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Sokhal BS, Mostafa OES, Ramasamy S, Spyridon R, Zaman S, Hajibandeh S, Hajibandeh S. Level 1a Evidence Comparing Use of Antibiotics Versus No Antibiotics in Management of Acute Left-Sided Uncomplicated Diverticulitis. Am Surg 2024; 90:1167-1175. [PMID: 38205505 DOI: 10.1177/00031348241227183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This meta-analysis aimed to compare the effectiveness of no antibiotics vs antibiotics in AUD patients. METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomized controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modeling with 95% confidence intervals (CIs). RESULTS 5 RCTs with 1934 AUD patients were included. 979 patients were managed without antibiotics (50.6%). Patients in the no antibiotic and antibiotic groups had comparable demographics (age, sex, and body mass index) and presenting features (temperature, pain score, and C-reactive protein levels). There was no significant difference in rates of complicated diverticulitis (OR: .61, 95% CI: 0.27-1.36, P = .23), abscess (OR: .51, 95% CI: .08-3.25, P = .47) or fistula (OR: .33, 95% CI: .03-3.15, P = .33) formation, perforation (OR: .98, 95% CI: .32-3.07, P = .98), recurrence (OR: .96, 95% CI: .66-1.41, P = .85), need for surgery (OR: 1.36, 95% CI: .47-3.95, P = .37), mortality (OR: 1.27, 95% CI: .14-11.76, P = .82), or length of stay (MD: .215, 95% CI: -.43-.73, P = .61) between the 2 groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, P = .0002). CONCLUSION There is no significant difference in baseline characteristics, clinical presentation, and adverse health outcomes between AUD patients treated without antibiotics compared to with antibiotics.
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Affiliation(s)
| | | | - Sadhasivam Ramasamy
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Roditis Spyridon
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Shafquat Zaman
- Department of General Surgery, Russells Hall Hospital, Dudley Group NHS Trust, Dudley, UK
| | - Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Department of General Surgery, University Hospitals Coventry & Warwickshire, Coventry, UK
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2
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Essam ME, Beintaris I, Rutter MD. Postcolonoscopy Diverticulitis. ACG Case Rep J 2024; 11:e01362. [PMID: 38737096 PMCID: PMC11086960 DOI: 10.14309/crj.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Colonoscopy, generally safe but not devoid of risks, can lead to rare complications. We present 2 cases of postcolonoscopy diverticulitis (PCD). Case 1 was a 63-year-old woman, following colonoscopy, who developed acute sigmoid diverticulitis, despite a Diverticular Inflammation and Complication Assessment (DICA) score of 2, indicating extensive diverticulosis without inflammation. Conservative management with antibiotics led to recovery. Remarkably, she experienced a recurrent episode. Case 2 was a 74-year-old woman who had 2 colonoscopies, revealing pancolonic diverticulosis (DICA score: 2) without inflammation. After the second procedure, she developed severe sigmoid diverticulitis, managed conservatively with antibiotics. Discussion highlights PCD's rarity (prevalence: 0.04%-0.08%) and unclear pathogenesis. Both cases had DICA scores ≥2, suggesting a potential risk factor. Clinicians should recognize PCD, as it can mimic more common postcolonoscopy complications. Early recognition and management are vital.
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Affiliation(s)
- Mahmoud E. Essam
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iosif Beintaris
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
| | - Matthew D. Rutter
- Department of Gastroenterology, University Hospital of North Tees and Hartlepool, Stockton-On Tees, United Kingdom
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Hawkins AT, Penson DF, Geiger TM, Bonnet KR, Mutch MG, Maguire LH, Schlundt DG, Rothman RL. The Patient Perspective on Colectomy for Recurrent Diverticulitis: A Qualitative Study. Ann Surg 2024; 279:818-824. [PMID: 38318711 PMCID: PMC10997445 DOI: 10.1097/sla.0000000000006225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Understand the patient's decision-making process regarding colectomy for recurrent diverticulitis. BACKGROUND The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient's perspective in this decision-making process. METHODS We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. RESULTS From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon). CONCLUSIONS Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.
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Affiliation(s)
- Alexander T Hawkins
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Timothy M Geiger
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Matthew G Mutch
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lilias H Maguire
- Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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Le NK, Cho NY, Mallick S, Chervu N, Kim S, Sakowitz S, Benharash P, Lee H. Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis. Am Surg 2024:31348241248701. [PMID: 38682325 DOI: 10.1177/00031348241248701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND The role of minimally invasive surgery (MIS) in the acute management of diverticulitis remains controversial. Using a national cohort, we examined the relationship between operative approaches with acute clinical and financial outcomes. METHODS Adults undergoing emergent colectomy for diverticulitis were tabulated from the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program. Regression models were developed to analyze the association between open and MIS approaches with major adverse events (MAE), as well as secondary endpoints. A subgroup analysis was conducted to compare outcomes between open and MIS requiring conversion to open (CTO). RESULTS Of 9194 patients, 1580 (17.3%) underwent MIS colectomy. The proportion of MIS resection increased from 15.1% in 2015 to 19.1% in 2020 (nptrend<.001). Compared to Open, MIS patients were younger, equally likely to be female, had a lower proportion of patients with ASA class ≥3, and a higher BMI. Preoperatively, MIS patients were less frequently diagnosed with sepsis. Following adjustment with open as reference, MIS approach had reduced odds of MAE (AOR .56), ostomy creation (AOR .12), shorter postoperative length of stay (LOS; β -1.63), and a lower likelihood of nonhome discharge (AOR .45, all P < .001). Additionally, CTO was linked to decreased likelihood of MAE (AOR .78, P = .01), ostomy creation (AOR .02, P < .001), comparable LOS (β -.46, P = .41), and reduced odds of nonhome discharge (AOR .58, P < .001), relative to open. DISCUSSION Compared to planned open colectomy, MIS resection was associated with improved clinical and financial outcomes, even in cases of CTO. Our findings suggest that whenever possible, MIS should be attempted first in emergent colectomy for diverticulitis. Nevertheless, future prospective studies are likely needed to further elucidate specific patient and clinical factors.
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Affiliation(s)
- Nguyen K Le
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nam Yong Cho
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Saad Mallick
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nikhil Chervu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Shineui Kim
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sara Sakowitz
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Peyman Benharash
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Hanjoo Lee
- Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Redd WD, Holub JL, Nichols HB, Sandler RS, Peery AF. Follow-up Colonoscopy for Detection of Missed Colorectal Cancer after Diverticulitis. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00393-8. [PMID: 38670477 DOI: 10.1016/j.cgh.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND AIMS Colonoscopy is often recommended following an episode of diverticulitis to exclude missed colorectal cancer (CRC). This is a controversial recommendation based on limited evidence. We estimated the prevalence and odds of CRC and advanced colorectal neoplasia on colonoscopy in patients with diverticulitis compared to CRC screening. METHODS Using data from the Gastrointestinal Quality Improvement Consortium registry, we performed a cross-sectional study with patients ≥40 years old undergoing outpatient colonoscopy for an indication of diverticulitis follow-up or CRC screening. The primary outcome was CRC. The secondary outcome was advanced colorectal neoplasia. Odds ratios and 95% confidence intervals were calculated. RESULTS We identified 4,591,921 outpatient colonoscopies performed for screening and 91,993 colonoscopies for diverticulitis follow-up. CRC prevalence was 0.33% in colonoscopies for screening and 0.31% in colonoscopies for diverticulitis. Compared to screening, patients with diverticulitis were less likely to have CRC (adjusted OR 0.84, 95% CI 0.74-0.94). CRC prevalence decreased to 0.17% in colonoscopies performed for diverticulitis only. Compared to screening, patients with diverticulitis as the only indication were less likely to have CRC (adjusted OR 0.49, 95% CI 0.36-0.68). CRC prevalence increased to 1.43% in patients with complicated diverticulitis. Compared to screening, patients with complicated diverticulitis were more likely to have CRC (adjusted OR 3.57, 95% CI 1.59-8.01). CONCLUSION The risk of CRC cancer is low in most patients with diverticulitis. Patients with complicated diverticulitis are the exception. Our results suggest that colonoscopy to detect missed CRC should include diverticulitis patients with a complication and those not current with CRC screening.
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Affiliation(s)
- Walker D Redd
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Robert S Sandler
- Department of Medicine, University of North Carolina, Chapel Hill, NC,; Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC
| | - Anne F Peery
- Department of Medicine, University of North Carolina, Chapel Hill, NC,; Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC.
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Pon K, Bigam D, Bradley NL. Large adrenal incidentaloma in conjunction with perforated diverticulitis. Trauma Surg Acute Care Open 2024; 9:e001380. [PMID: 38596568 PMCID: PMC11002374 DOI: 10.1136/tsaco-2024-001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Kendell Pon
- General Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David Bigam
- General Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nori L Bradley
- General Surgery, University of Alberta, Edmonton, Alberta, Canada
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Nantais J, Baxter NN, Saskin R, Calzavara A, Gomez D. Short- and long-term outcomes of acute diverticulitis in patients with transplanted kidneys. Colorectal Dis 2024; 26:734-744. [PMID: 38459424 DOI: 10.1111/codi.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 03/10/2024]
Abstract
AIM The safety of nonoperative treatment for patients with transplanted kidneys who develop acute diverticulitis is unclear. Our primary aim was to examine the long-term sequelae of nonoperative management in this group. METHOD We performed a population-based retrospective cohort study using linked administrative databases housed at ICES in Ontario, Canada. We included adult (≥18 years) patients admitted with acute diverticulitis between April 2002 and December 2019. Patients with a functioning kidney transplant were compared with those without a transplant. The primary outcome was failure of conservative management (operation, drainage procedure or death due to acute diverticulitis) beyond 30 days. The cumulative incidence function and a Fine-Grey subdistribution hazard model were used to evaluate this outcome accounting for competing risks. RESULTS We examined 165 patients with transplanted kidneys and 74 095 without. Patients with transplanted kidneys were managed conservatively 81% of the time at the index event versus 86% in nontransplant patients. Short-term outcomes were comparable, but cumulative failure of conservative management at 5 years occurred in 5.6% (95% CI 2.3%-11.1%) of patients with transplanted kidneys versus 2.1% (95% CI 2.0%-2.3%) in those without. Readmission for acute diverticulitis was also higher in transplanted patients at 5 years at 16.7% (95% CI 10.1%-24.7%) versus 11.6% (95% CI 11.3%-11.9%). Adjusted analyses showed increased failure of conservative management [subdistribution hazard ratio (sHR) 3.24, 95% CI 1.69-6.22] and readmissions (sHR 1.55, 95% CI 1.02-2.36) for patients with transplanted kidneys. CONCLUSION Most patients with transplanted kidneys are managed conservatively for acute diverticulitis. Although long-term readmission and failure of conservative management is higher for this group than the nontransplant population, serious outcomes are infrequent, substantiating the safety of this approach.
