Recurrent Acute Diverticulitis: When to Operate?

Abstract

Objective: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life. Methods: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. The literature was thoroughly searched for major studies tackling this topic. Furthermore, studies reporting on decision making based on quality of life were included. Risks of developing recurrent diverticulitis and the potential need of surgery were identified. Relevant surgical details that would decrease recurrence were also denoted. Results: Surgery has been the mainstay of treatment for quite some time. However, the paradigms of treatment have changed over the last few years, especially when long-term population studies confirmed that not all patients require surgical treatment with its associated risk of morbidity. Conclusion: Treatment now has to be patient-tailored with special attention to the subgroup of high-risk patients. These patients must be adequately selected, identifying the impact of the disease on the quality of life and weighing in the risks of the surgical intervention.

Increased incidence and recurrence rates of acute diverticulitis in patients with irritable bowel syndrome

“…Researchers have previously reported that IBS increases the risk of recurrence of diverticulitis [25]. In another investigation, younger age and persistence of postoperative symptoms after resection for diverticular disease are significantly associated with recurrent diverticulitis [26,27]. However, in our study, the diagnosis of IBS was made before the first episode of AD, which means there is no possibility of mixing IBS and postoperative symptoms.…”

Recurrent, Complicated Diverticulitis With Atypical Features

“…This patient’s presentation with recurrent diverticulitis has many atypical features including the recurrence and the complicated nature of the first presentation of diverticulitis. Though recurrent episodes of acute diverticulitis are seen in 20-35% of patients, a study examining 672 patients showed that less than 4% developed complicated diverticular disease with fistula, abscess, or frank perforation [ 3 ]. Within a span of nine months, our patient was admitted on at least five occasions with complicated diverticulitis, including a sealed perforation, colocutaneous fistula, and multiple abscesses.…”

“…Diagnosis is made with a combination of clinical findings and imaging. Imaging evaluates for complications such as fistula, abscess, bowel obstruction, or perforation [ 3 ]. According to the American College of Gastroenterology (ACG), antibiotics should be selectively used in acute, uncomplicated diverticulitis but withheld in mild cases.…”

Acquired Diverticulosis of the Entire Colon in a Cadaver

“…Treatment ranges from observation for diverticula-associated abdominal pain to colectomy for recurrent diverticulitis [15]. Al Harakeh et al found that pancolonic diverticulosis is associated with a medium risk of recurrent diverticulitis [16]. This finding suggests that the pathogenesis of recurrent diverticulitis is multifactorial and not solely dependent on diverticula quantity.…”