Diverticulitis: An Update From the Age Old Paradigm

Abstract

Monograph In BriefFor a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history-acute, chronic and recurrent.To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Diverticular disease was rarely described in the literature prior to the 1900's. In the late 1960's and early 1970's, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Previous surgical guidelines focused on

The Diverticular Disease Registry (DDR Trial) by the Advanced International Mini-Invasive Surgery Academy Clinical Research Network: Protocol for a Multicenter, Prospective Observational Study

“…Therefore, high-quality evidence is limited, and frequently recommendations have low levels of evidence. Moreover, the decisionmaking process for DD treatment is determined on a case-by-case basis according to the different clinical presentations, settings, surgeon expertise, and patient preferences [15]. In addition, the decision for elective surgery for SUDD or smouldering diverticular disease (SDD) truly belongs to a clinical grey zone that needs to be clarified.…”

“…Moreover, different surgical treatments have been proposed [8][9][10][11][12], while the surgical approach has been shifting to a minimally invasive approach even in the emergency setting [13,14]. Indeed, population, natural history, presentation, severity, and treatment for DD are heterogeneous, and optimal care for patients with DD needs highquality evidence from large cohort studies [15]. Initial experiences of registry on DD recently appeared in the literature [16][17][18], suggesting the genesis of networks dedicated to DD as the best feasible way to strengthen clinical evidence.…”

Metformin Reduces the Risk of Diverticula of Intestine in Taiwanese Patients with Type 2 Diabetes Mellitus

“…Overt inflammation subsequent to obstruction, trauma, ischemia, microperforation and infection of diverticula may cause acute diverticulitis with clinical manifestations of abdominal pain and bleeding ( Strate and Morris, 2019 ; Piscopo and Ellul, 2020 ). The lifetime risk of developing diverticulitis in patients with diverticula is approximately 10–25% ( Hawkins et al, 2020 ). Complications occur in approximately 12% of the patients with diverticulitis and may include abscess, perforation, peritonitis, stricture, obstruction and/or fistula ( Strate and Morris, 2019 ; Tursi et al, 2020 ).…”

Radiologic predictors for failure of non-operative management of complicated diverticulitis: a single-centre cohort study

“…Acute diverticulitis is a common and but potentially life-threatening inflammatory disease mostly of the sigmoid or descending colon of the older population. Clinical practice guidelines have gone through multiple changes during recent years [ 1 , 2 ]. While cases with free perforations and generalized peritonitis require emergency surgery [ 3 ], in cases with contained perforation, represented by localized intraabdominal air or abscess formation, the approach is primarily conservative.…”