Elective resection for diverticular disease of the sigmoid colon

Moreaux, J; Vons, C.

doi:10.1002/bjs.1800770927

Cited by 66 publications

(47 citation statements)

References 11 publications

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“…Thus, given the lack of efficacy of antibiotics and surgical resolution of pain, we recommend surgical intervention promptly in those patients presenting with atypical or chronic/smoldering symptoms in which all other diagnoses have been excluded. Similar to our results, Moreaux et al [21] reported the outcome of 72 patients who underwent sigmoid resection for chronic symptoms. As in our series, unsuspected abscess was discovered in 24 patients and symptoms of pain resolved in 59 patients.…”

Section: Introductionsupporting

confidence: 82%

Prophylactic Resection, Uncomplicated Diverticulitis, and Recurrent Diverticulitis

Wolff

Boostrom²

2012

Dig Dis

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The classifications of acute uncomplicated diverticulitis and complicated diverticulitis have served us well for many years. However, in recent years, we have noted the prevalence of variations of uncomplicated diverticulitis, which have not precisely fit under the classification of ‘acute resolving uncomplicated diverticulitis’, which manifests itself with the typical left lower quadrant pain, fever, diarrhea, elevated white blood count, and CT findings, such as stranding, and which resolves fairly promptly and completely on oral antibiotic therapy. For these other variations, we would suggest we use the term chronic diverticulitis, as a subset of uncomplicated diverticulitis, meaning there is no abscess, stricture, or fistula, but the episode does not respond to the usual antibiotic treatment, and there is a rebound symptomatology once the treatment has stopped, or there is continuing subliminal inflammation that continues, typically, for several weeks after the initial episode without complete resolution. This variation could also be termed ‘smoldering’ diverticulitis. A second variation of uncomplicated diverticulitis should be termed atypical diverticulitis, since this variant does not manifest all of the usual components of acute diverticulitis, particularly an absence of fever, and even white blood count elevation, and there may be a lack of diagnostic evidence of acute diverticulitis. This diagnosis must be compared with diarrhea-predominant irritable bowel syndrome, and it is sometimes very difficult to distinguish between these two entities. The character of the pain in irritable bowel syndrome is typically cramping intermittently, compared with the more constant pain in smoldering diverticulitis. In our study by Horgan, McConnell, Wolff and coworkers, 5% of 930 patients who underwent sigmoid resection fit into this category of atypical uncomplicated diverticulitis. These 47 patients all had diverticulosis, and 76% that had surgery had evidence of acute and chronic inflammation, and 15% had an unsuspected pericolonic abscess. There was no mortality and a low complication mortality rate (4.2%). Complete resolution of symptoms was achieved in 76.5 with 80% being pain free. Therefore, this is mostly a diagnosis of exclusion, and clinicians must be careful to perform a thorough workup and evaluation before proceeding to surgery with this as a diagnosis. Ischemic colitis is also in the differential diagnosis, and many patients who have diverticulitis, have irritable bowel syndrome as well, so caution must be used in predicting positive outcomes after surgery in these patients.

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Section: Introductionsupporting

confidence: 82%

Prophylactic Resection, Uncomplicated Diverticulitis, and Recurrent Diverticulitis

Wolff

Boostrom²

2012

Dig Dis

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“…Although there was endoscopic evidence of diverticulitis in only 13 per cent, on pathological examination it was found that 76 per cent had histological evidence of acute and chronic mucosal inflammation. In addition, seven patients had a previously undiagnosed pericolic abscess which is a feature not uncommonly encountered in patients having colonic resection for symptomatic diverticular disease 58,59 (although they are often small and hidden in the surrounding fatty tissue) 14 . Over three-quarters of the 47 patients had complete resolution of symptoms after surgery.…”

Section: Inflammatory Changesmentioning

confidence: 99%

Origin of symptoms in diverticular disease

Simpson

Scholefield

Spiller

2003

British Journal of Surgery

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Several theories now exist about the mechanisms underlying the symptoms of diverticular disease. Initial studies suggested that they may be due to alterations in the intracolonic pressure, extrapolating earlier thoughts on the likely pathogenesis of diverticula. It seems more likely, however, that several inter-related processes, such as muscular dysfunction, visceral hypersensitivity and inflammation, are involved in symptom generation.

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“…Until recently a two-staged procedure, usually as described by Hartmann [11, 12], has been the most common method for treating patients who require emergency surgery for complicated diverticular disease of the sigmoid colon [5,6,7,8,9,10,13,14,15,16], but it is also used when technical difficulties are encountered in electively operated patients [17, 18]. …”

Section: Introductionmentioning

confidence: 99%

Reversal of Hartmann’s Procedure after Surgery for Complications of Diverticular Disease of the Sigmoid Colon Is Safe and Possible in Most Patients

2005

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Background: Although evidence is growing that most patients who need an operation for diverticular disease of the sigmoid colon can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties. The outcomes of 65 patients who underwent secondary restoration after a Hartmann procedure for complicated diverticulitis were studied and the factors leading to complications and mortality were identified. Patients and Methods: Of 91 patients, in a consecutive 12-year period, whose primary operation was a Hartmann procedure, 72 survived longer than 3 months after discharge. Sixty-five underwent an attempted reversal of the Hartmann procedure. The POSSUM scores were calculated in all patients as well as the morbidity and mortality rates. Results: In 63 (96.9%) patients the bowel continuity could be restored with a morbidity of 38.5% and a mortality of 3.1%. The POSSUM and p-POSSUM scores adequately predicted the mortality in this series. Conclusion: This series shows that when surgical treatment for complicated diverticular disease of the sigmoid colon is necessary, the Hartmann procedure is still a valid indication. In a high percentage of patients the Hartmann procedure could be restored with a low mortality.

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Elective resection for diverticular disease of the sigmoid colon

Cited by 66 publications

References 11 publications

Prophylactic Resection, Uncomplicated Diverticulitis, and Recurrent Diverticulitis

Prophylactic Resection, Uncomplicated Diverticulitis, and Recurrent Diverticulitis

Origin of symptoms in diverticular disease

Reversal of Hartmann’s Procedure after Surgery for Complications of Diverticular Disease of the Sigmoid Colon Is Safe and Possible in Most Patients

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