M, Cornalba G, Pickhardt PJ. Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography: Follow-up in Patients Recovering from Acute Diverticulitis. Acad Radiol 2015; 22:1503-9. [PMID: 26482263 DOI: 10.1016/j.acra.2015.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the prognostic value of a diverticular disease severity score (DDSS) based on computed tomography colonography (CTC) after acute diverticulitis (AD). MATERIALS AND METHODS Of 252 patients who had an AD episode, we finally selected 46 patients who underwent both conventional CT at the acute event and CTC after 9 ± 7 weeks. Of these 46 patients, 17 underwent elective surgery after CTC. Disease severity was assessed with a 0-4 modified Hinchey CT-based score and a 1-4 CTC-based DDSS. A phone survey was performed 27 months later (range 4-52) for the 29 patients not surgically treated. RESULTS Significant correlation was found between CTC-based DDSS and clinical follow-up (P = 0.022) or elective surgery (P = 0.007), but not between clinical follow-up and CT-based score, extraluminal gas, C-reactive protein serum level, age, gender, or first versus recurrent AD episode. CTC demonstrated relevant additional findings in five of 46 (11%) patients: two AD complications (enterocolic and enterotubal fistulae), two colon cancers, and one extracolonic (lung) cancer. CONCLUSIONS The CTC-based DDSS showed a prognostic value and correlated with the risk of undergoing surgery, and clinically relevant additional findings were found in more than 10% of patients. CTC could be the preferred test in patients recovering after AD.
Collapse
|
18
|
Binda GA, Cuomo R, Laghi A, Nascimbeni R, Serventi A, Bellini D, Gervaz P, Annibale B. Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines. Tech Coloproctol 2015; 19:615-26. [PMID: 26377584 DOI: 10.1007/s10151-015-1370-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 02/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- G A Binda
- Department of Surgery, Galliera Hospital, Genoa, Italy.
| | - R Cuomo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Laghi
- Department of Radiological Sciences, Oncology and Pathology, Rome I.C.O.T. Hospital, La Sapienza University, Latina, Italy
| | - R Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - A Serventi
- Department of Surgery, Galliera Hospital, Genoa, Italy
| | - D Bellini
- Department of Radiological Sciences, Oncology and Pathology, Rome I.C.O.T. Hospital, La Sapienza University, Latina, Italy
| | - P Gervaz
- Coloproctology Unit, La Colline Clinic, Geneva, Switzerland
| | - B Annibale
- Division of Gastroenterology, Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | |
Collapse
|
19
|
[Treatment of the acute diverticulitis: A systematic review]. Presse Med 2015; 44:1113-25. [PMID: 26358668 DOI: 10.1016/j.lpm.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/23/2015] [Accepted: 08/03/2015] [Indexed: 01/04/2023] Open
Abstract
Acute diverticulitis is a common disease with increasing incidence. In most of cases, diagnosis is made at an uncomplicated stage offering a curative attempt under medical treatment and use of antibiotics. There is a risk of diverticulitis recurrence. Uncomplicated diverticulitis is opposed to complicated forms (perforation, abscess or fistula). Recent insights in the pathophysiology of diverticulitis, the natural history, and treatments have permitted to identify new treatment strategies. For example, the use of antibiotics tends to decrease; surgery is now less invasive, percutaneous drainage is preferred, peritoneal lavage is encouraged. Treatments of the diverticulitis are constantly evolving. In this review, we remind the pathophysiology and natural history, and summarize new recommendations for the medical and surgical treatment of acute diverticulitis.
Collapse
|
20
|
Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, Casetti T, Colecchia A, Festi D, Fiocca R, Laghi A, Maconi G, Nascimbeni R, Scarpignato C, Villanacci V, Annibale B. Italian consensus conference for colonic diverticulosis and diverticular disease. United European Gastroenterol J 2014; 2:413-42. [PMID: 25360320 PMCID: PMC4212498 DOI: 10.1177/2050640614547068] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.
Collapse
Affiliation(s)
- Rosario Cuomo
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
- Rosario Cuomo, Department of Clinical Medicine and Surgery, Federico II University Hospital School of Medicine via S. Pansini 5, 80131 Napoli, Italy.
