Diverticulitis: An update from the age old Paradigm

Hawkins, Alexander T.; Wise, Paul E.; Chan, Tiffany; Lee, Janet T.; Glyn, Tamara; Wood, Verity; Eglinton, Timothy; Frizelle, Frank; Khan, Adil; Hall, Jason F.; Ilyas, Mohammed Iyoob Mohammed; Michailidou, Maria; Nfonsam, Valentine; Cowan, Michelle L.; Williams, Jennifer; Steele, Scott R.; Alavi, Karim; Ellis, C. Tyler; Collins, Danielle; Winter, D. C.; Zaghiyan, Karen; Gallo, Gaetano; Carvello, Michele; Spinelli, Antonino; Lightner, Amy L.

doi:10.1016/j.cpsurg.2020.100863

Cited by 30 publications

(34 citation statements)

References 381 publications

(64 reference statements)

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“…AD is the most common complication of diverticulosis. 15 In the Western world, AD affecting the left side of the colon predominates, and right-sided AD is uncommon. 3,16,17 The epidemiology of RCD and AD show marked geographic variation, and has changed in recent decades.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

Turner

O’Grady

Senadeera

et al. 2021

ANZ Journal of Surgery

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Background: Once considered to be a congenital condition, the epidemiology of rightsided colonic diverticulosis (RCD) is evolving. Acute diverticulitis (AD) is a complication of RCD which is frequently misdiagnosed as appendicitis, resulting in unnecessary surgery, as there is strong evidence supporting medical management for right-sided AD. In general, the incidence of AD correlates with the prevalence of RCD, which shows marked geographic variation. Few data reporting RCD prevalence come from Western countries, so the aim of this study is to define the prevalence of RCD in a New Zealand population. Methods: Independent review of the imaging from 1000 consecutive patients undergoing a computed tomography Kidney/Ureter/Bladder scan for suspected urolithiasis at Christchurch Hospital between January and November 2017 was undertaken, to determine the presence or absence, and distribution of colonic diverticulosis. Patients were excluded if they had a history of colonic resection, known IBD, or were less than 18-years old.Results: Thirty-one patients were excluded, leaving 969 eligible patients. Overall, 95 patients (9.8%) had RCD identified. The prevalence of RCD increased significantly with advancing age, being present in 2.3% of those aged 18-29, increasing to 20.3% in those greater than 70-years old (p < 0.001). Conclusion:The prevalence of RCD in a New Zealand population is relatively high and increases significantly with age. This adds support to the role of cross-sectional imaging in the evaluation of suspected appendicitis, to exclude right-sided AD. The association with advancing age supports RCD being an acquired condition rather than a congenital condition as was previously thought.

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Section: Discussionmentioning

confidence: 99%

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

Turner

O’Grady

Senadeera

et al. 2021

ANZ Journal of Surgery

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“…Mariana Morales-Cruz 1 * and Paulina Moctezuma Velázquez 2 1 Department of Colorectal Surgery, Queen Elizabeth Hospital, Birmingham, UK 2 Hospital ABC, Ciudad de México, Mexico *Address all correspondence to: marmocru@gmail.com uncomplicated disease; further investigation in different populations and world regions is needed. More supervision on antibiotic prescription needs to be encouraged in patients who receive therapy for acute diverticulitis to make a cost-effect analysis for each case [50].…”

Section: Author Detailsmentioning

confidence: 99%

“…Lifestyle and Western diet seem to be the factors influencing this epidemiological change, increasing most dramatically among age groups between 18 and 64 years old. Amid young patients, diverticular disease is more common in men, while in the elderly population, the prevalence is similar between both sexes [2]. Diverticular disease can occur in any part of the colon, but the left side is more frequently affected in Western countries, while up to 70% of cases in Asia appear on the right side [3].…”

Section: Introductionmentioning

confidence: 99%

The Use of Antibiotics in Diverticulitis: An Update in Non-operative Management

Morales-Cruz¹,

Velázquez²

2022

Diverticular Disease of the Colon - Recent Knowledge of Physiopathology, Endoscopic Approaches, Clinical and Surgical Treatment

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Diverticulosis is a common disease among Western and developed nations. Approximately 20% of patients with diverticulosis will become symptomatic. Acute diverticulitis is a common manifestation of diverticular disease. Different classifications exist to try to categorize it but, it is generally considered as complicated or uncomplicated. Eighty-five percent of patients with an acute onset of diverticulitis will have an uncomplicated presentation. The best way to assess the degree and severity of the disease is a CT scan along with some biochemical parameters like CRP. Recent guidelines from associations all over the world accept non-antibiotic therapy as a valid strategy of treatment for the non-complicated diverticulitis. Antibiotics are still compulsory in immune-compromised patients, the elderly, those with comorbidities, and those with signs of sepsis. Recommendations should be made on a case-by-case basis.

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“…These small areas, where the usually firm muscle layers are perforated, offer a way for the mucosa and submucosa of the colon to protrude outwards, thus forming a colonic diverticulum [1]. The combination of western style diet (low daily fibre intake) and disordered motility of the bowel, which both contribute to increased intraluminal pressure in the colon are among the main proposed aetiological factors in the formation of diverticula [1,2]. It was once widely considered that diverticulitis occurs because of obstruction of diverticula that eventually leads to microtrauma, ischaemia, infection and even perforation.…”

Section: Pathophysiology Aetiology and Epidemiologymentioning

confidence: 99%

Management of acute colonic diverticulitis in the general and surgical emergency departments

2021

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Acute left colonic diverticulitis is a very common disease that primarily affects the older population in the Western world. The pathogenesis of acute inflammation of the diverticula may not be as simple as once thought, and the disease cascade could involve a combination of chronic inflammation and altered gut microbiota. Several lifestyle risk factors such as obesity, low-fibre diet, smoking, use of non-steroid anti-inflammatory drugs, inadequate physical activity and others have been associated with a higher risk for diverticulitis. It has been proven that uncomplicated diverticulitis in immunocompetent patients without systemic signs of infection can be treated symptomatically. Outpatient treatment with peroral antibiotics is effective for managing patients with uncomplicated diverticulitis and signs of systemic inflammation. New, less- invasive surgical options have been recognised as appropriate for a select group of patients with complicated diverticulitis. Laparoscopic lavage and drainage are suitable for abscesses where the bowel wall is intact. Resection with primary anastomosis with or without ileostomy is now considered an option for some patients that would historically have to undergo Hartmann’s procedure. The latter still remains the most common operating option even in tertiary referral centres around the world as it is suitable for more complicated cases and critically ill patients. Current evidence does not support routine colonoscopic evaluation for uncomplicated diverticulitis in younger patients without risk factors. Recurrent diverticulitis is now understood to be more benign than was previously thought. Elective resection of the sigmoid colon is therefore no longer a standard treatment for all patients with two or more episodes of acute diverticulitis.

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Diverticulitis: An update from the age old Paradigm

Cited by 30 publications

References 381 publications

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

The prevalence of right‐sided colonic diverticulosis in a New Zealand population

The Use of Antibiotics in Diverticulitis: An Update in Non-operative Management

Management of acute colonic diverticulitis in the general and surgical emergency departments

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