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Acute diverticulitis

D S Ahmad, E E Quist, G F Hutchins, I Bhat
The development of colonic diverticula is common in developed countries and complications of colonic diverticulosis are responsible for a remarkable burden of the disease. The natural history and management of complicated and recurrent diverticulitis in young patients are still a matter of debate. Coloenteric fistula is a rare complication of diverticulitis in young adults. In this report, and utilising a case study, we will review the natural history, outcome and management of acute diverticulitis in the young...
October 2016: Netherlands Journal of Medicine
David R Rosen, Grace S Hwang, Glenn T Ault, Adrian E Ortega, Kyle G Cologne
BACKGROUND: Diverticulitis has become a medically managed disease process; the indications and timing of surgical intervention have evolved. METHODS: We retrospectively reviewed all patients who underwent surgical intervention due to diverticular disease by the Division of Colon and Rectal Surgery from 2012 to 2014. RESULTS: Ninety-eight surgeries were performed. Indications included colovesicular fistula, multiple recurrences of diverticulitis, medically refractory diverticulitis, stricture, abscess, colocutaneous fistula, and colovaginal fistula...
August 3, 2016: American Journal of Surgery
Tao Peng, Liming Dong, Zhihua Zhu, Jing Cui, Qian Li, Xin Li, Heshui Wu, Chunyou Wang, Zhiyong Yang
RATIONALE AND OBJECTIVES: Some deep pelvic abscesses are not accessible through anterior or lateral approaches because of the presence of organs and structures. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous presacral space approach by reviewing our clinical experience and the literature. MATERIALS AND METHODS: The outcomes of 12 patients, who have undergone computed tomography (CT)-guided percutaneous presacral space drainage, were retrospectively reviewed, including demographic, clinical, and morphological data in the medical records...
October 12, 2016: Academic Radiology
Rasmus Gregersen, Laura Quitzau Mortensen, Jakob Burcharth, Hans-Christian Pommergaard, Jacob Rosenberg
PURPOSE: This study aimed to systematically review the literature and present the evidence on outcomes after treatment for acute diverticulitis with abscess formation. Secondly, the paper aimed to compare different treatment options. METHODS: PubMed, EMBASE and the Cochrane Library were searched. Two authors screened the records independently, initially on title and abstract and subsequently on full-text basis. Articles describing patients treated acutely for Hinchey Ib and II were included...
October 11, 2016: International Journal of Surgery
Antonio José Fernández López, Miguel González Valverde, Nuria Martínez Sanz, María Encarnación Tamayo Rodríguez, Antonio Albarracín Marín Blázquez
Duodenal diverticula are a rare, usually asymptomatic clinical condition. When a complication arises clinical suspicion is key for the diagnosis. On occasion these patients receive a delayed diagnosis and undergo inadequate medical therapy. We report the case of a patient with evidence of duodenal diverticulitis in association with gallbladder inflammation by contiguity, as well as his diagnosis and management.
October 2016: Revista Española de Enfermedades Digestivas
Ishwarya Balasubramanian, Christina Fleming, Helen M Mohan, Karl Schmidt, Eva Haglind, Des C Winter
BACKGROUND: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice. AIM: To assess outcomes of out-patient management of acute UD. METHODS: A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed...
October 5, 2016: Digestive Surgery
L Daniels, Ç Ünlü, N de Korte, S van Dieren, H B Stockmann, B C Vrouenraets, E C Consten, J A van der Hoeven, Q A Eijsbouts, I F Faneyte, W A Bemelman, M G Dijkgraaf, M A Boermeester
BACKGROUND: Antibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis. METHODS: Patients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy...
September 30, 2016: British Journal of Surgery
Shen-Shong Chang, Nicole Huang, Hsiao-Yun Hu
Patients with end-stage renal disease (ESRD) show a high incidence of bacterial translocation and impaired gastrointestinal motility. The intestinal tract is believed to be the most crucial source of translocated bacteria. To evaluate the risk of colonic diverticulitis in patients with ESRD, we conducted a nationwide population-based cohort study. Patients who met the following 3 criteria were defined as patients with ESRD: patients diagnosed with ESRD who received regular hemodialysis between 2000 and 2005, patients who received hemodialysis for more than 90% of the time during the observation period (2000-2011), and patients with no prior history of hemodialysis between 1997 and 1999...
September 2016: Medicine (Baltimore)
Piriyankan Ananthavarathan, Kamlesh Patel, Catherine Doran, Nigel Suggett
INTRODUCTION: Atraumatic splenic rupture is a rare surgical emergency that is often attributed to neoplastic or infectious causes. Rarely, it has been identified to also occur in the setting of an acute severe sepsis and in cases of pelvic or splenic abscess formation post-appendicectomy. However, to our knowledge, the co-presentation of acute appendiceal abscess and splenic rupture has not been previously described. PRESENTATION OF CASE: We present the case of a 67-year old male with decompensating haemorrhagic shock secondary to atraumatic splenic rupture on a background of an inadequately treated complicated appendicitis originally managed as diverticulitis with antibiotics in the community...
April 13, 2016: International Journal of Surgery Case Reports
Antonio Tursi, Marcello Picchio, Walter Elisei, Francesco Di Mario, Carmelo Scarpignato, Giovanni Brandimarte
BACKGROUND: Management of diverticular disease (DD) remains a point of debate. GOALS: To investigate the current opinion of participants of the 2nd International Symposium on Diverticular Disease, on real-life management of patients with DD of the colon. STUDY: Twelve questions were aimed at the diagnosis, treatment, and management options for diverticulosis and symptomatic DD. RESULTS: In total, 115 surveys from 8 European Countries were filled out...
