Persistent Perforation in Non-Faeculant Diverticular Peritonitis—Incidence and Clinical Significance

O’Leary, Donal Peter; Myers, E.; O’Brien, Odharnaith; Andrews, Emmet; McCourt, Morgan; Redmond, H. P.

doi:10.1007/s11605-012-2025-0

Cited by 10 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of note, the management of acute diverticulitis has undergone substantial change in recent years. This has largely been driven by advances made in interventional radiological techniques, improved surgical techniques and the availability of improved antibiotic therapies [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?

et al. 2016

View full text Add to dashboard Cite

Background: The usefulness of inflammatory indices in assessment of the severity of acute diverticulitis remains unestablished. The aim of this study was to determine whether inflammatory indices and hematological ratios could be utilised to differentiate between uncomplicated and complicated diverticulitis. Methods: Hematological and inflammatory indices were recorded for each admission with CT confirmed acute diverticulitis (101 complicated, 127 uncomplicated). Cases were divided into training (n = 57) and test sets (n = 171). A classification and regression tree (CART) analysis was employed in the training set to identify optimal inflammatory marker cut-off points associated with complicated diverticulitis. Samples (test set) were then categorized as (A) greater than and (B) less than CART identified cut-off points. The predictive properties of inflammatory marker cut-off points in distinguishing severity of diverticulitis were assessed using a univariate logistic regression analysis, summary receiver operating characteristic curves and confusion matrix generation. Results: C-reactive protein >109 mg/ml (OR 3.07, 95% CI 1.43-6.61, p = 0.004, area under the curve; AUC = 0.64) and white cell lymphocyte ratio (WLR) >17.72 (OR 4.23, 95% CI 1.95-9.17, p < 0.001, AUC = 0.64) were the most accurate parameters in distinguishing complicated and uncomplicated disease. WCC >21 × 10⁹/l (p = 0.02, AUC = 0.60) and lymphocyte count >0.55 × 10⁹/l (p = 0.009, AUC = 0.60) were less accurate. Conclusion: Widely used inflammatory indices are useful in the depiction of complicated diverticulitis. The indices cut-off points highlighted in this study should be considered at the time of diagnosis in combination with radiological features of complicated diverticulitis.

show abstract

Section: Introductionmentioning

confidence: 99%

Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?

et al. 2016

View full text Add to dashboard Cite

show abstract

“…it is noteworthy that our overall morbidity of 25% is not low; nevertheless, only 7 patients presented severe complications, which included the 5 failures requiring re-exploration and resection, and no patients in the series died. 24 in our experience, although a hydropneumatic test allowed us to identify 3 patients with an unsuspected perforation and exclude them from lavage, there were 5 failures of the initial treatment that required reoperation and resection. 21 however, despite being a randomized trial, there was some selection bias, because, as the authors stated very honestly, 52 patients were not assessed for eligibility because of surgeon preference.…”

Section: Discussionmentioning

confidence: 78%

Laparoscopic Peritoneal Lavage for Hinchey III Diverticulitis

Rossi

Mentz²,

Bertone³

et al. 2014

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

show abstract

“…Taken together, these clinical and imaging findings identify patients at high risk of failure of conservative management and indicate a persistent perforation, which is defined as a histologically proven perforation present within the surgically resected specimen. One study observed that in patients who underwent operative management for acute diverticulitis with peritonitis, a perforation identified histologically was associated with increased morbidity, length of stay in hospital, physiological score and operative severity score . A persistent perforation could explain the high rates of treatment failure after laparoscopic lavage for acute perforated diverticulitis where persistent and recurrent intra‐abdominal sepsis occur due to peritonitis and ongoing abscess formation, translating into higher reoperation rates and increased mortality …”

Section: Discussionmentioning

confidence: 99%

“…One study observed that in patients who underwent operative management for acute diverticulitis with peritonitis, a perforation identified histologically was associated with increased morbidity, length of stay in hospital, physiological score and operative severity score. 20 A persistent perforation could explain the high rates of treatment failure after laparoscopic lavage for acute perforated diverticulitis where persistent and recurrent intra-abdominal sepsis occur due to peritonitis and ongoing abscess formation, translating into higher reoperation rates and increased mortality. 21 Therefore, every effort should be made to distinguish patients with acute perforated diverticulitis who have generalized peritonitis requiring an emergency operation and those who do not have generalized peritonitis, and may be managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of acute perforated diverticulitis: A systematic review

Chua

Jeyakumar

et al. 2020

J of Digest Diseases

View full text Add to dashboard Cite

Objective Acute perforated diverticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis; however, a large proportion of patients are clinically stable with localized peritonitis. This article aimed to examine this specific group of patients by reviewing the outcomes of their conservative management. Methods A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non‐operative treatment for acute perforated diverticulitis were synthesized and tabulated. Results Of 479 patients, 407 (85%) were successfully managed non‐operatively. In total 70 (14.6%) patients failed non‐operative treatment and underwent operative surgical management, and two (0.4%) died. Emergency surgery includes a Hartmann's operation (40%) and resection with anastomosis with or without stoma (24%), laparoscopic lavage (16%) and surgical drainage (20%). The success rate of conservative management was 94.0% and 71.4% for patients with pericolic and distant free air, respectively. Treatment failure was associated with a high volume of free air, distant free air and the presence of abscess. Conclusions Conservative management is safe and successful in patients with acute perforated diverticulitis without generalized peritonitis. The early recognition of patients who show clinical signs of persistent perforation is important to ensure the success of this strategy.

show abstract

Persistent Perforation in Non-Faeculant Diverticular Peritonitis—Incidence and Clinical Significance

Cited by 10 publications

References 20 publications

Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?

Do Inflammatory Indices Play a Role in Distinguishing between Uncomplicated and Complicated Diverticulitis?

Laparoscopic Peritoneal Lavage for Hinchey III Diverticulitis

Conservative management of acute perforated diverticulitis: A systematic review

Contact Info

Product

Resources

About