Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach?

Association between diverticular disease requiring surgical intervention and mortality in the postlung transplant population ‐ a retrospective cohort study

“…In our cohort, 10% of patients required surgery for complicated diverticular disease. This rate is consistent with previous investigations of patients with diverticular disease post‐transplantation which have found surgical rates varying from 4.5% (8) , to as high as 40% . This increase in complicated diverticular disease following transplant is significantly higher than what has been described in the general population.…”

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

“…16,21,27,28 In one of the included studies, postoperative mortality was defined as mortality during postoperative hospital stay following index operation. 12 Secondary outcomes included (1) 30-day postoperative morbidity following both emergent and elective surgery; (2) mean length of stay (LOS) following index operation for diverticular disease in either the emergent or elective setting; (3) rate of emergent operation; (4) rate of ostomy formation at index operation; and (5) type of operation (i.e. Hartmann's procedure, sigmoid resection with primary anastomosis, sigmoid resection with primary anastomosis and proximal diversion, etc.).…”

“…16,26 Whereas one of the studies included patients regardless of previous attacks of diverticulitis. 12 The remaining eight studies did not report whether included patients had a medical history significant for diverticular disease. The most common reported sources of immunosuppression were corticosteroids (n ¼ 1,426, 47.9%), status-post transplant (n ¼ 1,343, 45.1%), malignancy (n ¼ 82, 2.8%), chemotherapy (n ¼ 44, 1.5%), and other immunosuppressive pharmacological agents (n ¼ 109, 3.7%).…”

“…Mortality rates in patients initially managed nonoperatively in the remaining three studies ranged from 5.9% to 20%. 12,15,21…”

“…3,11e14 Moreover, immunosuppressed patients fail medical management in up to 60% of cases and have increased risk of mortality with medical management only. 11,12,15,16 Elective resection was identified as an important consideration in past American Society of Colon and Rectum Surgeons (ASCRS) guidelines for immunocompromised patients following a single episode of acute colonic diverticulitis. 7 However, the most recent ASCRS guidelines concluded that upon further review of the available literature, an overall lack of compelling evidence exists to suggest routine elective resection.…”