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Affiliation(s)
- Jordan Nantais
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - David Gomez
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Division of General Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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8
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Phyu R, Patrizio HA, Schachter T. Ovarian Carcinosarcoma Mimicking Symptoms of Recurrent Diverticulitis: A Case Report. Cureus 2024; 16:e57948. [PMID: 38738152 PMCID: PMC11082829 DOI: 10.7759/cureus.57948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Ovarian carcinosarcoma, also known as malignant mixed müllerian tumor, is a rare and highly aggressive form of ovarian cancer. This report discusses a case where initial misdiagnosis underscored the complexity of diagnosing this condition. The findings highlight the critical nature of considering ovarian malignancies in the differential diagnosis for postmenopausal women presenting with abdominal pain and altered bowel habits. The significance of utilizing advanced imaging techniques and tumor markers in the early detection of ovarian carcinosarcoma is emphasized, demonstrating how such strategies can substantially affect patient management and outcomes. This case also illustrates the effectiveness of a multidisciplinary approach in treating this challenging malignancy, contributing to our understanding and management of ovarian carcinosarcoma.
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Affiliation(s)
- Riley Phyu
- Department of Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Harrison A Patrizio
- Department of Clinical Education and Assessment Center, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Todd Schachter
- Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
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Levy MJ, Osterkamp RL, Glauninger K, Strate LL. Diverticulosis morphology is associated with risk of diverticulitis. Eur J Gastroenterol Hepatol 2024; 36:382-386. [PMID: 38417057 PMCID: PMC10914328 DOI: 10.1097/meg.0000000000002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
The size, number and distribution of diverticula vary greatly in patients with diverticulosis. We aimed to study the association between the morphology of diverticulosis assessed on colonoscopy and the risk of diverticulitis. We performed a retrospective, case-control study of cases with a history of diverticulitis and controls with diverticulosis without diverticulitis matched on sex, age (within 5 years) and year of colonoscopy. Diverticulosis characteristics were obtained from endoscopy reports and were categorized according to severity, extent, number and size. We used conditional logistic regression on matched pairs to calculate the odds of diverticulitis among patients with diverticulosis according to differing morphologic characteristics. We identified 85 cases with computed tomography-documented diverticulitis and 85 matched controls with diverticulosis without a diagnosis of diverticulitis. In cases, 60% had left-sided only diverticulosis, 2% had right-sided only and 38% had both right and left-sided diverticulosis; whereas in controls, the distribution was 53%, 18% and 29%, respectively. Cases were more likely to have large diverticula [odds ratio (OR), 3.33; 95% confidence interval (CI), 1.30-8.56 for left colon only and 1.89, 95% CI, 0.78-4.57 for both right and left]. Similarly, when the severity of diverticulosis was compared between the groups, cases were more likely to have moderate or severe diverticulosis (OR, 3.44; 95% CI, 1.51-7.84 for moderate and OR, 8.87; 95% CI, 2.98-26.37 for severe). Diverticulitis cases were more likely to have large diverticula and severe diverticulosis when compared to controls suggesting that size and severity are novel risk factors for diverticulitis.
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Affiliation(s)
- Miriam J Levy
- University of Washington Department of General Internal Medicine, 1959 NE Pacific St, Settle, WA 98195
| | - Rebecca L Osterkamp
- Division of Gastroenterology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359773, Seattle, WA 98104
| | - Kristof Glauninger
- Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322
| | - Lisa L Strate
- Division of Gastroenterology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359773, Seattle, WA 98104
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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024. [PMID: 38558004 DOI: 10.1002/wjs.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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11
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Taah-Amoako P, Bediako-Bowan AAA, Dakubo JCB. The Prevalence and Management Outcomes of Diverticular Disease in a Tertiary Facility in Ghana. J West Afr Coll Surg 2024; 14:141-145. [PMID: 38562396 PMCID: PMC10980321 DOI: 10.4103/jwas.jwas_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/31/2023] [Indexed: 04/04/2024]
Abstract
Background Diverticular disease of the colon, previously believed to be rare among Africans, is now an emerging disease entity in many African countries. The increasing morbidity and varied presentations are associated with this. Objectives To determine the prevalence of diverticular disease among patients who underwent lower gastrointestinal endoscopies over a 5-year period and evaluate the common presentations, interventions, and treatment outcomes at the Korle-Bu Teaching Hospital (KBTH), Ghana. Materials and Methods This was a retrospective cross-sectional study of patients who underwent either a colonoscopy or proctosigmoidoscopy between January 2017 and December 2021, at the KBTH. The records of patients admitted for complications of diverticular disease over the same period were also reviewed. Results A total of 4266 patients underwent lower gastrointestinal endoscopy over the study period. Out of this, 380 were diagnosed with diverticular disease giving a prevalence of 8.91%. This comprised 58.95% male and 41.05% female. Their mean age was 67.02 (standard deviation ± 11.45). The age ranged from 26 to 95 years with a median of 67. Sixty-seven patients with 88 episodes of admission were managed for complications. The average age was 69.26 (SD ± 13.28) and ranged from 40 to 98 years with an interquartile range of 20 years. Complications were predominantly bleeding diverticular disease (94.32%), whereas 5.6% presented with diverticulitis. Ninety percent were managed conservatively, and 10% had surgical intervention. Conclusion This study concludes that the prevalence of diverticular disease among Ghanaians undergoing lower gastrointestinal endoscopy is still low and bleeding is the commonest indication for admission which is mostly managed conservatively.
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Affiliation(s)
- Philip Taah-Amoako
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, Bono Regional Hospital, Sunyani, Ghana
| | - Antoinette Afua Asiedua Bediako-Bowan
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
- Mwin Tuba Hospital & Colo-Proctology Centre, Accra, Ghana
| | - Jonathan C. Balea Dakubo
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
- Mwin Tuba Hospital & Colo-Proctology Centre, Accra, Ghana
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Jedidi L, Mabrouk A, Ghali H, Ben Dhaou A, Ben Lahouel S, Daldoul S, Said Latiri H, Ben Moussa M. Right-sided acute diverticulitis in a North African country: Presentation and management in one surgical center. World J Surg 2024. [PMID: 38557977 DOI: 10.1002/wjs.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia. METHODS This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021. RESULTS Forty patients were included in our study. The mean age was 42 years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5 ± 3 days). Follow-up showed no recurrences. CONCLUSION Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.
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Affiliation(s)
- Laila Jedidi
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia
| | - Aymen Mabrouk
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
| | - Anis Ben Dhaou
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Sami Daldoul
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
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Petersbourg D. Small Bowel Diverticulitis: An Unusual Cause of Abdominal Pain. J Belg Soc Radiol 2024; 108:28. [PMID: 38523725 PMCID: PMC10959129 DOI: 10.5334/jbsr.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Teaching point: Small bowel diverticulitis, much less common than its colonic counterpart, is a diagnosis that must be considered in the presence of abdominal pain, especially in an elderly person.
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McClintock S, Stupart D, Hoh SM, Redden AM, Schultz B, Robertson A, Moore E, Pollard J, Guest G, Watters D. Oral versus intravenous antibiotics in the treatment of uncomplicated colonic diverticulitis: results of a randomized non-inferiority control trial. ANZ J Surg 2024; 94:397-403. [PMID: 37962086 DOI: 10.1111/ans.18768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Colonic diverticular disease is common and its incidence increases with age, with uncomplicated diverticulitis being the most common acute presentation (1). This typically results in inpatient admission, placing a significant burden on healthcare services (2). We aimed to determine the safety and effectiveness of using intravenous or oral antibiotics in the treatment of uncomplicated diverticulitis on 30-day unplanned admissions, c-reactive protein (CRP), White Cell Count (WCC), pain resolution, cessation of pain medication, return to normal nutrition, and return to normal bowel function. METHODS This single centre, 2-arm, parallel, 1:1, unblinded non-inferiority randomized controlled trial compared the safety and efficacy of oral antibiotics versus intravenous antibiotics in the outpatient treatment of uncomplicated colonic diverticulitis. Inclusion criteria were patients older than 18 years of age with CT proven acute uncomplicated colonic diverticulitis (Modified Hinchey Classification Stage 0-1a). Patients were randomly allocated receive either intravenous or oral antibiotics, both groups being treated in the outpatient setting with a Hospital in the Home (HITH) service. The primary outcome was the 30-day unplanned admission rate, secondary outcomes were biochemical markers, time to pain resolution, time to cessation of pain medication, time to return to normal function and time to return to normal bowel function. RESULTS In total 118 patients who presented with uncomplicated colonic diverticulitis were recruited into the trial. Fifty-eight participants were treated with IV antibiotics, and 60 were given oral antibiotics. We found there was no significant difference between groups with regards to 30-day unplanned admissions or inflammatory markers. There was also no significant difference with regards to time to pain resolution, cessation of pain medication use, return to normal nutrition, or return to normal bowel function. CONCLUSION Outpatient management of uncomplicated diverticulitis with oral antibiotics proved equally as safe and efficacious as intravenous antibiotic treatment in this randomized non-inferiority control trial.
