Current Controversies in the Management of Diverticulitis: A Review

Abstract

Background: Symptomatic diverticular disease is challenging for patients, clinicians and health services. The prevalence increases with age and BMI and as such, the burden of this disease is set to increase with higher rates of acute presentations already documented. The natural history of recurrent episodes, complications and symptom progression is not fully understood. Furthermore, medical and surgical management strategies are under constant appraisal, debate and evolution. Methods: A review of the contemporary literature was performed to examine the emerging trend towards conservative treatment. Results: Routine use of in-patient, intravenous antibiotics may not be required and outpatient management is possible for certain patients. Universal colonoscopy examination after uncomplicated acute diverticulitis is controversial but is mandatory after complicated episodes. Recent, high-profile, clinical trials suggest that less aggressive surgical management of both acute and chronic presentations may be feasible in some cases. Conclusions: Diverticulitis is a common yet challenging topic that demands clinicians to provide an individualised yet evidence-based approach.

Metabolic Syndrome Exponentially Increases the Risk of Adverse Outcomes in Operative Diverticulitis

“…Another important question remains whether a primary anastomosis should be performed or a Hartmann procedure subsequently. 33 There are several studies supporting the use of either type of intervention [34][35][36] but how the risk-benefit ratio would be altered when factoring in MS is not clear and there is a lack of randomized trials addressing this specific question.…”

Colonoscopy Should Be Performed After an Episode of Uncomplicated Diverticulitis

“…As reported by Nally and Kavanagh [1], in a systematic review and meta-analysis, Sharma et al [2] found a pooled prevalence of colorectal cancer of 0.7% (95% CI 0.3-1.4%) in 1,497 patients (8 studies) with uncomplicated diverticulitis who underwent endoscopy. In a systematic review and meta-analysis performed this year, we found a pooled prevalence of colorectal cancer of 1.3% (95% CI 0.1-2.0%) among 3,834 patients (15 studies) with uncomplicated episodes [3].…”

“…We read with interest the review article by Nally and Kavanagh [1] about the current controversies in the management of diverticulitis. In a section about follow-up colonoscopy, the authors recommended that endoscopic evaluation be performed after an episode of complicated diverticulitis to rule out colorectal cancer, but considered the indication for colonoscopy to be debatable in patients with uncomplicated episodes.…”

Manejo Conservador en Diverticulitis Aguda Perforada Con Aire Extraluminal

“…Considerando esta realidad, la tendencia actual es un abordaje menos invasivo para la DC; varios autores y algunas guías clínicas dan cuenta de esta afirmación [5][6][7][8][9] . Una situación especial constituye la DA perforada asociada a neumoperitoneo y/o burbujas extracolónicas.…”

“…El tratamiento óptimo de la diverticulitis aguda complicada es materia de debate, si bien la mayoría de las guías clínicas recomienda la sigmoidectomía de urgencia, la tendencia actual es evitar la emergencia quirúrgica a través de terapias menos invasivas con un claro beneficio en morbimortalidad [5][6][7][8][9] . En este contexto publicaciones recientes plantean que el manejo no quirúrgico de pacientes con diverticulitis perforada con aire extraluminal (DPA) es una alternativa terapéutica controversial, que en casos seleccionados puede ofrecer buenos resultados y evitar la necesidad de una ostomía [10][11][12][13][14][15] .…”