Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years

Frileux, P; Dubrez, J; Burdy, Gaëlle; Roullet-Audy, J C; Dalban-Sillas, Brigitte; Bonnaventure, F.; Frileux, M.‐A.

doi:10.1111/j.1463-1318.2009.01866.x

Cited by 27 publications

(22 citation statements)

References 38 publications

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“…In conclusion, reviewing literature data published in the last 10 years (table 1), the risk of severe complication for complicated recurrent episode of AD is low with a rate of emergent surgery ranging from 0 [15,21] to 5.5% [56], risk of stoma formation ranging from 0 [15] to 3.9% [56], and rate of related death ranging from 0 [17,21] to 0.5% [57]. …”

Section: Risk Of Severe Complicationsmentioning

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 Outdated literature suggested a high recurrence rate (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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Section: Risk Of Severe Complicationsmentioning

confidence: 99%

Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

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“…SCAD has usually a more benign course, 29, 30 but some cases of severe disease may require immunosuppressors or surgery. Moreover, AUD may be managed with conservative therapy, 31 but it often recurs with complication 32 . In light of this information, it is probable that less aggressive forms of SCAD (types A and C) required less aggressive clinical and endoscopic follow‐up, whereas UCD or more aggressive forms of SCAD (types B and D) required more aggressive clinical and endoscopic follow‐up.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory manifestations at colonoscopy in patients with colonic diverticular disease

Tursi

Elisei

Giorgetti

et al. 2010

Alimentary Pharmacology &Amp; Therapeutics

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“…1 However, in the author's experience, Hartmann's operation is the safer procedure with a mortality close to zero and a permanent stoma rate of only 5 percent. 2 Selected patients with Hinchey grades II and III peritonitis from perforated diverticulitis may also be treated by laparoscopic lavage. 3 Hartmann's operation is also indicated in acute ischemic colitis involving the sigmoid.…”

Section: Benign Diseasesmentioning

confidence: 99%

“…2,6 Restoration of continuity should be considered in fit patients after good recuperation following the primary surgery; age is not a contraindication if the patient's general condition is suitable and the patient is well motivated. A full discussion on the risks and benefits is necessary.…”

Section: Restoration Of Continuitymentioning

confidence: 99%

Hartmann’s procedure

Frileux¹

2015

Operative Surgery of the Colon, Rectum and Anus, Sixth Edition

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HistoryIn 1923, Henri Hartmann described an operation which is now defi ned as resection of the sigmoid colon with construction of a terminal colostomy and closure of the rectal stump (Figure 5.12.1). A variable length of rectum may also be resected. The indication was initially cancer of the upper or middle third of the rectum, at a time when anterior resection had not been developed. Today, Hartmann's operation is usually performed as an emergency procedure to treat the complications of various colorectal diseases. PrinciPles and justification indications and contraindicationsHartmann's operation is indicated when it is necessary to perform a resection of the sigmoid and when an immediate anastomosis appears unsafe. This operation allows resection of the sigmoid at the primary stage, but requires another major procedure for re-establishing the continuity. benign diseasesHartmann's operation once represented the gold standard in perforated sigmoid diverticulitis that required urgent operation. There is now a debate between this procedure and primary anastomosis. Hartmann's operation is criticized for associated high morbidity and mortality rates and the diffi culty of restoring intestinal continuity. 1 However, in the author's experience, Hartmann's operation is the safer procedure with a mortality close to zero and a permanent stoma rate of only 5 percent. 2 Selected patients with Hinchey grades II and III peritonitis from perforated diverticulitis may also be treated by laparoscopic lavage. 3 Hartmann's operation is also indicated in acute ischemic colitis involving the sigmoid.Acute colitis, in the form of toxic megacolon or fulminant colitis, may require an emergency colectomy, but it is generally agreed that primary coloproctectomy should be avoided in this situation, and total abdominal colectomy is favored. Some choose to close the rectal stump, while others (including the author) prefer a sigmoid mucous fi stula to avoid the possible complications caused by leakage from the suture line in the rectum. If Hartmann's 5.12.1

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Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years

Abstract: Complicated diverticulitis can be managed with a low mortality. Hartmann's operation was proven safe in our experience. The risk of recurrence was higher than observed in many recent studies but few recurrences were severe.

Cited by 27 publications

References 38 publications

Clinical Presentation and Risks

Clinical Presentation and Risks

Inflammatory manifestations at colonoscopy in patients with colonic diverticular disease

Hartmann’s procedure

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