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Affiliation(s)
- Sam McClintock
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Douglas Stupart
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Su Mei Hoh
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Ann-Maree Redden
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Belinda Schultz
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Amy Robertson
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Eileen Moore
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - James Pollard
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Glenn Guest
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - David Watters
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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Atalay RT, Kolawole O, Ayele GM, Gobezie AA, Kibreab A, Michael MB. Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis. Cureus 2024; 16:e55674. [PMID: 38586678 PMCID: PMC10997493 DOI: 10.7759/cureus.55674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Acute diverticulitis is a prevalent medical condition with increasing incidence rates. While the sigmoid colon is the most commonly affected part of the large intestine, there have been occurrences of right-sided diverticulitis although uncommon. We present a case report highlighting the atypical presentation of diverticulitis in a 27-year-old female patient. The patient experienced right upper and epigastric pain and was ultimately diagnosed with right-sided diverticulitis, supported by her CT imaging findings. This uncommon presentation underscores the importance of considering diverse clinical manifestations when diagnosing and managing diverticulitis.
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Affiliation(s)
| | | | - Girma M Ayele
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Abay A Gobezie
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Angesom Kibreab
- Gastroenterology, Howard University Hospital, Washington DC, USA
| | - Miriam B Michael
- Internal Medicine, Howard University Hospital, Washingon DC, USA
- Internal Medicine, University of Maryland, Baltimore, USA
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Jacqueline D, Lince K, DeMario VK, Zarutskie A, Cisse S, Sogunro O. Diverticulitis in the Under-40 Population. Cureus 2024; 16:e56190. [PMID: 38618478 PMCID: PMC11016325 DOI: 10.7759/cureus.56190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As obesity and lifestyle factors become more prevalent in younger populations, we are diagnosing and treating diverticulitis in younger patients. In this study, the demographics, risk factors for the development, and treatment of acute diverticulitis were assessed focusing on patients under the age of 40. METHODS A retrospective review of the electronic medical records of a cohort of subjects diagnosed with diverticulitis was performed. Inclusion criteria included patients aged 18-40 who were treated for acute diverticulitis with or without any complications. RESULTS Of the 109 patients, 40 patients required surgery, and 69 patients were managed conservatively. Analysis showed that the Hinchey classification (p<0.001) was the strongest predictor of treatment modality. CONCLUSIONS As the incidence of diverticulitis has increased in recent decades, so too has the frequency with which elective surgical procedures are performed as treatment. While these procedures are vital components in the management of diverticulitis, the majority of research comparing conservative versus surgical treatments has been done in patients over 50 years old. Although diverticulitis has been classically thought of as a disease of the elderly, it has become more prevalent in younger populations due to the rise of obesity and lifestyle modification in the under-40 population. Although the prevalence of treatment and diagnosis of acute diverticulitis in younger patients has risen, there is a paucity of data surrounding treatment protocols for diverticulitis in association with patient symptoms for patients under the age of 40 years old. Our study has found that there is a higher incidence of complications in diverticulitis in patients under the age of 40. Additionally, when considering the pattern of complication presentation in younger patients with complicated diverticulitis, surgical intervention might not be appropriate. The current treatment algorithm relates diverticulitis complications with surgical interventions. However, our data suggest that patients under the age of 40 presenting with abscesses or strictures may not need surgical intervention. This information could be particularly helpful in guiding physicians and younger patients in selecting the best choice of care and minimizing complications. Additionally, further research should help guide treatment protocol in this specific population of patients, as there is a lack of established guidelines pertaining to diverticulitis surrounding younger patients.
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Affiliation(s)
- Danisi Jacqueline
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Kimberly Lince
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Virgil K DeMario
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Alexander Zarutskie
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Shannon Cisse
- Biomolecular Science, Central Connecticut State University, New Britain, USA
| | - Olutayo Sogunro
- Surgery, Hartford Healthcare, St. Vincent's Medical Center, Bridgeport, USA
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Vijfschagt ND, de Boer MR, Berger MY, Burger H, Holtman GA. Accuracy of diagnostic tests for acute diverticulitis that are feasible in primary care: a systematic review and meta-analysis. Fam Pract 2024; 41:1-8. [PMID: 38271592 PMCID: PMC10901479 DOI: 10.1093/fampra/cmad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Recognition of acute diverticulitis is important to determine an adequate management strategy. Differentiating it from other gastrointestinal disorders is challenging as symptoms overlap. Clinical tests might assist the clinician with this diagnostic challenge. Previous reviews have focussed on prognostic questions and imaging examinations in secondary care. OBJECTIVE To evaluate the diagnostic accuracy of clinical tests feasible in primary care for acute diverticulitis in suspected patients. METHOD We have systematically searched multiple databases for diagnostic accuracy studies of tests feasible in primary care compared to a reference standard in suspected patients. Two reviewers independently selected studies, extracted data, and assessed study quality with the QUADAS-2 tool. We have meta-analysed the results in the case of more than four studies per index test. RESULTS Seventeen studies were included, all studies were performed in secondary care (median prevalence 48%). Individual signs and symptoms showed a wide range in sensitivity (range 0.00-0.98) and specificity (range 0.08-1.00). Of the four laboratory tests evaluated, CRP >10 mg/l had the highest sensitivity (range 0.89-0.96) with specificity ranging from 0.28 to 0.61. Ultrasound had the highest pooled sensitivity and specificity of 0.92 (95% CI 0.86-0.96) and 0.94 (95% CI 0.88-0.97), respectively. CONCLUSION None of the studies were performed in primary care. Individual signs and symptoms alone are insufficiently informative for acute diverticulitis diagnosis. CRP showed potential for ruling out and ultrasound had a high diagnostic accuracy. More research is needed about the diagnostic accuracy of these tests in primary care. PROSPERO REGISTRATION NUMBER CRD42021230622.
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Affiliation(s)
- Natasja D Vijfschagt
- Department of Primary- and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel R de Boer
- Department of Primary- and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of Primary- and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huibert Burger
- Department of Primary- and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of Primary- and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ladna M, George J, Forsmark CE. Recurrent Acute Upper Gastrointestinal Bleed Due to Diffuse B-cell Lymphoma of the Duodenum in a Renal Transplant Patient: A Case Report and Literature Review. Cureus 2024; 16:e54555. [PMID: 38516468 PMCID: PMC10956918 DOI: 10.7759/cureus.54555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/23/2024] Open
Abstract
A patient status post (s/p) renal transplantation in 2014 presented with an upper gastrointestinal bleed (UGIB). The source of the bleed was found to be a large mass in the duodenum with histopathology from biopsies obtained during esophagogastroduodenoscopy revealing diffuse large B-cell lymphoma (DLBCL) of the duodenum. His mycophenolate was stopped, and the tacrolimus dose was reduced due to active malignancy. He was discharged and completed one cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) before presenting back to ED with hemorrhagic shock from a large upper GI bleed requiring admission to the medical intensive care unit. Post-transplant lymphoproliferative disorders such as DBLCL can present 10 years from the transplant date. These malignancies are at high risk for bleed, especially after treatment with chemotherapy is initiated.
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Affiliation(s)
- Michael Ladna
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - John George
- Gastroenterology, University of Florida College of Medicine, Gainesville, USA
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Aslam A, Lewis DJ, Veerasingham M, Afzal MZ, Alsaffar A. Colouterine fistula relating to diverticulitis: a rare clinical entity. J Surg Case Rep 2024; 2024:rjae035. [PMID: 38333561 PMCID: PMC10850048 DOI: 10.1093/jscr/rjae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
Colouterine fistula is a rare but recognizable complication of diverticulitis. This case illustrates the presence of a colouterine fistula in an elderly patient who had an atypical presentation for diverticulitis. She was initially treated with intravenous antibiotics for diverticulitis with a contained abscess. This gave her an opportunity to avoid surgery. However, her sepsis failed to respond to the initial treatment. Progress computerized tomography imaging demonstrated the presence of a colouterine fistula for which she required source control. Thus she underwent laparotomy, Hartmann's procedure, and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The diagnosis of colouterine fistula was confirmed intraoperatively and on histopathology. Subsequently, the patient had an uneventful recovery following the operation. This case highlights the rarity but also the veracity of this clinical entity.