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pace
- Department of Biochemical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, AOU Careggi, Florence, Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, University of Perugia School of Medicine, Perugia, Italy
| | | | | | - Antonio Colecchia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberto Fiocca
- Pathology Unit, IRCCS San Martino-IST University Hospital, Genoa, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, La ‘Sapienza' University, Rome, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, L. Sacco University Hospital, Milan, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carmelo Scarpignato
- Clinical Pharmacology & Digestive Pathophysiology Unit, University of Parma, Parma, Italy
| | | | - Bruno Annibale
- Medical-Surgical and Translational Medicine Department, La Sapienza University, Rome, Italy
| |
Collapse
|
21
|
Antonopoulos P, Almyroudi M, Kolonia V, Kouris S, Troumpoukis N, Economou N. Toxic Megacolon and Acute Ischemia of the Colon due to Sigmoid Stenosis Related to Diverticulitis. Case Rep Gastroenterol 2013; 7:409-13. [PMID: 24163654 PMCID: PMC3806696 DOI: 10.1159/000355345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We present a rare case of toxic megacolon accompanied by necrosis of the colon due to chronic dilation caused by stenosis of the sigmoid colon as a complication of diverticulitis. The patient presented at the emergency department with diffuse abdominal pain, fever (38.8°C) and tachycardia (120 beats/min). Physical examination revealed distension and tenderness on deep palpation on the left lower quadrant without peritoneal signs. Abdominal computed tomography showed located stenosis in the sigmoid colon and marked dilation of the descending (12 cm diameter) and transverse (7.5 cm diameter) colon. A few hours later, the patient developed severe septic shock with electrolyte abnormalities. He had a history of two prior admissions to our hospital due to crises of acute diverticulitis. Based on Jalan's criteria the diagnosis was compatible with toxic megacolon. The patient's condition deteriorated suddenly and an emergency colectomy was performed. The operative findings revealed a necrotic colon. Histology examination confirmed the diagnosis of ischemia of the colon. To our knowledge this is the first published report in the literature which refers to a rare complication of diverticulitis, namely chronic stenosis which complicated to colonic ischemia and toxic megacolon.
Collapse
Affiliation(s)
- P Antonopoulos
- Computed Tomography and Magnetic Resonance Imaging Department, Sismanogleio General Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
22
|
Sibileau E, Boulay-Coletta I, Jullès MC, Benadjaoud S, Oberlin O, Zins M. Appendicitis and diverticulitis of the colon: Misleading forms. Diagn Interv Imaging 2013; 94:771-92. [PMID: 23759294 DOI: 10.1016/j.diii.2013.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
23
|
C-reactive protein as a marker of complicated diverticulitis in patients on anti-inflammatory medications. Tech Coloproctol 2013; 18:145-9. [PMID: 23807310 DOI: 10.1007/s10151-013-1044-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/16/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diverticulitis is a common indication for surgical emergency room admission, often leading to abdominal computed tomography (CT) scanning for both diagnosis and staging. C-reactive protein (CRP) has been identified as a useful biomarker of inflammation. Aspirin and corticosteroids are known to down-regulate CRP production. In this study, we evaluated the usefulness of CRP as a biomarker for complicated diverticulitis and specifically in patients on anti-inflammatory medications: aspirin and corticosteroids. METHODS We analyzed the medical records of patients diagnosed at one medical center during a two-year period, with left-sided diverticulitis, according to clinical data and CT scan. Disease severity was assessed by the Hinchey score using the radiological findings detected by CT. RESULTS A total of 295 patients were included in the study. Two hundred and forty-three (82 %) were classified with uncomplicated (Hinchey 1a) and 52 (18 %) with complicated disease (Hinchey > 1a). Mean CRP levels were 133.5 and 63.5 mg/ml for those with complicated and uncomplicated disease, respectively (p < 0.001), and 139 and 60 mg/ml, respectively (p < 0.001) in the subgroup of patients taking aspirin (n = 61). For 14 patients on corticosteroid treatment, the difference in mean CRP levels for complicated and uncomplicated disease was not statistically significant. CRP > 90 mg/ml had 88 % sensitivity and 75 % specificity for complicated disease. CONCLUSIONS The CRP level distinguished between complicated and uncomplicated disease among left-sided diverticulitis patients including those taking aspirin, but not among those on corticosteroid treatment.
