Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis

Duarte-Chavez, Rodrigo; Stoltzfus, Jill; Yellapu, Vikas; Martins, Noel; Nanda, Sudip; Longo, Santo; Geme, Berhanu; Schneider, Yecheskel

doi:10.1007/s00384-020-03736-2

Cited by 8 publications

(7 citation statements)

References 54 publications

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“…With the wide use of steroid-free immunosuppression as well as high noncompliance rate of steroid usage, it is hard to quantify the degree of immunosuppression among those patients. 12,15 We did not have sufficient follow-up data to monitor the long-term recurrence rate, its associated necessity for emergent operation, or percentages of patients undergoing definitive elective colectomy. This study was designed to address the safety and feasibility of trialing nonoperative approach for acute uncomplicated diverticulitis and complicated diverticulitis with abscess in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience

Etzioni

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Acute diverticulitis in immunocompromised patients is associated with high morbidity and mortality rates with either medical or surgical treatment. Thus, management approach is controversial, especially for patients presenting with nonperforated disease. OBJECTIVE: This study aimed to report the Mayo clinic experience of acute diverticulitis management in immunocompromised patients. DESIGN: This design is based on a retrospective cohort study. SETTING: This study was conducted with institutional data composed from 3 tertiary referral centers. PATIENTS: Immunocompromised patients presenting with acute diverticulitis at 3 Mayo clinic sites between 2016 and 2020 were included. MAIN OUTCOME MEASURES: The main outcome measures were the management algorithm and short-term outcomes. RESULTS: Immunocompromised patients presenting with acute uncomplicated diverticulitis (86) were all managed nonoperatively at presentation with a success rate of 93% (80/86). Two patients (2.3%, 2/86) required surgery during the same admission, and 4 patients (4.8%, 4/84) had 30-day readmission. Complicated diverticulitis patients with abscess (22) were all managed nonoperatively first with a success rate of 95.4% (21/22). One patient (4.6%, 1/22) required surgery during the same admission. All the patients who presented with obstruction (2), fistula (1), or free perforation (11) underwent surgery except one who chose hospice. Overall, the major complication rate was 50% (8/16) and mortality rate was 18.8% (3/16) among patients who underwent surgery during the same admission. For patients who presented with perforated diverticulitis, the mortality rate was 27.3% (3/11), compared with 0% (0/111) for patients who presented with nonperforated disease. LIMITATIONS: This cohort was limited by its retrospective nature and heterogeneity of the patient population. CONCLUSIONS: Nonoperative management was safe and feasible for immunocompromised patients with colonic diverticulitis without perforation at our center. Perforated colonic diverticulitis in immunocompromised patients was associated with high morbidity and mortality rate. See Video Abstract at http://links.lww.com/DCR/B988. MANEJO DE LA DIVERTICULITIS AGUDA EN PACIENTES INMUNOCOMPROMETIDOS: EXPERIENCIA DE LA CLINICA MAYO ANTECEDENTES: La diverticulitis aguda en pacientes inmunocomprometidos se asocia con una alta tasa de morbilidad y mortalidad con el tratamiento médico o quirúrgico. Por lo tanto, el enfoque de manejo es controvertido, especialmente para pacientes que presentan enfermedad no perforada. OBJETIVO: El propósito fue informar la experiencia de la clínica Mayo en el manejo de la diverticulitis aguda en pacientes inmunocomprometidos. DISEÑO: Este es un estudio de cohorte retrospectivo ENTORNO CLÍNICO: Este estudio se realizó con datos institucionales compuestos de tres centros de referencia terciarios. PACIENTES: Se incluyeron pacientes inmunocomprometidos que presentaron diverticulitis aguda en tres sitios de la clínica Mayo entre 2016 y 2020. RESULT...

