Outcome of younger patients with acute diverticulitis

Hjern, Fredrik; Josephson, T.; Altman, Daniel; Holmström, Bo; Johansson, Claes

doi:10.1002/bjs.6137

Cited by 67 publications

(48 citation statements)

References 37 publications

(50 reference statements)

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“…During the follow-up of that study (5.2 years), only one of the 259 younger patients (0.5%) presented at a later date with perforation. More recently, Hjern et al 16 followed 234 patients and found that surgical management during the first admission was undertaken less commonly in younger than in older patients (2% vs 6.8%). During follow-up (30 months), no statistical difference between the 2 groups was observed in recurrent diverticulitis or need for further surgery.…”

Section: Discussionmentioning

confidence: 99%

Presentation and Treatment Outcome of Diverticulitis in Younger Adults: A Different Disease Than in Older Patients?

Kotzampassakis

Pittet

Schmidt³

et al. 2010

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 99%

Presentation and Treatment Outcome of Diverticulitis in Younger Adults: A Different Disease Than in Older Patients?

Kotzampassakis

Pittet

Schmidt³

et al. 2010

Diseases of the Colon &Amp; Rectum

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“…Moreover, they also noted that complicated recurrence rate was significantly greater in patients who presented with complicated initial disease in comparison with those who did not present with a complicated disease. On the contrary, two retrospective studies did not reach the same conclusions, finding no influence related to CT severity on the outcome after a first episode of diverticulitis treated medically [18,19]. …”

Section: Discussionmentioning

confidence: 88%

Value of CT for Acute Left-Colonic Diverticulitis: The Surgeon’s View

Ambrosetti

2012

Dig Dis

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Aim: To determine the immediate and later role(s) of initial CT in patients presenting with their first episode of acute left-colonic diverticulitis. Methods: Prospective inclusion of 542 patients hospitalized in the University Hospital of Geneva between 1986 and 1997. 465 (86%) patients had a CT. CT grading of diverticulitis was divided between moderate diverticulitis (no sign of colonic perforation) and severe diverticulitis (signs of colonic perforation). Results: During the index hospitalization, surgical treatment of the first episode of acute diverticulitis was needed in 26% of patients with CT-severe diverticulitis compared to 4% for patients with CT-moderate diverticulitis. At 5 years of follow-up after medical treatment of the first episode, incidence of remote complications was the highest (49%) for patients with CT-severe diverticulitis and the lowest (22%) for patients with CT-moderate diverticulitis. Finally, we found that the location of the diseased segment, which is important to guide the type of resection in case of elective surgery, varies in 35% of patients who had 2 episodes of acute diverticulitis. Conclusion: CT is the indispensable tool both to confirm the suspected diagnosis of acute diverticulitis and to appreciate the risk of surgical treatment during the initial acute episode. Moreover, CT grading of diverticulitis is a statistically significant prognostic parameter of the chance of secondary complicated outcome after a first acute diverticulitis episode successfully treated medically. Finally, CT gives the exact location of diverticulitis. In case of elective surgery this colonic segment should be removed.

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“…9 Of 221 patients treated medically following a first admission with acute diverticulitis, overall readmission was 20.8% (46/221). 10 A further study of 502 patients from New Zealand reported a recurrence rate of 18.8% (60/320) with a median follow-up of 101 months and no increase in mortality related to recurrent episodes. 11 These studies are all small and have varying diagnostic criteria for acute diverticulitis and its recurrence.…”

Section: Epidemiology and Pathogenesismentioning

confidence: 94%

Review article: the pathogenesis and management of acute colonic diverticulitis

Humes

Spiller

2014

Aliment Pharmacol Ther

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SummaryBackgroundAcute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years.AimTo review the current understanding of the aetiology and treatment of acute diverticulitis.MethodsA search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis.ResultsThere are 75 hospital admissions per year for acute diverticulitis per 100 000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7‐year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti‐inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in‐hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited.ConclusionsFurther high‐quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence‐based.

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Outcome of younger patients with acute diverticulitis

Abstract: First episodes of acute diverticulitis were not more aggressive in patients aged 50 years or less. Recurrence rates were slightly higher than in older patients.

Cited by 67 publications

References 37 publications

Presentation and Treatment Outcome of Diverticulitis in Younger Adults: A Different Disease Than in Older Patients?

Presentation and Treatment Outcome of Diverticulitis in Younger Adults: A Different Disease Than in Older Patients?

Value of CT for Acute Left-Colonic Diverticulitis: The Surgeon’s View

Review article: the pathogenesis and management of acute colonic diverticulitis

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