The 5-year natural history of complicated diverticular disease

Abstract

The natural history of complicated diverticular disease based on details of 300 patients entered into a national audit between 1985 and 1988 is reported. Questionnaires were sent to the general practitioners of 176 patients with this condition 5 years after hospital admission; 120 responded. Of these 120 patients, ten died from recurrent complicated diverticular disease, 29 died from other disorders and 81 remain alive. Forty of 110 patients (excluding those who died from recurrence) are still symptomatic or were so at the time of unrelated death. Thirty-nine patients developed a severe complication after the index admission, 14 of whom had the same complication initially. Of the 77 patients who had initially been managed by sigmoid resection, only two developed recurrent complications compared with 37 of 43 managed conservatively. Of the ten patients who died from recurrent diverticular disease, nine had not undergone sigmoid colectomy at or after the original admission. These data argue for interval sigmoid colectomy in most patients who initially present to hospital with complicated diverticular disease to prevent later development of potentially lethal complications.

Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease

“…Diverticular disease of the colon is common in developed countries and its prevalence is correlated with advancing age [1][2][3][4] . Studies on the natural history of the disease [3,5,9] have indicated that most patients with colonic diverticula remain entirely asymptomatic for their lifetime. Actually there are no definitive data to support any therapeutic recommendation, or routine follow-up regimen, for asymptomatic subjects, although it is reasonable to recommend a life-style characterized by regular physical activity and a diet high in fruit and vegetable fibers [18] .…”

“…Diverticular disease and its clinical consequences have recently become increasingly prevalent, paralleling western patterns of living and eating, the ageing population, and economic and industrial development [4] . Although a large majority of patients with diverticular disease will remain entirely asymptomatic for their entire life, 20% of them may manifest clinical illness [4,5] and a worse quality of life [6] . Furthermore, since available data [2,3] suggest that the incidence of diverticular disease is increasing and that its prevalence increases with age, the identification of a management strategy for the disease represents an healthy priority.…”

Colectomia eletiva laparoscópica esquerda para a doença diverticular: estudo monocêntrico sobre 205 pacientes consecutivos

“…Although it is assumed that those cases don't have a persistent septic focus, nor major irreversible anatomical changes, the authors don't think that the operation could be considered as prophylactic once the symptomatic disease had been established. Regardless of the efforts to question the natural history of this disease 9 , it is considered the surgical resection of the involved colon the only mean of its eradication and thus to avoid its complications.…”

“…Laparoscopic colonic resection to remove the diseased segment of the colon but not all diverticula is the recommended procedure 2 . By reviewing the literature, laparoscopic colectomy proves to be safe comparing to open procedures in terms of morbidity and mortality 9,10,13 . The authors had a morbidity rate of 11.7%, a mortality rate of 0.48% and two anastomotic fistulae, which are comparable to the rate in the literature which ranges from 0-5.5%.…”

Comparison of long-term quality of life in patients with diverticular disease. Are there any benefits to surgery?

“…The reason is the comparison between postoperative course after elective and acute surgery. Higher morbidity, longer hospitalization, increased hospital charges, and an elevation in mortality could be good reasons for prophylactic resection [21,22]. Good functional outcome and a low rate of recurrence after elective surgery has been acknowledged, as by Thörn [23].…”