CT and Clinical Features of Acute Diverticulitis in an Urban U.S. Population: Rising Frequency in Young, Obese Adults

Zaidi, Eram; Daly, Barry

doi:10.2214/ajr.05.0033

Cited by 71 publications

(52 citation statements)

References 15 publications

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“…Moreover, nerve entrapment, encountered in 3.7% of Pfannenstiel incisions, could account for disabling postoperative pain [26]. While no additional skin incision except the trocar ports are needed for TLCCA, there is a nonnegligible gain of cosmesis as more sigmoidectomies for diverticular disease are performed in younger patients due to disease epidemiology [27]. The only modification in terms of skin incision is a slight enlargement of the right iliac fossa port opening such as a small McBurney incision, which has the advantage of having a low incisional hernia prevalence of 0.1% [28].…”

Section: Discussionmentioning

confidence: 99%

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

et al. 2007

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Section: Discussionmentioning

confidence: 99%

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

et al. 2007

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“…Patients with immune deficiency caused by HIV infection, diabetes, malignancy or chemotherapy do not have an increased risk of complicated diverticulitis (level C [47,48]). Some reports indicate an increased risk of ACD in obese patients, but evidence is inconsistent (level B [49] and level C [50,51]).…”

Section: Special Patient Groupsmentioning

confidence: 99%

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

Andeweg¹,

Mulder²,

et al. 2013

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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.

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“…On CT images, SAD was measured as the distance between the anterior and posterior skin on one cross--sectional scan obtained at the level of the fourth lumbar vertebra [13,27]. TAD was measured on the outer borders of the body outline from the right side to the left side at the widest point and the same vertebral level [3,13].…”

Section: Anthropometric Measurementsmentioning

confidence: 99%

Volumetric evaluation of fat in the renal sinus in normal subjects using stereological method on computed tomography images and its relationship with body composition

et al. 2014

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CT and Clinical Features of Acute Diverticulitis in an Urban U.S. Population: Rising Frequency in Young, Obese Adults

Cited by 71 publications

References 15 publications

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

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

Volumetric evaluation of fat in the renal sinus in normal subjects using stereological method on computed tomography images and its relationship with body composition

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