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Affiliation(s)
- Anoosha Aslam
- Department of General Surgery, Tamworth Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - David J Lewis
- Department of General Surgery, Tamworth Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Mayooran Veerasingham
- Department of Obstetrics and Gynaecology, Tamworth Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Mohamed Z Afzal
- Department of General Surgery, Tamworth Hospital, Dean Street, North Tamworth, NSW 2340, Australia
| | - Asar Alsaffar
- Department of General Surgery, Tamworth Hospital, Dean Street, North Tamworth, NSW 2340, Australia
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Williamson AJ, Cain BT, Hoggan TJ, Larsen MW, Kimball ER, Bloomquist K, Galyean P, Zickmund S, Cohan JN. Challenges and Opportunities in the Elective Management of Diverticulitis: Perspectives From a National Sample of Colorectal Surgeons. Dis Colon Rectum 2024; 67:264-272. [PMID: 37787524 PMCID: PMC10841111 DOI: 10.1097/dcr.0000000000002941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Diverticulitis is a complex, heterogeneous disease process that affects a diverse population of patients. In the elective management of this disease, treatment guidelines have shifted toward patient-centered, individualized decision-making. It is not known what challenges surgeons face as they approach these nuanced treatment decisions in practice. OBJECTIVE This study aimed to identify opportunities to support colorectal surgeons in elective diverticulitis treatment. DESIGN This was a qualitative study using standardized, semistructured interviews to explore the perspectives of 29 colorectal surgeons recruited using a purposive sampling technique. Data were analyzed using an "open-coding" approach. SETTINGS Interviews with a national sample of colorectal surgeons were conducted from a single center using an online video platform. PATIENTS This study did not involve patients. MAIN OUTCOME MEASURES Interviews explored surgeons' experiences treating diverticulitis in the elective setting, focusing on perceived challenges in providing patient-centered care as well as opportunities to improve treatment decisions. RESULTS Our qualitative analysis identified an overarching challenge in elective diverticulitis management for surgeons: difficulty ensuring adequate patient understanding of the risks and benefits of various treatments. This was thought to be due to 1) preexisting patient expectations about treatment and 2) lack of data regarding long-term treatment outcomes. Surgeons identified 2 potential opportunities to combat these challenges: 1) patient education and 2) additional research regarding treatment outcomes, with potential for the development of diverticulitis-specific decision support tools. LIMITATIONS These results are based on a national sample of colorectal surgeons, but they capture qualitative data that is not intended to provide generalizable findings. CONCLUSIONS As surgeons work toward providing individualized care for diverticulitis patients, they find it difficult to adequately counsel patients regarding the patient-specific risks of various treatments. The results of this study identify specific contributors to this problem as well as potential targets for intervention, which can guide future efforts to support surgeons in providing patient-centered care. See Video Abstract . DESAFOS Y OPORTUNIDADES EN EL MANEJO ELECTIVO DE LA DIVERTICULITIS PERSPECTIVAS DE UNA MUESTRA NACIONAL DE CIRUJANOS COLORRECTALES ANTECEDENTES:La diverticulitis es un proceso patológico complejo y heterogéneo que afecta a una población diversa de pacientes. En el manejo electivo de esta enfermedad, las pautas de tratamiento se han desplazado hacia una toma de decisiones individualizada y centrada en el paciente. No se sabe qué desafíos enfrentan los cirujanos al abordar estas decisiones de tratamiento matizadas en la práctica.OBJETIVO:Identificar oportunidades para apoyar a los cirujanos colorrectales en el tratamiento electivo de la diverticulitis.DISEÑO:Este fue un estudio cualitativo que utilizó entrevistas semiestructuradas estandarizadas para explorar las perspectivas de 29 cirujanos colorrectales reclutados mediante una técnica de muestreo intencional. Los datos se analizaron utilizando un enfoque de "codificación abierta".ESCENARIO:Las entrevistas con una muestra nacional de cirujanos colorrectales se realizaron desde un solo centro utilizando una plataforma de video en línea.PRINCIPALES MEDIDAS DE RESULTADO:Las entrevistas exploraron las experiencias de los cirujanos en el tratamiento de la diverticulitis en el entorno electivo, centrándose en los desafíos percibidos en la prestación de atención centrada en el paciente, así como en las oportunidades para mejorar las decisiones de tratamiento.RESULTADOS:Nuestro análisis cualitativo identificó un desafío general en el manejo de la diverticulitis electiva para los cirujanos: la dificultad para asegurar que el paciente comprenda adecuadamente los riesgos y beneficios de los diversos tratamientos. Se pensó que esto se debía a 1) las expectativas preexistentes del paciente sobre el tratamiento y 2) la falta de datos sobre los resultados del tratamiento a largo plazo. Los cirujanos identificaron dos oportunidades potenciales para combatir estos desafíos: 1) educación del paciente y 2) investigación adicional sobre los resultados del tratamiento, con potencial para el desarrollo de herramientas de apoyo a la toma de decisiones específicas para la diverticulitis.LIMITACIONES:Estos resultados se basan en una muestra nacional de cirujanos colorrectales, pero capturan datos cualitativos que no pretenden proporcionar hallazgos generalizables.CONCLUSIONES:A medida que los cirujanos trabajan para brindar atención individualizada a los pacientes con diverticulitis, les resulta difícil aconsejar adecuadamente a los pacientes sobre los riesgos específicos de los pacientes para los diversos tratamientos. Los resultados de este estudio identifican contribuyentes específicos a este problema, así como objetivos potenciales para la intervención, que pueden guiar los esfuerzos futuros para ayudar a los cirujanos a brindar atención centrada en el paciente. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
| | - Brian T. Cain
- Division of General Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Elisabeth R. Kimball
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Kennedi Bloomquist
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Patrick Galyean
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Susan Zickmund
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Jessica N. Cohan
- Division of General Surgery, University of Utah, Salt Lake City, Utah
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Forman-Ankjaer B, Hvid-Jensen F, Kobel CM, Greve T. Short communication: first case of bacteraemia caused by Dielma fastidiosa in a patient hospitalized with diverticulitis. APMIS 2024; 132:130-133. [PMID: 38095319 DOI: 10.1111/apm.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024]
Abstract
Dielma fastidiosa is a gram-negative, anaerobic rod belonging to the family Erysipelotrichaceae. D. fastidiosa has previously been isolated in human stool samples as part of the commensal flora; however, prior to this case, it has never been identified as a human pathogen. We present the first case of bacteraemia with D. fastidiosa. Bacterial growth in the blood culture bottle was detected by the automated blood culture system BacT/ALERT 3D. Culturing was performed, and bacterial colonies were identified as D. fastidiosa using MALDI-TOF MS. A subsequent whole-genome sequencing using Illumina NovaSeq was performed, and a phylogenetic tree depicting all available sequences of D. fastidiosa was generated. The reference MALDI-TOF spectrum and species identification was compared with the previously published spectrum. Whole-genome sequencing confirmed the tentative MALDI-TOF species identification. Notably, the maximum-likelihood-based phylogenetic analysis placed the D. fastidiosa isolate from this clinical case within the known variation of the eight publicly available sequences of this species. We identified D. fastidiosa by whole-genome sequencing followed by maximum-likelihood analysis as a possible pathogen in this case of bacteraemia in a patient hospitalized with diverticulitis.
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Affiliation(s)
| | | | - Carl Mathias Kobel
- Microbial Ecology and Meta-Omics group, Norwegian University of Life Sciences, Ås, Norway
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
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Lauricella S, Brucchi F, Palmisano D, Baldazzi G, Bottero L, Cassini D, Faillace G. Right-sided colonic diverticulitis. Short and long-term surgical outcomes and 2-year quality of life. World J Surg 2024; 48:484-492. [PMID: 38529850 DOI: 10.1002/wjs.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 03/27/2024]
Abstract
AIM We aimed to investigate the short and the long-term outcomes and 2-year Quality of Life (QoL) of patients with right-sided colonic diverticulitis (RCD) surgically managed. METHOD We conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1-year post surgery. The enrolled patients completed the EuroQoL (EQ-5D-3L) during a regular follow-up visit at 12 and 24 months after surgery. RESULTS Three hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non-operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo-caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien-Dindo as grade I-II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24-month follow-up. A statistically significant difference between preoperative and 24-month QoL index values (median 0.72; IQR = 0.57-0.8 vs. median 0.9; IQR = 0.82-1; p = 0.0003) was observed. CONCLUSIONS The study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery.
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Affiliation(s)
- Sara Lauricella
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Francesco Brucchi
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
- University of Milan, Milan, Italy
| | - Dario Palmisano
- University of Milano-Bicocca, Cinisello Balsamo, Milan, Italy
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | | | - Luca Bottero
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Faillace
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
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Decker JA, Scheurig-Münkler C, Luitjens JH, Schwarz F, Kroencke T, Bette S. Inpatient treatment of acute diverticulitis between 2010 and 2021 - A German nationwide study about long-term trends and effects of the SARS-CoV-2 pandemic. Colorectal Dis 2024; 26:335-347. [PMID: 38115093 DOI: 10.1111/codi.16811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 12/21/2023]
Abstract
AIM The aims of this study were to analyse all hospitalizations for acute diverticulitis in Germany from 2010 to 2021 and to assess the effects of the first 2 years of the SARS-CoV-2 pandemic on hospitalizations for acute diverticulitis. METHOD Using data from the German Federal Statistical Office, we analysed fully anonymized healthcare data of hospitalizations and treatment regimens with acute diverticulitis as the main diagnosis between 2010 and 2021. Logistic regression analyses for in-hospital mortality were performed. RESULTS A total of 608,162 hospitalizations were included. While the number of hospitalizations constantly increased until 2019 (+52.4%), a relative decrease of 10.1% was observed between 2019 and 2020, followed by stable numbers of hospitalizations in 2021 (+1.1% compared with 2020). In-hospital mortality showed a relative decrease of 33.2% until 2019 and thereafter a relative increase of 26.9% in 2020 and of 7.5% in 2021. A 21.6% and a 19.3% drop in hospitalizations was observed during the first and second waves of the SARS-CoV-2 pandemic, mostly affecting hospitalizations for uncomplicated diverticulitis, with a corresponding 11.6% and 16.8% increase in admissions for complicated diverticulitis. Multivariable logistic regression analyses showed significantly higher in-hospital mortality for hospitalizations in which surgery (OR = 2.76) and CT (OR = 1.32) were given, as well as lower mortality for women (OR = 0.88), whereas percutaneous drainage was not associated with higher in-hospital mortality compared with conservative treatment (OR = 0.71). CONCLUSION This study points out the long-term trends in inpatient treatment for acute diverticulitis and the in-hospital mortality risk factors of patients hospitalized for acute diverticulitis in a large nationwide cohort, as well as changes in these trends and factors resulting from the SARS-CoV-2 pandemic. These changes might be attributable to delayed diagnosis and thus more severe stages of disease as a result of containment measures.
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Affiliation(s)
- Josua A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Christian Scheurig-Münkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Jan H Luitjens
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Florian Schwarz
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
- Medical Faculty, Ludwig Maximilian University Munich, Munich, Germany
- Clinic for Diagnostic and Interventional Radiology, Donau-Isar-Klinikum, Deggendorf, Germany
| | - Thomas Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Augsburg, Germany
| | - Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
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24
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Silva C, Monteiro C, Barbosa F, Cunha I, Coutada R, Carvalho A. Colouterine Fistula as a Rare Cause of Postmenopausal Abnormal Uterine Bleeding: A Case Report. J Clin Med 2024; 13:783. [PMID: 38337477 PMCID: PMC10856449 DOI: 10.3390/jcm13030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.
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Affiliation(s)
- Cátia Silva
- Gynecological Department, Coimbra Hospital and University Centre, 3000-075 Coimbra, Portugal
| | - Cristina Monteiro
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Fernando Barbosa
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Inês Cunha
- Gastroenterology Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal;
| | - Rosália Coutada
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
| | - Agostinho Carvalho
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
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25
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Bangeas P, Konstantinidis N, Chrisopoulou T, Karatzia D, Giakoustidis A, Papadopoulos VN. Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature. Medicina (Kaunas) 2024; 60:229. [PMID: 38399517 PMCID: PMC10890375 DOI: 10.3390/medicina60020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.
