Changing Patterns in the Surgical Treatment of Diverticular Disease

Rodkey, Grant V.; Welch, Claude E.

doi:10.1097/00000658-198410000-00008

Cited by 177 publications

(91 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our patients' response to this modality was similar to that in the literature [17][18][19]. After discharge from the hospital only 42% completed long-term follow-up.…”

Section: Discussionsupporting

confidence: 85%

Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait

Elsayed¹,

Juma²,

Al‐Sayer³

1999

Med Princ Pract

View full text Add to dashboard Cite

Objective: To evaluate the diagnostic and therapeutic modalities of all patients admitted to a hospital over a period of time. Methods: Review of the medical files of 60 cases of colonic diverticulitis seen over a period of 5 years at the Amiri Hospital, Kuwait, which serves a population of about 150,000. Results: Two thirds of our patients were females. The age at presentation was lower (56.6 year) than in the West. The commonest presenting manifestation was left iliac fossa pain and tenderness. Plain abdominal X-ray and an erect chest X-ray were the most valuable diagnostic tools. Ultrasound scan was helpful in percutaneous drainage of pericolic abscesses. Combined CT scan with water-soluble enemas is recommended once the patient’s condition is stable. Conclusion: The majority of conservatively managed patients responded well to treatment. Surgery should be reserved for those presenting with generalized peritonitis (6/60), for the very few who do not respond to the conservative modality (4/54), or those who come back with recurrent diverticulitis.

show abstract

“…Our patients' response to this modality was similar to that in the literature [17][18][19]. After discharge from the hospital only 42% completed long-term follow-up.…”

Section: Discussionsupporting

confidence: 85%

Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait

Elsayed¹,

Juma²,

Al‐Sayer³

1999

Med Princ Pract

View full text Add to dashboard Cite

show abstract

“…Following successful conservative therapy for a first attack of diverticulitis, approximately one-third of patients will remain asymptomatic, one-third will have episodic abdominal cramps without frank diverticulitis, and one-third will proceed to a second attack of diverticulitis [1,18,47,48,49]. For several years pertinent literature claimed that after 2 attacks of uncomplicated diverticulitis, at each further episode there was progressively a higher probability of recurrent attacks with less chances of response to medical treatment and an increasing risk of complicated diverticulitis as high as 60% with a doubling of the mortality rate.…”

Section: Risk Of Severe Complicationsmentioning

confidence: 99%

Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

View full text Add to dashboard Cite

Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25–35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2–14% and a risk of stoma and related death of 0–2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them.

show abstract

“…This difference in incidence of ACD between men and women has been noticed in other countries as well. Patients younger than 50 years of age with ACD are predominantly men, whereas in the age group of 50-70 years there seems to be a preference for women [7,8,9,10,11]. Patients with mild (recurrent) diverticulitis are usually treated by a general practitioner or on an outpatient basis, which makes it difficult to accurately determine the true incidence and recurrence rates of diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

View full text Add to dashboard Cite

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

show abstract

Changing Patterns in the Surgical Treatment of Diverticular Disease

Cited by 177 publications

References 28 publications

Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait

Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait

Clinical Presentation and Risks

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Contact Info

Product

Resources

About