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Section: Discussionmentioning

confidence: 99%

Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience

Etzioni

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…They suggested that colonic perforation might be caused by renal cyst infection, but they could not prove that it involved the diverticulum [ 6 ]. Duarte-Chavez et al found that colonic diverticulosis, diverticulitis, and diverticular bleeding are considerably more common in patients with ADPKD than in the general population and that colonic surgery was less prevalent in those patients with diverticulitis [ 7 ]. The group found higher odds ratios for diverticular disease in patients with non-steroidal anti-inflammatory drug use, hypertension, constipation, and ADPKD, but did not find a relation between intestinal perforation and diverticulosis [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Duarte-Chavez et al found that colonic diverticulosis, diverticulitis, and diverticular bleeding are considerably more common in patients with ADPKD than in the general population and that colonic surgery was less prevalent in those patients with diverticulitis [ 7 ]. The group found higher odds ratios for diverticular disease in patients with non-steroidal anti-inflammatory drug use, hypertension, constipation, and ADPKD, but did not find a relation between intestinal perforation and diverticulosis [ 7 ]. In summary, no specific data have been reported on the relationship between intestinal diverticulosis and intestinal perforation.…”

Section: Discussionmentioning

confidence: 99%

Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease

et al. 2022

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We herein report a case of enterocutaneous fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 37-year-old Japanese man was admitted to our hospital. Three months prior to transfer to our hospital, he developed intense flank pain with gross hematuria. His serum creatinine had decreased to 7.8 mg/dL and hemodialysis was started, but gross hematuria persisted and he developed hypotension. Upon admission, plain chest radiography did not reveal any free air, but computed tomography (CT) showed generalized ventral subcutaneous air from the head to the lower extremities and enlarged kidneys. Enterography showed leakage of contrast medium from the descending colon into the subcutaneous area. C-reactive protein was 23.1 mg/dL. A colostomy was placed in the transverse colon proximal to the perforation, and systemic subcutaneous drainage was performed. The fever subsequently resolved, and the C-reactive protein test became negative. Three months later, renal artery embolization was performed, and 12 months thereafter, CT showed a marked decrease in kidney size. We assume that a markedly enlarged kidney leaded to intestinal perforation, which developed into an enterocutaneous fistula. Consequently, intestinal fluid leaked into the subcutaneous cavity of the abdominal wall and spread systemically, resulting in extensive subcutaneous abscesses.

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“…A recent large retrospective study found that prevalence of diverticulosis was higher in patients with an ADPKD diagnosis, compared with those without, with a median age at onset of 64 years, compared with 72 years in those without an ADPKD diagnosis. 51 Diverticulitis was also more prevalent in those patients with an ADPKD diagnosis, with a higher prevalence of diverticulitis in patients with an ADPKD diagnosis and a kidney transplant, compared with patients with a kidney transplant and no ADPKD diagnosis. 51 It is reasonable, therefore, to have a high degree of suspicion for diverticular complications particularly in older patients or patients with ESKD from ADPKD.…”

Section: Diverticulosis and Herniasmentioning

confidence: 97%

“… 51 Diverticulitis was also more prevalent in those patients with an ADPKD diagnosis, with a higher prevalence of diverticulitis in patients with an ADPKD diagnosis and a kidney transplant, compared with patients with a kidney transplant and no ADPKD diagnosis. 51 It is reasonable, therefore, to have a high degree of suspicion for diverticular complications particularly in older patients or patients with ESKD from ADPKD.…”

Section: Diverticulosis and Herniasmentioning

confidence: 97%

Beyond Loss of Kidney Function: Patient Care in Autosomal Dominant Polycystic Kidney Disease

Hogan,

Simmons,

Ullman

et al. 2023

Kidney360

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Patients with autosomal dominant polycystic kidney disease benefit from specialized care over their lifetimes, starting with diagnosis of the condition with ongoing discussion of both the renal course and extra-renal issues. Both renal and extra-renal issues may continue to cause major morbidity even after successful kidney transplant or initiation of RRT, and extra-renal disease aspects should always be considered as part of routine management. In this review, we will focus on updates in pain/depression screening, cardiac manifestations, liver and pancreatic cysts, kidney stone management, and genetic counseling. In some instances, we have shared our current clinical practice rather than an evidence-based guideline. We anticipate more standardization of care after the release of the Kidney Disease Improving Global Outcomes guidelines for management in autosomal dominant polycystic kidney disease later this year.

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Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis

Cited by 8 publications

References 54 publications

Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience

Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience

Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease

Beyond Loss of Kidney Function: Patient Care in Autosomal Dominant Polycystic Kidney Disease

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