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Affiliation(s)
- Petros Bangeas
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Nikolaos Konstantinidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Tania Chrisopoulou
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Despoina Karatzia
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Alexandros Giakoustidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Vasileios N. Papadopoulos
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
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26
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Krebs JR, Mazirka P, Fazzone B, Ault T, Read TE, Terracina KP. Sarcopenia is a Poor Predictor of Outcomes in Elective Colectomy for Diverticulitis. Am Surg 2024:31348241229630. [PMID: 38263953 DOI: 10.1177/00031348241229630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Sarcopenia is associated with adverse perioperative outcomes in patients undergoing operations for malignancy, but its influence on patients undergoing elective colectomy for diverticulitis is unknown. We hypothesized that sarcopenia is associated with adverse perioperative events in patients undergoing elective colectomy for diverticulitis. METHODS Comorbidities, operative characteristics, and postoperative complications were extrapolated from our institutional EMR in patients undergoing elective colectomy for diverticulitis from 2016 to 2020. Sarcopenia was calculated using perioperative imaging and defined by standard skeletal muscle index (SMI) and psoas muscle index (PMI) thresholds. Univariate analysis was used to compare sarcopenic and non-sarcopenic patients. RESULTS 148 patients met inclusion criteria. Using SMI thresholds, 95 patients (64%) were sarcopenic. With SMI criteria, sarcopenic patients were older (67 vs 52 years old; P < .01) and had lower BMIs (26.2 vs 34.0, respectively; P < .001) than non-sarcopenic patients. There were no differences in baseline characteristics, postoperative complications, and non-home discharge between groups (P > .05 for all). Postoperative length of stay was greater in sarcopenic patients (3 IQR 2-5 vs 2 IQR 2-3 days; P < .01). Using PMI thresholds, 68 (46%) met criteria for sarcopenia. Using PMI thresholds, sarcopenic patients were older (68 vs 57.5 years old; P < .01) and had lower BMIs (25.8 vs 32.8; P < .01). There were no differences in comorbidities or measured operative outcomes between groups (P > .05 for all), other than postoperative length of stay which was longer in the sarcopenic group (3.5 IQR 3-5 vs 2 IQR 2-3; P < .01). CONCLUSIONS Incidence of sarcopenia was high in patients undergoing elective colectomy for diverticulitis in our practice, but sarcopenia was not associated with adverse perioperative outcomes. In select patients, elective colectomy for diverticulitis can be safely performed in the presence of sarcopenia.
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Affiliation(s)
- Jonathan R Krebs
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
| | - Pavel Mazirka
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
| | - Brian Fazzone
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
| | - Taylor Ault
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
| | - Thomas E Read
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
| | - Krista P Terracina
- Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, Gainesville, FL, USA
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27
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Kariyasu T, Nishikawa M, Yamaguchi H, Machida H. CT Fistulography Documented Colocutaneous Fistula Secondary to Diverticulitis. Intern Med 2024:3140-23. [PMID: 38220188 DOI: 10.2169/internalmedicine.3140-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Toshiya Kariyasu
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Makiko Nishikawa
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Hidenori Yamaguchi
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
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28
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Islam S, Shah A, Naraynsingh V. Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen. Cureus 2024; 16:e52228. [PMID: 38352077 PMCID: PMC10861364 DOI: 10.7759/cureus.52228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Isolated jejunal diverticular (JD) perforation is extremely rare; it usually presents as a diagnostic dilemma and is often discovered incidentally on laparotomy. Most of these perforations are single. Literature has revealed only one case of multiple small bowel diverticular perforations. We report the first case of simultaneous perforation of four jejunal diverticulae in an 85-year-old male. Small bowel resection and primary anastomosis were performed. The patient had an uneventful post-operative recovery. This case highlights the importance of prompt diagnosis and timely management to reduce the morbidity and mortality of these patients. It should be included in the differential diagnosis in all elderly patients presenting with acute abdomen.
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Affiliation(s)
- Shariful Islam
- General Surgery/Oncoplastic Breast Surgery, San Fernando General Hospital, San Fernando, TTO
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Aneela Shah
- General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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29
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Saha B, Jang S, Friesen JN, Kalinoski-DuBose V, Verma A, Mundell W. Concomitant Sigmoid Diverticulitis and Periampullary Duodenal Diverticulitis Complicated by Lemmel Syndrome: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241253342. [PMID: 38742534 PMCID: PMC11095166 DOI: 10.1177/23247096241253342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/30/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024] Open
Abstract
Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.
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Affiliation(s)
- Bibek Saha
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samuel Jang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Anjul Verma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - William Mundell
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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30
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Ocaña J, García-Pérez JC, Fernández-Martínez D, Aguirre I, Pascual I, Lora P, Espin-Basany E, Labalde-Martínez M, León C, Pastor-Peinado P, López-Domínguez C, Muñoz-Plaza N, Valle A, Dujovne P, Alías D, Pérez-Santiago L, Correa A, Carmona M, Fernández-Cebrián JM, Die J. Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group. Colorectal Dis 2024; 26:120-129. [PMID: 38010046 DOI: 10.1111/codi.16810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023]
Abstract
AIM Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. METHODS A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. RESULTS A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS. CONCLUSION Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.
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Affiliation(s)
- Juan Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Carlos García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Ignacio Aguirre
- Colorectal Surgery Unit, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Isabel Pascual
- Colorectal Division, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Lora
- Colorectal Division, Hospital Univseristario Cabueñes, Gijón, Spain
| | - Eloy Espin-Basany
- Department of Colorectal Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carmen León
- Division of Coloproctology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Paula Pastor-Peinado
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Nerea Muñoz-Plaza
- Division of Coloproctology, Hospital Universitario Burgos, Burgos, Spain
| | - Ainhoa Valle
- Division of Coloproctology, Hospital Universitario de Getafe, Getafe, Spain
| | - Paula Dujovne
- Division of Coloproctology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - David Alías
- Unit of Coloproctology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Alba Correa
- Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain
| | - María Carmona
- Division of Coloproctology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - José María Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Die
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Inurria A, Suárez-Pérez A, Calabuig P, Orós J. Citrobacter freundii-associated lesions in stranded loggerhead sea turtles ( Caretta caretta). Vet Pathol 2024; 61:140-144. [PMID: 37377060 DOI: 10.1177/03009858231183983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Citrobacter freundii, an opportunistic bacterial pathogen belonging to the family Enterobacteriaceae, has been sporadically reported in sea turtles. Here, the authors describe 3 unusual lesions associated with C. freundii infection in 3 loggerhead sea turtles stranded on the coast of Gran Canaria Island, Spain. It is possible that these 3 distinct lesions played a major role in the death of these turtles. The first turtle had caseous cholecystitis, a lesion not previously described in sea turtles. The second turtle had large intestinal diverticulitis, a rare condition in loggerheads. The third turtle had bilateral caseous salt gland adenitis. Histologically, numerous gram-negative bacilli were observed at the deepest edge of inflammation in all cases. Pure cultures of C. freundii were obtained from these 3 lesions. Molecular detection of C. freundii DNA in formalin-fixed paraffin-embedded samples from the lesions of the 3 turtles confirmed the microbiological isolation. These cases, in addition to expanding the limited body of knowledge on bacterial infections in sea turtles, highlight the potential pathogenic role of C. freundii in loggerhead turtles.
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Affiliation(s)
- Alicia Inurria
- University of Las Palmas de Gran Canaria (ULPGC), Arucas, Spain
| | - Alejandro Suárez-Pérez
- University of Las Palmas de Gran Canaria (ULPGC), Arucas, Spain
- AnimalLab, Las Palmas de Gran Canaria, Spain
| | - Pascual Calabuig
- Tafira Wildlife Rehabilitation Center, Las Palmas de Gran Canaria, Spain
| | - Jorge Orós
- University of Las Palmas de Gran Canaria (ULPGC), Arucas, Spain
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Tiralongo F, Di Pietro S, Milazzo D, Galioto S, Castiglione DG, Ini’ C, Foti PV, Mosconi C, Giurazza F, Venturini M, Zanghi’ GN, Palmucci S, Basile A. Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template. Diagnostics (Basel) 2023; 13:3628. [PMID: 38132212 PMCID: PMC10742435 DOI: 10.3390/diagnostics13243628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey's modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Stefano Di Pietro
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Dario Milazzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Sebastiano Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Corrado Ini’
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | | | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
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Ezeme C, Amaefule-Orie G, Yeung TM, Bowyer R. Sigmoid Diverticulitis in a Tight Spot: An Atypical Presentation Within a Ventral Hernia. Cureus 2023; 15:e50875. [PMID: 38249178 PMCID: PMC10799236 DOI: 10.7759/cureus.50875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Ventral hernia and acute diverticulitis may present with similar symptoms posing difficulty in clinical diagnosis. Rarely, complicated sigmoid diverticulitis is found within an irreducible ventral hernia sac in the emergency setting. Intraoperative decision on the appropriate surgical option depends on the surgeon's experience and the patient's clinical state. We present a case of a middle-aged female who came in with infraumbilical hernia containing necrotic sigmoid diverticulitis. Her surgical history was cesarean section and total abdominal hysterectomy with a re-look laparotomy. She had an emergency exploration of the hernia through a midline incision, excision of the necrotic diverticulum, and the formation of loop colostomy at the site of the hernia. Post-operative recovery was uneventful and she has been scheduled for an elective sigmoid colectomy and reversal of the stoma. This study highlights that complicated sigmoid diverticulitis can rarely present as an irreducible ventral hernia and that less is often more in safely getting patients out of trouble in an emergency.