October 2016: Journal of Clinical Gastroenterology
Angelo Campanini, Umberto De Conto, Francesco Cavasin, Fernanda Bastiani, Antonio Camarotto, Luigi Gardini, Alessandra Geremia, Cristina Marastoni, Carlo Missorini, Elena Quarantelli, Umberto Sassi, Francesco Scarabello, Nadia Dal Bo, Matteo Riccò, Simone Grillo, Stefano Landi, Francesco Di Mario
INTRODUCTION: In routine colonoscopy, diverticulosis is the most commonly found feature, but only a minority of these cases show symptoms of diverticular disease.From June 2014 to December 2014, we enrolled prospectively 178 patients affected by symptomatic uncomplicated diverticular disease (Male/Female=0.47, mean age 71.7±11.5 y, range 41 to 95 y) from 15 General Pratictioners patient files. All patients were symptomatic; in all cases, diagnosis was been confirmed by a colonoscopy performed at least 1 year before...
October 2016: Journal of Clinical Gastroenterology
Rudi De Bastiani, Guido Sanna, Pierluigi Fracasso, Maurizio D'Urso, Edoardo Benedetto, Antonio Tursi
GOALS: To investigate the current opinion of Italian general practitioners (GPs) on the management of patients with diverticular disease (DD) of the colon. BACKGROUND: The management of DD remains a point of debate, and guidelines are not uniform in their advice. STUDY: A web-based survey was conducted among Italian GPs. Twelve questions were aimed at the diagnosis, treatment, and management options for diverticulosis and symptomatic DD. RESULTS: In total, 245 surveys were filled out...
October 2016: Journal of Clinical Gastroenterology
Knut-Arne Wensaas, Amrit Pali Hungin
Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined...
October 2016: Journal of Clinical Gastroenterology
Ricardo Escalante G, Leonardo Bustamante-Lopez, Ana Lizcano, Bernardo Acosta M
PURPOSE: The aim of this study was to assess laparoscopic lavage in patients with acute diverticulitis. BACKGROUND: In recent times, laparoscopic peritoneal lavage has been considered a therapeutic alternative to standard resection procedures. In Hinchey III diverticulitis there is the possibility of avoiding ostomies or resection procedures. STUDY: This retrospective study was conducted in a single-care institution. RESULTS: Patients requiring emergency surgery for perforated diverticulitis and generalized peritonitis between March 2011 and May 2014 were identified from a prospective database...
October 2016: Journal of Clinical Gastroenterology
Giovanni Barbara, Cesare Cremon, Maria R Barbaro, Lara Bellacosa, Vincenzo Stanghellini
Colonic diverticulosis is an increasingly common condition in Western industrialized countries. About 20% of patients develop symptoms, including abdominal pain, bloating, changes in bowel habits, and, eventually, diverticulitis or other complications. The management of symptomatic uncomplicated diverticular disease (SUDD) and the prevention of acute diverticulitis remains a challenge for the clinician. The rationale for the use of aminosalicylates, such as mesalazine, is based on the assumption of low-grade inflammation in SUDD and symptoms generation, whereas an overt inflammation may induce diverticulitis in patients with diverticular disease...
October 2016: Journal of Clinical Gastroenterology
Alberto Lué, Viviana Laredo, Angel Lanas
Diverticular disease (DD) of the colon represents the most common disease affecting the large bowel in western countries. Its prevalence is increasing. Recent studies suggest that changes in gut microbiota could contribute to development of symptoms and complication. For this reason antibiotics play a key role in the management of both uncomplicated and complicated DD. Rifaximin has demonstrated to be effective in obtaining symptoms relief at 1 year in patients with uncomplicated DD and to improve symptoms and maintain periods of remission following acute colonic diverticulitis (AD)...
October 2016: Journal of Clinical Gastroenterology
Johannes K Schultz, Sheraz Yaqub, Tom Øresland
Throughout the last century, the incidence of diverticular disease of the colon has increased tremendously in industrialized countries; nevertheless, the management of this condition is still controversial. Although several international guidelines for the management of diverticular disease are based on the same evidence, the recommendations differ greatly, emphasizing the lack of high-quality prospective studies. In Scandinavia, official guidelines for the management of diverticular disease exist only in Denmark...
October 2016: Journal of Clinical Gastroenterology
Bruno Annibale, Marilia Carabotti, Rosario Cuomo
Diverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment...
October 2016: Journal of Clinical Gastroenterology
Antonella Gallo, Gianluca Ianiro, Massimo Montalto, Giovanni Cammarota
Diverticulosis of the colon is a common condition in western countries. Acute diverticulitis may occur in 10% to 25% of the patients, sometimes associated with the presence of complications such as abscess, fistula, and perforation. Early diagnosis and accurate assessment of acute diverticulitis are necessary to start an efficacious treatment promptly, either conservatively or by surgery. The clinical picture may mimic other abdominal conditions; therefore, imaging techniques such as ultrasound or computed tomography are usually recommended, although they are expensive, examiner dependent, and potentially harmful...
October 2016: Journal of Clinical Gastroenterology
Nicola Flor, Simone Soldi, Edoardo Zanchetta, Sara Sbaraini, Filippo Pesapane
Different scenarios embrace computed tomography imaging and diverticula, including asymptomatic (diverticulosis) and symptomatic patients (acute diverticulitis, follow-up of acute diverticulitis, chronic diverticulitis). If the role of computed tomography is validated and widely supported by evidence in case of acute diverticulitis, this is not the case of patients in their follow-up for acute diverticulitis or with symptoms related to diverticula, but without acute inflammation. In these settings, computed tomography colonography is gaining consensus as the preferred radiologic test...
October 2016: Journal of Clinical Gastroenterology
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