Collapse
|
24
|
Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography. ACTA ACUST UNITED AC 2013; 37:1101-9. [PMID: 22366853 DOI: 10.1007/s00261-012-9858-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this update article is to evaluate findings on CT colonography in patients with chronic diverticulitis and to compare the findings in patients with colorectal carcinoma. MATERIALS AND METHODS Different morphological criteria retrieved from a literature review were retrospectively analyzed in a series of 13 patients with proven chronic diverticulitis. The findings were compared with a series of 10 patients with colorectal carcinoma. RESULTS Overall, the findings in chronic diverticulitis resemble the findings in acute diverticulitis. The advantage of virtual CT colonography in differentiating both entities relies in the combination of morphological features previously described on axial computed tomography and double contrast barium enema. The single strongest morphological feature pointing towards the diagnosis of chronic diverticulitis is the presence of diverticula in the affected segment. In the presence of diverticula in the affected segment, a long segment (≥10 cm), thick fascia sign without adenopathies, mild bowel wall thickening, tapered margins, and distorted but preserved mucosal folds are likely to further improve accuracy of diagnosing chronic diverticulitis. CONCLUSION The single strongest morphological sign to differentiate chronic diverticulitis from colorectal cancer is the presence of diverticula in the affected segment.
Collapse
Affiliation(s)
- Stefaan Gryspeerdt
- Virtual Colonoscopy Teaching Centre, Akkerstraat 32 c, 8830 Hooglede, Belgium.
| | | |
Collapse
|
25
|
Flor N, Rigamonti P, Pisani Ceretti A, Romagnoli S, Balestra F, Sardanelli F, Cornalba G, Pickhardt PJ. Diverticular disease severity score based on CT colonography. Eur Radiol 2013; 23:2723-9. [PMID: 23660775 DOI: 10.1007/s00330-013-2882-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/21/2013] [Accepted: 04/13/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We propose a diverticular disease severity score (DDSS) based on CT colonography (CTC) findings. METHODS Seventy-nine patients (62 ± 14.5 years) underwent CTC after recovering from an episode of acute diverticulitis. Two independent readers classified each case using a four-point scale (DDSS), based on maximum sigmoid colon wall thickness (MSCWT) and minimum lumen diameter at CTC: 1 = MSCWT <3 mm, lumen diameter ≥15 mm; 2 = MSCWT 3-8 mm, lumen diameter ≥5 mm; 3 = MSCWT ≥8 mm, lumen diameter ≥5 mm; 4 = MSCWT ≥8 mm, lumen diameter <5 mm. Intra- and interobserver reproducibility was evaluated. Of 79 patients, 32 (40 %) underwent surgery after CTC; MSCWT was directly measured on the pathological specimen. RESULTS Intra- and interobserver reproducibility of DDSS were almost perfect (k = 0.90-0.84). DDSS significantly correlated with the probability of surgery (P = 0.001). After surgery, histopathology revealed acute/chronic diverticular inflammation only in 29 cases, and superimposed sigmoid cancer (n = 2) or Crohn's disease (n = 1) in 3 patients with a DDSS of 4. MSCWT at histopathology correlated with DDSS (P = 0.008). CONCLUSION DDSS is highly reproducible and correlates with pathological MSCWT. Nearly 1 in 3 patients with a DDSS of 4 had significant superimposed histopathology. CTC with DDSS can provide colorectal surgeons with valuable information. KEY POINTS • A diverticular disease severity score (DDSS) based on CT colonography is proposed. • This DDSS is based on sigmoid colon wall thickness and lumen diameter. • High scores may be associated with relevant coexisting lesions. • A CTC-based DDSS may influence therapeutic decision-making.
Collapse
Affiliation(s)
- Nicola Flor
- Unità Operativa Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, via A di Rudinì 8, 20142, Milano, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Choi PW. Colouterine fistula caused by diverticulitis of the sigmoid colon. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:321-4. [PMID: 23346512 PMCID: PMC3548148 DOI: 10.3393/jksc.2012.28.6.321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.