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Affiliation(s)
- Constantine Ezeme
- Department of Surgery, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, GBR
- Department of Surgery, St. Richard's Hospital, Chichester, GBR
| | - Grace Amaefule-Orie
- Department of Anesthesia, Northampton General Hospital NHS Trust, Northampton, GBR
| | - Trevor M Yeung
- Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Richard Bowyer
- Department of Surgery, St. Richard's Hospital, Chichester, GBR
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Stovall SL, Johnson MP, Evans ET, Kaplan JA, Law JK, Moonka R, Bahnson HT, Simianu VV. Understanding the Geographic Distribution of Diverticulitis Hospitalizations in Washington State. Am Surg 2023; 89:5720-5728. [PMID: 37144833 DOI: 10.1177/00031348231174002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The incidence of diverticulitis in the United States is increasing, and hospitalization remains a surrogate for disease severity. State-level characterization of diverticulitis hospitalization is necessary to better understand the distribution of disease burden and target interventions. METHODS A retrospective cohort of diverticulitis hospitalizations from 2008 through 2019 was created using Washington State's Comprehensive Hospital Abstract Reporting System. Hospitalizations were stratified by acuity, presence of complicated diverticulitis, and surgical intervention using ICD diagnosis and procedure codes. Patterns of regionalization were characterized by hospital case burden and distance travelled by patients. RESULTS During the study period, 56,508 diverticulitis hospitalizations occurred across 100 hospitals. Most hospitalizations were emergent (77.2%). Of these, 17.5% were for complicated diverticulitis, and 6.6% required surgery. No single hospital received more than 5% (n = 235) of average annual hospitalizations. Surgeons operated in 26.5% of total hospitalizations (13.9% of emergent hospitalizations, and 69.2% of elective hospitalizations). Operations for complicated disease made up 40% of emergent surgery and 28.7% of elective surgery. Most patients traveled fewer than 20 miles for hospitalization, regardless of acuity (84% for emergent hospitalization and 77.5% for elective hospitalization). DISCUSSION Hospitalizations for diverticulitis are primarily emergent, nonoperative, and broadly distributed across Washington State. Hospitalization and surgery occur close to patients' homes, regardless of acuity. This decentralization needs to be considered if improvement initiatives and research in diverticulitis are to have meaningful, population-level impact.
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Affiliation(s)
- Stephanie L Stovall
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Meredith P Johnson
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ethan T Evans
- Diabetes Clinical Research Program, Benaroya Research Institute, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Joanna K Law
- Department of Gastroenterology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ravi Moonka
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Henry T Bahnson
- Clinical Research Program, Benaroya Research Institute, Seattle, WA, USA
| | - Vlad V Simianu
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
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Louie NK, Champagne B. Diverticular Abscess Complicating Pregnancy at 18 Weeks' Gestation in a 30-Year-Old Female: A Case Report. Cureus 2023; 15:e50590. [PMID: 38222159 PMCID: PMC10788125 DOI: 10.7759/cureus.50590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
The co-occurrence of diverticulitis with pregnancy is incredibly rare and the management of recurrent complicated diverticulitis may not be feasible in a pregnant patient. Adding cases to the incredibly sparse literature may highlight similarities and create potential recommendations for at-risk populations. We present a case of a female at 18 weeks' gestation who presented with left lower quadrant pain. The initial physical exam and clinical findings revealed severe abdominal tenderness without signs of generalized peritonitis, leukocytosis with predominant neutrophils, and fundal height with confirmatory ultrasonography of intrauterine pregnancy. The main diagnosis was diverticulitis complicated by an abscess and pregnancy, confirmed with CT imaging. The initial intervention was IV antibiotics and bowel rest; however, with each subsequent discharge, she returned to the emergency department with worsening symptoms. Eventually, at 28 weeks, she was escalated to IV meropenem, CT-guided drainage of the abscess, and preterm vaginal delivery at 28 weeks, with a lower anterior resection and diverting ileostomy at six weeks postpartum. She is currently being followed outpatient with improvement in pain, meaningful healthy weight gain, and a healthy newborn child. While management of diverticulitis is generally straightforward, severe presentations like this, even when compared to existing literature, suggest traditional notions of contraindications and risks may not fully apply. Timing and management of recurrent diverticulitis in pregnancy necessitate further research to establish comprehensive guidelines tailored to these at-risk populations.
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Affiliation(s)
- Nathan K Louie
- Colorectal Surgery, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Bradley Champagne
- Colorectal Surgery, Our Lady of Lourdes Regional Medical Center, Lafayette, USA
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Harrison NJ, Samuels LR, Dusetzina SB, Alexopoulos SP, Ziogas IA, Hawkins AT. The Association Between Solid Organ Transplant and Recurrence of Acute Diverticulitis: A National Assessment. Ann Surg 2023:00000658-990000000-00699. [PMID: 37982509 PMCID: PMC11102932 DOI: 10.1097/sla.0000000000006151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Compare rates and severity of recurrent acute diverticulitis in patients with and without solid organ transplant. SUMMARY BACKGROUND DATA Immunocompromised solid organ transplant recipients have been considered higher risk for both recurrence and severity of acute diverticulitis. Current guidelines recommend an individualized approach for colectomy in these patients, but these are based on single-center data. METHODS We identified patients with acute diverticulitis using the Merative MarketScan commercial claims data from 2014-2020. Patients were classified by history of solid organ transplant. The primary outcome was recurrence of acute diverticulitis with an associated antibiotic prescription ≥60 days from the initial episode. Secondary outcomes included hospitalization, colectomy, and ostomy in patients with recurrence. Analyses used inverse probability weighting to adjust for imbalances in covariates. RESULTS Of 170,697 patients with evidence of acute diverticulitis, 442 (0.2%) had a history of solid organ transplantation. In the weighted cohort, among people who had not been censored at one year (n=515), 112 (22%; 95% CI 20%-25%) experienced a recurrence within the first year. Solid organ transplantation was not significantly associated with a risk of recurrence (HR 1.19; 95% CI 0.94-1.50). There was also no statistically significant difference in the hospitalization rate for recurrent diverticulitis. Restricting the analysis to hospitalized recurrences, there was no statistically significant difference observed in either length of stay or discharge status. CONCLUSIONS In this national analysis of commercially-insured patients with acute diverticulitis we found no statistically significant differences in recurrence between those with and without a history of solid organ transplant. We do not support an aggressive colectomy strategy based on concern for increased recurrence rate and severity in a solid organ transplant population.
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Affiliation(s)
- Noah J Harrison
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
| | - Lauren R Samuels
- Vanderbilt University School of Medicine, Department of Health Policy, Nashville, TN
| | - Stacie B Dusetzina
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Sophoclis P Alexopoulos
- Vanderbilt University Medical Center, Division of Hepatobiliary Surgery and Liver Transplantation, Nashville, TN
| | - Ioannis A Ziogas
- Vanderbilt University Medical Center, Division of Hepatobiliary Surgery and Liver Transplantation, Nashville, TN
| | - Alexander T Hawkins
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
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Guerra ME, Chiu AS, Chilakamarry S, Jean R, Brandt WS, Ruangvoravat L, Davis KA. Risk Factors for the Failure of Non-operative Management Among Patients Admitted for Colonic Diverticulitis. Am Surg 2023; 89:4552-4558. [PMID: 35986004 DOI: 10.1177/00031348221121546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Diverticulitis is one of the most diagnosed gastrointestinal diseases in the country, and its incidence has risen over time, especially among younger populations, with increasing attempts at non-operative management. We elected to look at acute diverticular disease from the lens of a failure analysis, where we could estimate the hazard of requiring operative intervention based upon several clinical factors. MATERIALS AND METHODS The National Inpatient Sample (NIS) was queried between 2010 and 2015 for unplanned admissions among adults with a primary diagnosis of diverticulitis. We used a proportional hazards regression to estimate the hazard of failed non-operative management from multiple clinical covariates, measured as the number of inpatient days from admission until colonic resection. We also evaluated patients who received percutaneous drainage, to investigate whether this was associated with decreasing the failure rate of non-operative management. RESULTS A total of 830,993 discharges over the study period, of whom 83,628 (10.1%) underwent operative resection during the hospitalization, and 35,796 (4.3%) patients underwent percutaneous drainage. Half of all operations occurred by hospital day 1. Among patients treated with percutaneous drainage, 11% went on to require operative intervention. The presence of a peritoneal abscess (HR 3.20, P < .01) and sepsis (HR 4.16, P < .01) were the strongest predictors of failing non-operative management. Among the subset of patients with percutaneous drains, the mean time from admission to drain placement was 2.3 days. CONCLUSION Overall 10.1% of unplanned admissions for diverticulitis result in inpatient operative resection, most of which occurred on the day of admission. Percutaneous drainage was associated with an 11% operative rate.
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Affiliation(s)
| | - Alexander S Chiu
- Department of Surgery,University of Wisconsin--Madison, Madison, WI, USA
| | | | - Raymond Jean
- Department of Surgery, Harborview Medical Center, Seattle, WA, USA
| | - Whitney S Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Lucy Ruangvoravat
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of General Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Kimberly A Davis
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of General Surgery, Yale School of Medicine, New Haven, CT, USA
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Ore AS, Allar BG, Fabrizio A, Cataldo TE, Messaris E. Trends in the Management of Non-emergent Surgery for Diverticular Disease and the Impact of Practice Parameters. Am Surg 2023; 89:4590-4597. [PMID: 36044675 DOI: 10.1177/00031348221124319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the rise in diverticular disease, the ASCRS developed practice parameters to ensure high-quality patient care. Our study aims to evaluate the impact of the 2014 practice parameters on the treatment of non-emergent left-sided diverticular disease. METHODS This is a retrospective cohort study using the ACS-National Surgical Quality Improvement Project (ACS-NSQIP). Elective sigmoid resections performed by year were evaluated and compared before and after practice parameters were published. RESULTS Overall, 46,950 patients met inclusion criteria. There was a significant decrease in the number of non-emergent operations when evaluating before and after guideline implementation (P < .001). There was a significant decrease in the number of patients younger than 50 years of age operated electively for diverticular disease (25.8% vs. 23.9%, P = .005). Adoption of minimally invasive surgery continued to increase significantly throughout the study period. CONCLUSIONS Publication of the 2014 ASCRS practice parameters is associated with a change in management of diverticular disease in the non-emergent setting.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin G Allar
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mansour MR, Kessler SA, Khreisat A, Skrzynski JK. Asymptomatic colo-ovarian fistula amidst acute psychosis: a case report. J Surg Case Rep 2023; 2023:rjad525. [PMID: 37901605 PMCID: PMC10602661 DOI: 10.1093/jscr/rjad525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023] Open
Abstract
This paper presents a rare case of an asymptomatic colo-ovarian fistula in a 45-year-old female with acute psychosis and a history of bipolar disorder, seizure disorder and substance misuse. The intricate diagnostic challenges arising from the patient's complex medical history underscore the significance of a multidisciplinary approach. The absence of typical gastrointestinal symptoms and the presence of a tubo-ovarian abscess complicated the diagnosis of acute on chronic sigmoid diverticulitis and colo-ovarian fistula. Surgical intervention, including sigmoid resection, anastomosis and left salpingo-oophorectomy, led to successful resolution. This case highlights the need for further understanding of colo-ovarian fistula pathophysiology, improved diagnostic strategies, and the nuanced interplay between medical and psychiatric conditions in complex clinical scenarios.
