Prognostic factors from computed tomography in acute left colonic diverticulitis

Ambrosetti, P.; Robert, John; Witzig, J A; Mirescu, D; Gautard, R. de; Borst, F.; Meyer, Patrick; Rohner, A

doi:10.1002/bjs.1800790208

Cited by 80 publications

(41 citation statements)

References 15 publications

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“…Independent of the emergent and urgent cases, indication is usually seen in cases of recurrent attacks which require repeated antibiotic therapy and hospitalization. Follow-up studies of patients with a first clinical attack of diverticulitis showed that approximately 25% have a new episode within 2 years and attacks tend to become more severe with length of diverticular disease [28]. Because of the relatively low perioperative risk and low morbidity and mortality, early resection is recommended to avoid emergency surgery in acute exacerbated situations [3, 10, 12].…”

Section: Discussionmentioning

confidence: 99%

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

et al. 1999

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Background: The Hartmann procedure remains the standard concerning the surgical treatment of acute complicated sigmoid diverticulitis. The aim of this study was to prove the possibility of performing a secure primary anastomosis without colostomy in patients with complicated acute diverticulitis. Methods: From June 1988 to October 1996, 113 patients suffering from acute complicated sigmoid diverticulitis were included in this prospective study. Within 24–48 h of hospital admission, when symptoms of the illness persisted despite the use of antibiotic therapy, the patients underwent primary resection of the sigmoid. In all patients primary anastomosis was performed, using CEEA staplers, avoiding colostomy and intraoperative colon irrigation. Results: During the observation period of 19 days, there was no anastomotic leakage found either by radiological methods or clinical parameters. Two patients died of early septic complications, 1 of therapy-resistant endocarditis. Conclusion: The results of this study demonstrate the safety of primary anastomosis after primary resection of the sigmoid under antibiotic conditions, avoiding the disadvantages associated with two-stage procedures.

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Section: Discussionmentioning

confidence: 99%

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

et al. 1999

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“…To establish which patients are more likely to need surgery, Ambrosetti et al [43] clearly showed that the certain parameters in association with diverticulitis can divide the condition into mild and severe forms. The severe parameters seen on CT scanning are predictors of the likelihood of not being able to treat the patient conservatively.…”

Section: The Decision To Operatementioning

confidence: 99%

The Surgeon’s View

Senapati

2012

Dig Dis

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Diverticular disease affects up to 50% of people by the time they reach the age of 80. The major complications of diverticular disease (abscess, perforation, fistula, obstruction and bleeding) have their own management pathways, but the treatment of uncomplicated diverticulitis is controversial. On initial presentation, diverticulitis is always treated conservatively. Whether this should be followed by resectional surgery has been the subject of speculation for many decades. The American Society of Colon and Rectal Surgeons recommended in 2000 that an elective resection should follow two attacks of acute diverticulitis. Much of the work underpinning their policy was based on seminal studies by Parks in the 1960s and 1970s who followed cohorts of patients with diverticular disease and examined their outcomes. However, many of these studies were based on inaccurate diagnostic data where the diagnosis was made primarily on clinical grounds. Investigations such as barium enema or colonoscopy are not reliable in confirming the presence of inflammation. Since CT scanning has become routine, the diagnosis of acute diverticulitis can now be made accurately. In recent years much work has been done, such as by Ambrosetti, who has produced evidence predicting the outcome of diverticulitis based on CT findings. More recent papers, in which the diagnosis of acute diverticulitis is likely to have been made more accurately, confirm that although recurrent attacks of diverticulitis are fairly common, there is a very low incidence of serious complications after long-term follow-up. It has also become apparent that the majority of patients who present with the major complications of diverticulitis, specifically abscess, perforation and fistula, do so as their first presentation of the disease, without previous episodes of diverticulitis. The corollary of this is that patients having had acute diverticulitis do not run the risk of developing life-threatening complications without elective surgery. The complications of left-sided colonic resection are not inconsiderable with anastomotic leaks, the formation of a stoma, either temporary or permanent, as well as mortality. When these data are put alongside the very low risk of serious harm to the patient after diverticulitis, the balance of opinion has now swung heavily in favour of a more conservative approach. In addition to this there are modern and innovative medical therapeutic approaches to the treatment of diverticulitis such as 5ASAs, poorly absorbed antibiotics and probiotics.

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“…The time interval claimed necessary to distinguish between the two episodes varies among authors, ranging between 1 [1], 2 [2,3] and 3 months [4]. …”

Section: Definitionmentioning

confidence: 99%

Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

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Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25–35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2–14% and a risk of stoma and related death of 0–2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them.

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Prognostic factors from computed tomography in acute left colonic diverticulitis

Cited by 80 publications

References 15 publications

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

The Surgeon’s View

Clinical Presentation and Risks

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