Collapse
Affiliation(s)
- Pyong Wha Choi
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
27
|
Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment. Surg Endosc 2012; 26:2061-71. [PMID: 22274929 DOI: 10.1007/s00464-012-2157-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/20/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients presenting with acute diverticulitis (AD) and signs of acute peritonitis, the presence of extradigestive air (EDA) on a computer tomography (CT) scan is often considered to indicate the need for emergency surgery. Although the traditional management of "perforated" AD is open sigmoidectomy, more recently, laparoscopic drainage/lavage (usually followed by delayed elective sigmoidectomy) has been reported. The aim of this retrospective study is to evaluate the results of nonoperative management of emergency patients presenting with AD and EDA. METHODS The outcomes of 39 consecutive hemodynamically stable patients (23 men, mean age = 54.7 years) who were admitted with AD and EDA and were managed nonoperatively (antibiotic and supportive treatment) at a tertiary-care university hospital between January 2001 and June 2010 were retrospectively collected and analyzed. These included morbidity (Clavien-Dindo) and treatment failure (need for emergency surgery or death). A univariate analysis of clinical, radiological, and laboratory criteria with respect to treatment failure was performed. Results of delayed elective laparoscopic sigmoidectomy were also analyzed. RESULTS There was no mortality. Thirty-six of the 39 patients (92.3%) did not need surgery (7 patients required CT-guided abscess drainage). Mean hospital stay was 8.1 days. Duration of symptoms, previous antibiotic administration, severe sepsis, PCR level, WBC concentration, and the presence of abdominal collection were associated with treatment failure, whereas "distant" location of EDA and free abdominal fluid were not. Five patients had recurrence of AD and were treated medically. Seventeen patients (47.2%) underwent elective laparoscopic sigmoidectomy for which mean operative time was 246 min (range = 100-450) and the conversion rate was 11.8%. Mortality was nil and the morbidity rate was 41.2%. Mean postoperative stay was 7.1 days (range = 4-23). CONCLUSIONS Nonoperative management is a viable option in most emergency patients presenting with AD and EDA, even in the presence of symptoms of peritonitis or altered laboratory tests. Delayed laparoscopic sigmoidectomy may be useless in certain cases and its results poorer than expected.
Collapse
|
28
|
Ben Yaacoub I, Boulay-Coletta I, Jullès MC, Zins M. CT findings of misleading features of colonic diverticulitis. Insights Imaging 2010; 2:69-84. [PMID: 22347935 PMCID: PMC3259374 DOI: 10.1007/s13244-010-0051-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/05/2010] [Accepted: 10/28/2010] [Indexed: 01/09/2023] Open
Abstract
Colonic diverticulitis (CD) is a common entity whose diagnosis is particularly based on computed tomography (CT) examination, which is the imaging technique of choice. However, unusual CT findings of CD may lead to several difficulties and potential pitfalls: due to technical errors in the management of the CT examination, due to the anatomical situation of the diseased colon, in diagnosing unusual complications that may concern the gastrointestinal tract, intra- and retroperitoneal viscera or the abdominal wall, and in differentiating CD from other abdominal inflammatory and infectious conditions or colonic cancer. The aim of this work is to delineate the pitfalls of CT imaging and illustrate misleading CT features in patients with suspected CD.
Collapse
Affiliation(s)
- Ismahen Ben Yaacoub
- Radiology Department, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75674 Paris Cedex 14, France
| | | | | | | |
Collapse
|
29
|
Reymond E, Collomb D, Reche F, Bricault I. Abcès myométrial et péri-sigmoïdien sur sigmoïdite : traitement par drainage radiologique. ACTA ACUST UNITED AC 2010; 91:1151-4. [DOI: 10.1016/s0221-0363(10)70162-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
30
|
Valentino M, Serra C, Ansaloni L, Mantovani G, Pavlica P, Barozzi L. Sonographic features of acute colonic diverticulitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:457-463. [PMID: 19655391 DOI: 10.1002/jcu.20619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. Sonography is frequently used as the initial imaging modality because of its ready availability. This pictorial essay aims to provide an overview of the sonographic features of acute colonic diverticulitis and of the more common differential diagnosis.
Collapse
Affiliation(s)
- Massimo Valentino
- Urgency/Emergency, General Surgery and Transplantation Department, Radiology Unit, S. Orsola-Malpighi, University Hospital, Bologna, Italy
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To prospectively determine the functional impact of elective laparoscopic sigmoidectomy after prior acute diverticulitis. SUMMARY BACKGROUND DATA Decision-analysis for elective colonic resection after acute diverticulitis is predicated on future risk estimates of disease recurrence and complication rates. Quality of life alone is rarely countenanced as sufficient to warrant the supposed risk of intervention. METHODS Consecutive patients undergoing laparoscopic sigmoid colectomy for prior diverticulitis over 18 months were studied at baseline (preoperative) and again subsequently (3, 6, and 12 months postoperatively) regarding quality of life and bowel symptomatology [gastrointestinal quality of life index (GIQLI)]. All patients also had enquiry made into urinary and sexual function at the same time points (men underwent international prostate symptom severity and international index of erectile function, respectively, whereas for women the urinary dysfunction index and a modified questionnaire for the evaluation of sexual function were used). RESULTS Forty-six patients (mean age 58.3, 26 men) were studied, 45 of whom had their surgery completed laparoscopically. Quality of life significantly improved in the group overall, with 36 patients having an increase in their GIQLI >10 points (23 patients >20 points). This improvement was evident by 3 months and maintained thereafter. The improvement was due to increments in gastrointestinal symptomatology subdomain and was most significant in those with lowest preoperative scoring. Five patients' GIQLI score deteriorated without obvious predictive event. Not one of the patients presented evident alteration in urinary and sexual functioning postoperatively. CONCLUSIONS Significant improvement in quality of life and social functioning accrues from elective sigmoid resection in the majority of patients. Avoidance of subsequent episodic attacks therefore should not represent the sole reason for operating but instead patient-centered issues should be prioritized.