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Affiliation(s)
- Meghan R Mansour
- Department of Medical Education, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, United States
| | - Steven A Kessler
- Department of Medical Education, Oakland University William Beaumont School of Medicine, Rochester Hills, MI 48309, United States
| | - Ali Khreisat
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48703, United States
| | - Justin K Skrzynski
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48703, United States
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Gopalan V, Baker WG, Albright S, Crawshaw M D B. A Rare Case of Diverticulitis With a Colo-Adnexal Fistula. Cureus 2023; 15:e47017. [PMID: 37965414 PMCID: PMC10642620 DOI: 10.7759/cureus.47017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Diverticulitis is a very common cause of hospitalization in the United States with fistula formation being a common complication. However, a fistula formation between the sigmoid colon and an ovary is an exceptional rarity. We present a case of a 22-year-old female with a colo-ovarian fistula misdiagnosed as a tubo-ovarian abscess after a recent episode of diverticulitis. Initial workup, imaging studies, and treatment ending with Hartmann's procedure with eventual colostomy reversal are described. A review of similar cases within the literature and fistulas is also presented.
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Affiliation(s)
- Varsha Gopalan
- Obstetrics and Gynecology, American University of Antigua, New York, USA
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41
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Fernandez Trokhimtchouk T, Morillo Cox Á, Flores LF, Reinoso Brito D, Andrade A. Coexistence of Acute Appendicitis and Sigmoid Diverticulitis. Cureus 2023; 15:e47642. [PMID: 38022345 PMCID: PMC10668632 DOI: 10.7759/cureus.47642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
In recent years, there has been a notable increase in acute diverticulitis cases, attributed to modern lifestyles and improved diagnostic techniques. We present a rare case of concurrent acute appendicitis and diverticulitis in a 35-year-old male who came to the emergency department with abdominal pain. While appendicitis typically requires surgery, diverticulitis is often managed conservatively. Computed tomography is key in diagnosis and decision-making. Despite their differing treatments, cases like this challenge the perception of their rarity. This case prompts consideration of multifocal abdominal pathology. Recognizing concurrent appendicitis and diverticulitis is crucial for guiding appropriate diagnostic and treatment strategies, potentially including non-operative management in select cases.
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Affiliation(s)
| | | | - Luis F Flores
- General Surgery, Universidad Internacional del Ecuador, Quito, ECU
| | | | - Andres Andrade
- General and Colorectal Surgery, Axxis Hospital, Quito, ECU
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Sahli H, Dahlbäck C, Lydrup ML, Buchwald P. Impact of previous diverticulitis on 5-year survival and recurrence rates in patients with colorectal cancer. Scand J Gastroenterol 2023; 58:1280-1285. [PMID: 37296500 DOI: 10.1080/00365521.2023.2221361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Diverticulitis and colorectal cancer (CRC) share epidemiological characteristics, but their relationship remains unknown. It is unclear if prognosis following CRC differ for patients with previous diverticulitis compared to those with sporadic cases and patients with inflammatory bowel disease or hereditary syndromes. AIM The aim was to determine 5-year survival and recurrence after colorectal cancer in patients with previous diverticulitis, inflammatory bowel disease and hereditary colorectal cancer compared to sporadic cases. METHODS Patients <75 years of age diagnosed with colorectal cancer at Skåne University Hospital Malmö, Sweden, between January 1st 2012 and December 31st 2017 were identified through the Swedish colorectal cancer registry. Data was retrieved from the Swedish colorectal cancer registry and chart review. Five-year survival and recurrence in colorectal cancer patients with previous diverticulitis were compared to sporadic cases, inflammatory bowel disease associated and hereditary colorectal cancer. RESULTS The study cohort comprised 1052 patients, 28 (2.7%) with previous diverticulitis, 26 (2.5%) IBD, 4 (1.3%) hereditary syndromes and 984 (93.5%) sporadic cases. Patients with a history of acute complicated diverticulitis had a significantly lower 5-year survival rate (61.1%) and higher recurrence rate (38.9%) compared to sporadic cases (87.5% and 18.8% respectively). CONCLUSION Patients with acute complicated diverticulitis had worse 5-year prognosis compared to sporadic cases. The results emphasize the importance of early detection of colorectal cancer in patients with acute complicated diverticulitis.
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Affiliation(s)
- Hannah Sahli
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Dahlbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marie-Louise Lydrup
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Alexandersson BT, Hugerth LW, Hedin C, Forsberg A, Talley NJ, Agreus L, Järbrink-Sehgal E, Engstrand L, Andreasson A, Schmidt PT. Diverticulosis is not associated with altered gut microbiota nor is it predictive of future diverticulitis: a population-based colonoscopy study. Scand J Gastroenterol 2023; 58:1131-1138. [PMID: 36987880 DOI: 10.1080/00365521.2023.2194010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The etiopathogenesis of diverticular disease is unknown. OBJECTIVE To compare the fecal and mucosa-associated microbiota between participants with and without diverticulosis and participants who later developed diverticulitis versus those that did not from a population-based study. METHODS The PopCol study, conducted in Stockholm, Sweden, invited a random sample of 3556 adults to participate, of which 745 underwent colonoscopy. Overall, 130 participants (17.5%) had diverticulosis. 16S rRNA gene sequencing was conducted on available sigmoid biopsy samples from 529 and fecal samples from 251 individuals. We identified individuals who subsequently developed acute diverticulitis up to 13 years after sample collection. In a case-control design matching for gender, age (+/-5 years), smoking and antibiotic exposure, we compared taxonomic composition, richness and diversity of the microbiota between participants with or without diverticulosis, and between participants who later developed acute diverticulitis versus those who did not. RESULTS No differences in microbiota richness or diversity were observed between participants with or without diverticulosis, nor for those who developed diverticulitis compared with those who did not. No bacterial taxa were significantly different between participants with diverticulosis compared with those without diverticulosis. Individuals who later developed acute diverticulitis (2.8%) had a higher abundance of genus Comamonas than those who did not (p = .027). CONCLUSIONS In a population-based cohort study the only significant difference was that those who later develop diverticulitis had more abundance of genus Comamonas. The significance of Comamonas is unclear, suggesting a limited role for the gut microbiota in the etiopathogenesis of diverticular disease.
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Affiliation(s)
| | - Luisa W Hugerth
- Department of Microbiology, Center for Translational Microbiome Research, CTMR, Tumour and Cell Biology (MTC), Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | - Charlotte Hedin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Gastroenterology unit, Stockholm, Sweden
| | - Anna Forsberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Lars Agreus
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ellionore Järbrink-Sehgal
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Michael E.DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lars Engstrand
- Department of Microbiology, Center for Translational Microbiome Research, CTMR, Tumour and Cell Biology (MTC), Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | - Anna Andreasson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Psychology, Macquarie University, New South Wales, Australia
| | - Peter T Schmidt
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Chait JS, Galli LD, Clark CJ. Indications for Operative Management of Complicated Duodenal Diverticula: A Review. Am Surg 2023; 89:3043-3046. [PMID: 36533836 DOI: 10.1177/00031348221146957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely require intervention. In recent years, surgical management has been restricted to patients with significant complicated sequelae, such as perforation, abscess, or fistula formation. We present the rare case of a perforated broad-based diverticulum in the third portion of the duodenum necessitating surgical correction. The patient presented with persistent symptoms following failure of conservative management and underwent surgical resection. Due to difficulty visualizing the extent of the diverticulum, a novel intraoperative technique of bowel insufflation via nasogastric tube was used allowing for elucidation of the diverticular borders and complete resection. Although DD are common, there exists no consensus on when operative intervention is indicated. Given that significant morbidity and mortality can be associated with symptomatic DD, a systematic way to guide management decisions is needed. After conducting a review of the literature, we propose that the modified Hinchey classification can be used not only to categorize duodenal diverticulitis but to guide treatment choice in cases with unclear risk benefit profiles.
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Affiliation(s)
- Joshua S Chait
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lucas D Galli
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Altman-Merino A, Bonnet K, Schlundt D, Wrenn J, Self WH, Gordon EJ, Hawkins AT. Complex Patient Perspectives on Evolving Diverticulitis Treatment Patient Perspectives on Diverticulitis. medRxiv 2023:2023.06.26.23291565. [PMID: 37425810 PMCID: PMC10327256 DOI: 10.1101/2023.06.26.23291565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Despite evidence that antibiotics may not be necessary to treat acute uncomplicated diverticulitis, they remain the mainstay of treatment in the United States. A randomized controlled trial evaluating antibiotic effectiveness could accelerate implementation of an antibiotic-free treatment strategy, but patients may be unwilling to participate. Objective This study aims to assess patients' attitudes regarding participation in a randomized trial of antibiotics versus placebo for acute diverticulitis, including willingness to participate. Design This is a mixed-methods study with qualitative and descriptive methods. Settings Interviews were conducted in a quaternary care emergency department and surveys were administered virtually through a web-based portal. Patients Patients with either current or previous acute uncomplicated diverticulitis participated. Interventions Patients underwent semi-structured interviews or completed a web-based survey. Main Outcome measures: Rates of willingness to participate in a randomized controlled trial was measured. Salient factors related to healthcare decision-making were also identified and analyzed. Results Thirteen patients completed an interview. Reasons to participate included a desire to help others or contribute to scientific knowledge. Doubts about the efficacy of observation as a treatment method were the main barrier to participation. In a survey of 218 subjects, 62% of respondents reported willingness to participate in a randomized clinical trial. "What my doctor thinks," followed by "What I've experienced in the past" were the most important decision-making factors. Limitations There is possible selection bias inherent to using a study to evaluate willingness to participate in a study. Also, the population sampled was disproportionately White compared to the population affected by diverticulitis. Conclusions Patients with acute uncomplicated diverticulitis maintain complex and varying perceptions of the use of antibiotics. Most surveyed patients would be willing to participate in a trial of antibiotics versus placebo. Our findings support a trial's feasibility and facilitate an informed approach to recruitment and consent.
