Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis

Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
British Journal of Surgery (Impact Factor: 5.54). 02/2005; 92(2):133-42. DOI: 10.1002/bjs.4873
Source: PubMed


Diverticulitis is a common condition. Practice guidelines from many organizations recommend bowel resection after two attacks. The evidence for such a recommendation is reviewed.
A Medline literature search was performed to locate English language articles on surgery for diverticular disease. Further articles were obtained from the references cited in the literature initially reviewed.
Most people with diverticulosis are asymptomatic. Diverticular disease occurs in over 25 per cent of the population, increasing with age. After one episode of diverticulitis one-third of patients have recurrent symptoms; after a second episode a further third have a subsequent episode. Perforation is commonest during the first episode of acute diverticulitis. After recovering from an episode of diverticulitis the risk of an individual requiring an urgent Hartmann's procedure is one in 2000 patient-years of follow-up. Surgery for diverticular disease has a high complication rate and 25 per cent of patients have ongoing symptoms after bowel resection.
There is no evidence to support the idea that elective surgery should follow two attacks of diverticulitis. Further prospective trials are required.

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Available from: Frank Antony Frizelle, Oct 04, 2015
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    • "In the present study, most of the perforations, 89 %, occurred during the first admission for acute colonic diverticulitis. This was in accordance with other recent studies [19, 28, 29]. Elective resection of the sigmoid colon to prevent perforation after the first episode would be unnecessary for most patients, since the risk of free perforation is highest at the index episode [11, 30]. "
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    ABSTRACT: Hospitalization for acute colonic diverticulitis has become more and more frequent. We studied the changes in the rate of admission and incidence of the disease during the last 25 years. We performed a retrospective analysis of all cases treated for acute diverticulitis during 1988-2012 at one hospital serving a defined population in Mid-Norway. The study made a distinction between admission rates and incidence rates. The admission rates defined the total number of cases admitted, while the incidence rates defined the number of new patients hospitalized for acute diverticulitis (first admission). Poisson regression was used to analyse factors associated with diverticulitis incidence rates. A total of 851 admissions in 650 different patients were identified, with an overall admission rate of 38.5 (CI 35.9 to 41.1) per 100,000 person-years. The admission rate increased from 17.9 (CI 14.1 to 22.3)/100,000 during 1988-1992 to 51.1 (CI 44.8 to 58.0)/100,000 during 2008-2012. Poisson regression analysis showed a significant increase in admission rates with a factor of 2.8 (C.I. 2.2 to 3.5) during 25 years. The overall incidence rate (IRR) of new patients was 29.4 (CI 27.1 to 31.7)/100,000 person-years. IRR increased significantly with a factor of 2.6 (CI 1.96 to 3.34) during 25 years, while IRR for perforations increased even more, by a factor of 3.3 (CI 1.24 to 8.58). The hospital admission rates as well as incidence rates for acute colonic diverticulitis increased significantly during the 25-year time span.
    International Journal of Colorectal Disease 05/2014; 29(8). DOI:10.1007/s00384-014-1888-9 · 2.45 Impact Factor
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    • "Emergency surgery is indicated in patients who have purulent or fecal peritonitis. Otherwise complicated diverticulitis is generally considered as an indication for elective colon resection in a later stage [8, 9]. "
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    ABSTRACT: A 58-year-old woman presented to the emergency department with cauda equina syndrome and sepsis. The symptoms were attributed to a complicated episode of sigmoid diverticulitis. MRI showed that the diverticulitis had caused an intra-abdominal fistula to a presacrally localized abscess expanding into the spinal canal, compressing the cauda equina nerves. Although Hartmann's procedure was performed, the neurological symptoms persisted, causing the patient to remain partially paraplegic. This case report illustrates that cauda equina syndrome is a condition that can also be caused by intra-abdominal pathology such as diverticulitis.
    Case Reports in Gastroenterology 10/2013; 7(3):455-461. DOI:10.1159/000355940
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    • "There were 23 total patients (17.9%) who underwent colectomy, and of these, six patients (26%) underwent surgery because of disease recurrence. Recent reports, however, have consistently recommended against surgical intervention for repeated episodes of uncomplicated diverticulitis.32,33 Moreover, the new edition of the practice parameters of the American Society of Colon and Rectal Surgeons from 2006 no longer recommends elective surgery after two or more uncomplicated episodes of diverticulitis.9 "
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    ABSTRACT: Acute complicated diverticulitis can be subdivided into moderate diverticulitis and severe diverticulitis. Although there have been numerous studies on the risk factors for complicated diverticulitis, little research has focused on severe diverticulitis. This study was designed to identify the risk factors for severe diverticulitis in an acute diverticulitis attack using the modified Hinchey classification. Patients were included if they had any evidence of acute diverticulitis detected by computed tomography. The patients were subdivided into severe diverticulitis (Hinchey class ≥Ib; abscesses or peritonitis) and moderate diverticulitis (Hinchey class Ia; pericolic inflammation) groups. Of the 128 patients, 25 exhibited severe diverticulitis, and 103 exhibited moderate diverticulitis. In a multivariate analysis, age >50 years (odds ratio [OR], 5.27; p=0.017), smoking (OR, 3.61; p=0.044), comorbidity (OR, 4.98; p=0.045), leukocytosis (OR, 7.70; p=0.003), recurrence (OR, 4.95; p=0.032), and left-sided diverticulitis (OR, 6.92; p=0.006) were significantly associated with severe diverticulitis. This study suggests that the risk factors for severe diverticulitis are age >50 years, smoking, comorbidity, leukocytosis, recurrent episodes, and left-sided diverticulitis.
    Gut and liver 07/2013; 7(4):443-9. DOI:10.5009/gnl.2013.7.4.443 · 1.81 Impact Factor
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