Collapse
|
32
|
Abstract
Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann's procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.
Collapse
|
33
|
Kassab A, El-Bialy G, Hashesh H, Callen P. Magnetic resonance imaging and hysteroscopy to diagnose colo-uterine fistula: A rare complication of diverticulitis. J Obstet Gynaecol Res 2008; 34:117-20. [DOI: 10.1111/j.1447-0756.2007.00713.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Abstract
We report a case of pneumocephalus, as a complication of diverticulitis, in a 48-year-old man who presented with back pain and mild disorientation. There are no previous reports of diverticulitis causing this phenomenon.
Collapse
Affiliation(s)
- S Shetty
- Bristol Royal Infirmary, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK.
| | | | | |
Collapse
|
35
|
Iacopini F, Bizzotto A, Boskoski I, Bulajic M, Costamagna G. Epidemiology and management of diverticular disease of the colon. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/1745509x.3.4.551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of this review is mainly to show the high prevalence of diverticulosis and the clinical relevance of uncomplicated and complicated diverticular disease worldwide. The prevalence of diverticular disease is directly related to the aging of the population and in western countries is diagnosed in approximately 50–65% of adult subjects. The often more frequent adoption of an incorrect dietary style, such as a low-fiber diet, and the progressive increase in the average age of western populations will increase the prevalence of this pathology and the economic burden for health systems even more so. Furthermore, the management of uncomplicated diverticular disease, segmental colitis associated to diverticula and diverticulitis, which represent the different manifestations of the symptomatic spectrum of colonic diverticulosis, are reported.
Collapse
Affiliation(s)
- Federico Iacopini
- Università Cattolica “A. Gemelli”, Digestive Endoscopy Unit, Department of Surgery, Rome, Italy
| | - Alessandra Bizzotto
- Università Cattolica “A. Gemelli”, Digestive Endoscopy Unit, Department of Surgery, Rome, Italy
| | - Ivo Boskoski
- Università Cattolica “A. Gemelli”, Digestive Endoscopy Unit, Department of Surgery, Rome, Italy
| | - Milutin Bulajic
- Università Cattolica “A. Gemelli”, Digestive Endoscopy Unit, Department of Surgery, Rome, Italy
| | - Guido Costamagna
- Università Cattolica “A. Gemelli”, Digestive Endoscopy Unit, Department of Surgery, Rome, Italy
| |
Collapse
|
36
|
Ambrosetti P, Francis K, Weintraub D, Weintraub J. Functional results following elective laparoscopic sigmoidectomy after CT-proven diagnosis of acute diverticulitis evaluation of 43 patients and review of the literature. J Gastrointest Surg 2007; 11:767-72. [PMID: 17417713 DOI: 10.1007/s11605-007-0138-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We performed a prospective study to analyze the functional results following elective laparoscopic sigmoidectomy for computed tomography (CT)-proven diagnosis of acute diverticulitis and review the literature. Forty-three of 45 available patients (96%) who had laparoscopic sigmoidectomy for CT-proven acute diverticulitis answered, after a mean time of 40 months, a questionnaire exploring new abdominal symptoms, bowel function, and the patient's own judgement of the surgical outcome. Surgical technique aimed at removing all the sigmoid by taking down the splenic flexure and do a colorectal anastomosis. Four patients (9%) complained of new abdominal pain. Bowel function was reported as better for 24 patients (56%), unchanged for 16 patients (37%), and worse for 3 (7%). Twenty patients (47%) considered their final result as excellent to good, 17 patients (40%) as satisfying, and 6 patients (13%) as mediocre. Male gender, absence of preoperative history compatible with an irritable bowel syndrome, length of resected sigmoid and residual acute inflammation on histology are statistically predictive of a better postoperative degree of satisfaction. After elective laparoscopic sigmoidectomy for CT-proven diverticulitis, a great majority of patients are very satisfied with their postoperative general comfort.