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Affiliation(s)
| | | | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Jessie Wrenn
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN
- Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, TN
| | - Wesley H Self
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Nashville, TN
| | - Elisa J Gordon
- Vanderbilt University Medical Center, Department of Surgery, and Center for Biomedical Ethics and Society, Nashville, TN
| | - Alexander T Hawkins
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
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Chikaraishi K, Kaneko K, Kanai H, Kobayashi T, Tanabe Y. Emergency laparoscopic sigmoid colectomy with primary anastomosis for Hinchey stages III and IV diverticulitis. Asian J Endosc Surg 2023. [PMID: 37165303 DOI: 10.1111/ases.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/27/2022] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
For patients with perforated diverticulitis, many reports have focused on laparoscopic surgery without primary anastomosis. We performed laparoscopic surgery with primary anastomosis in three patients (two with Hinchey stage III, one with IV), with a median age of 53 years, all female, and no prior medical history. They all were hemodynamically stable. The median operation time was 91 minutes (range: 56-227 minutes) and the median blood loss was 50 mL (range: 0-200 mL). Their post-operative course was uneventful, and patients commenced oral intake at a median of 5 post-operative days and were discharged at a median of 12 post-operative days. This procedure may be an option for Hinchey stages III and IV diverticulitis.
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Affiliation(s)
| | | | - Hideki Kanai
- Shin-yurigaoka general hospital, Kawasaki-city, Japan
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Wang K, Atkinson M, Nyandoro MG, Biddle K, Lew LZW, Weber DG. Diagnosing the acute abdomen during a global contrast shortage: a single centre experience. ANZ J Surg 2023. [PMID: 37138498 DOI: 10.1111/ans.18463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to a global shortage of iodinated contrast media (ICM) in early 2022. ICM is used in more than half of the computed tomography of the abdomen and pelvis (CTAP) performed to diagnose an acute abdomen (AA). In response to the shortage, the RANZCR published contrast-conserving recommendations. This study aimed to compare AA diagnostic outcomes of non-contrast CTs performed before and during the shortage. METHODS A single-centre retrospective observational cohort study of all adult patients presenting with an AA who underwent a CTAP was conducted during the contrast shortage period from May to July 2022. The pre-shortage control comparison group was from January to March 2022; key demographics, imaging modality indication and diagnostic outcomes were collected and analysed using SPSS v27. RESULTS Nine hundred and sixty-two cases met the inclusion criteria, of which n = 502, 52.2% were in the shortage period group. There was a significant increase of 464% in the number of non-contrast CTAPs performed during the shortage period (P < 0.001). For the six AA pathologies, only n = 3, 1.8% of non-contrast CTAPs had equivocal findings requiring further imaging with a contrast CTAP. Of the total CTs performed, n = 464, 48.2% were negative. CONCLUSION This study showed that when non-contrast CTs are selected appropriately, they appear to be non-inferior to contrast-enhanced CTAPs in diagnosing acute appendicitis, colitis, diverticulitis, hernia, collection, and obstruction. This study highlights the need for further research into utilizing non-contrast scans for assessing the AA to minimize contrast-associated complications.
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Affiliation(s)
- Katie Wang
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Mitchell Atkinson
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Kirsten Biddle
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Leslie Zhi Wei Lew
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dieter G Weber
- General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Tong JKC, Mascuilli T, Wirtalla C, Aarons CB, Saur NM, Mahmoud NN, Kelz RR. Exploring ethnic differences in post-discharge patterns of surgical care for older adults admitted with diverticulitis. Colorectal Dis 2023; 25:1006-1013. [PMID: 36655392 PMCID: PMC10257996 DOI: 10.1111/codi.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/11/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
AIM We aimed to evaluate ethnic differences in patterns of care following an index nonoperative admission for acute diverticulitis amongst a universally insured patient cohort. METHODS We identified nationwide Medicare beneficiaries aged 65.5 years or older hospitalized between 1 July 2015 and 1 November 2017 for nonoperative management of an index admission for diverticulitis. Patients were followed for 1 year to examine patterns of care. Primary categorical outcomes included receipt of an elective operation, emergency operation, nonoperative readmission or no further hospitalizations for diverticulitis. Multinomial regression was performed to determine the association between ethnicity and receipt of each primary outcome category whilst adjusting for potential confounders. We examined the use of percutaneous drainage during the index admission to better understand its association with subsequent care patterns. RESULTS Amongst 22 630 study patients, subsequent operative treatment was less common for Black, Hispanic, Asian and American Indian patients relative to White patients. Multinomial logistic regression noted that Black (relative risk 0.40; 95% CI 0.32-0.50) and Asian (relative risk 0.37; 95% CI 0.15-0.91) patients were associated with the lowest relative risk of undergoing an elective interval operation compared to White patients. Black patients were also associated with a 1.43 (95% CI 1.19-1.73) increased risk of requiring subsequent nonoperative readmissions for disease recurrence compared to White patients. The use of percutaneous drainage was higher amongst White patients relative to Black patients (6.9% vs. 4.0%, P value < 0.001). CONCLUSION We have identified ongoing inequities in the consumption of medical resources, with White patients being more likely to undergo elective colectomy and percutaneous drainage. Differences in care are not fully alleviated by equal access to insurance.
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Affiliation(s)
- Jason K C Tong
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinicians Scholars Veterans Affairs Fellow, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tory Mascuilli
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Wirtalla
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cary B Aarons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole M Saur
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Najjia N Mahmoud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Polese B, Carabotti M, Rurgo S, Ritieni C, Sarnelli G, Barbara G, Pace F, Cuomo R, Annibale B. Patients with Diverticular Disease Have Different Dietary Habits Compared to Control Subjects: Results from an Observational Italian Study. Nutrients 2023; 15:2119. [PMID: 37432301 PMCID: PMC10180998 DOI: 10.3390/nu15092119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 07/12/2023] Open
Abstract
The role of dietary habits as risk factor for the development of diverticular complications has strongly emerged in the last years. We aimed to evaluate possible differences in dietary habits between patients with diverticular disease (DD) and matched controls without diverticula. Dietary habits were obtained from standardized food frequency questionnaires collected at entry to the Diverticular Disease Registry (REMAD). We compared controls (C) (n = 119) with asymptomatic diverticulosis (D) (n = 344), symptomatic uncomplicated diverticular disease (SUDD) (n = 154) and previous diverticulitis (PD) (n = 83) patients, in terms of daily calories, macro and micronutrients and dietary vitamins. Daily kcal intake and lipids, both saturated and unsaturated, were significantly lower in patients with DD than C. Total protein consumption was lower in PD than D, with differing consumption of unprocessed red meat, white meat and eggs between groups. Consumption of fibre, both soluble and insoluble, was lower in patients with PD compared to patients with SUDD, D and C, whereas dietary vitamins A, C, D and E and Oxygen Radical Adsorbance Capacity index were lower in all DD groups compared to C. This observational study showed that DD patients have different dietary habits, mainly in terms of caloric, fat, fibre and vitamin intake, compared to control subjects.
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Affiliation(s)
- Barbara Polese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (B.P.); (S.R.); (G.S.)
| | - Marilia Carabotti
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy; (C.R.); (B.A.)
| | - Sara Rurgo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (B.P.); (S.R.); (G.S.)
| | - Camilla Ritieni
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy; (C.R.); (B.A.)
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (B.P.); (S.R.); (G.S.)
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Fabio Pace
- Complex Operative Unit (UOC) of Gastroenterology, Bolognini Hospital, 24068 Seriate, Italy;
| | - Rosario Cuomo
- UOC of Gastroenterology, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy; (C.R.); (B.A.)
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50
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Kwon LM, Lee K, Kim MJ, Lee IJ, Kim GC. Acute Ileal Diverticulitis: Computed Tomography and Ultrasound Findings. Diagnostics (Basel) 2023; 13:diagnostics13081408. [PMID: 37189509 DOI: 10.3390/diagnostics13081408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Acute ileal diverticulitis is a rare disease mimicking acute appendicitis. Inaccurate diagnosis with a low prevalence and nonspecific symptoms leads to delayed or improper management. METHODS This retrospective study aimed to investigate the characteristic sonographic (US) and computed tomography (CT) findings with clinical features in seventeen patients with acute ileal diverticulitis diagnosed between March 2002 and August 2017. RESULTS The most common symptom was abdominal pain (82.3%, 14/17) localized to the right lower quadrant (RLQ) in 14 patients. The characteristic CT findings of acute ileal diverticulitis were ileal wall thickening (100%, 17/17), identification of inflamed diverticulum at the mesenteric side (94.1%, 16/17), and surrounding mesenteric fat infiltration (100%, 17/17). The typical US findings were outpouching diverticular sac connecting to the ileum (100%, 17/17), peridiverticular inflamed fat (100%, 17/17), ileal wall thickening with preserved layering pattern (94.1%, 16/17), and increased color flow to the diverticulum and surrounding inflamed fat on color Doppler imaging (100%, 17/17). The perforation group had a significantly longer hospital stay than non-perforation group (p = 0.002). In conclusion, acute ileal diverticulitis has characteristic CT and US findings that allow radiologists to accurately diagnose the disease.
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Affiliation(s)
- Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu 41404, Republic of Korea
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