Collapse
|
37
|
Munikrishnan V, Helmy A, Elkhider H, Omer AA. Management of acute diverticulitis in the East Anglian region: results of a United Kingdom regional survey. Dis Colon Rectum 2006; 49:1332-40. [PMID: 16897334 DOI: 10.1007/s10350-006-0594-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Acute diverticulitis is the most common presentation of diverticular disease; however, no published guidelines for management are available in the United Kingdom. This survey was designed to assess the current United Kingdom regional practice compared with the guidelines published by The American Society of Colon and Rectal Surgeons. METHODS A questionnaire survey focused on the management of acute diverticulitis was sent to all consultants, specialist registrars, and staff-grade surgeons in general surgery in one United Kingdom region. RESULTS Eighty-two questionnaires were returned (80 percent). A majority (80 percent) would request routine blood tests, abdominal, and erect chest x-rays on arrival. Pethidine (56 percent) was the preferred analgesic, followed by morphine (40 percent). Ninety-four percent used an antibiotic combination of second/third-generation cephalosporin and metronidazole. Computerized tomography was the most commonly used initial investigation (42 percent). Forty percent use barium enema and 31 percent use a combination of barium enema and sigmoidoscopy as follow-up investigations. In patients older than aged 50 years, elective resection would be considered by a majority (51 percent) only when complications arose. In those aged 50 years or younger, 35 percent would resect only if complications arose with only 6 percent after a single episode of acute diverticulitis. CONCLUSIONS There are major differences in the management of patients with acute diverticulitis in our current practice in one United Kingdom region compared with the guidelines published by The American Society of Colon and Rectal Surgeons, which are based on published literature. There is an urgent need to establish similar guidelines in the United Kingdom to improve the clinical outcome of patients with such a common condition.
Collapse
|
38
|
Warren O, Kinross J, Paraskeva P, Darzi A. Emergency laparoscopy--current best practice. World J Emerg Surg 2006; 1:24. [PMID: 16945124 PMCID: PMC1564132 DOI: 10.1186/1749-7922-1-24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 08/31/2006] [Indexed: 12/18/2022] Open
Abstract
Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.
Collapse
Affiliation(s)
- Oliver Warren
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - James Kinross
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - Paraskevas Paraskeva
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - Ara Darzi
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| |
Collapse
|
39
|
Dominguez EP, Sweeney JF, Choi YU. Diagnosis and management of diverticulitis and appendicitis. Gastroenterol Clin North Am 2006; 35:367-91. [PMID: 16880071 DOI: 10.1016/j.gtc.2006.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Diverticulitis and appendicitis are common infections of the gastrointestinal tract that require urgent medical and surgical attention. Successful management of these conditions requires a multidisciplinary approach among primary care providers, gastroenterologists, surgeons, and radiologists. The diagnosis of appendicitis, in particular, can be difficult. Advances in radiographic imaging have improved the diagnostic accuracy in these infections. Minimally invasive surgical techniques have improved the patient's postoperative recovery when surgery is necessary in the management of these conditions.
Collapse
Affiliation(s)
- Edward P Dominguez
- Minimally Invasive Surgery, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, TX 77030, USA
| | | | | |
Collapse
|
40
|
Buckley O, Geoghegan T, McAuley G, Persaud T, Khosa F, Torreggiani WC. Pictorial review: magnetic resonance imaging of colonic diverticulitis. Eur Radiol 2006; 17:221-7. [PMID: 16625348 DOI: 10.1007/s00330-006-0236-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 02/08/2006] [Accepted: 03/02/2006] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging (MRI) is rapidly emerging as a useful imaging modality for the evaluation of the gastrointestinal tract. Increasingly rapid sequences and improving hardware have significantly improved the visualisation of diseases of the colon. MRI has a major advantage over CT in that there is no ionising radiation. In our institution, MRI has increasingly been used as a complimentary imaging modality to CT in the diagnosis and evaluation of diverticulitis and its complications. In this review article, we illustrate the emerging role of MRI in the diagnosis and evaluation of colonic diverticulitis.
Collapse
Affiliation(s)
- Orla Buckley
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
| | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- Kim C E Sigaloff
- Department of Paediatrics, Emma's Children's Hospital, Amsterdam, The Netherlands
| | | | | |
Collapse
|