@article {pmid40944057,
year = {2025},
author = {Vaccari, S and Pirrera, B and Ussia, A and Lauro, A and Minghetti, M and Cervellera, M and D'Andrea, V and Tonini, V},
title = {Emergency Surgery for Acute Left-Sided Complicated Diverticulitis in the Elderly: What Are the Predictor Factors of Mortality and Morbidity?.},
journal = {Journal of clinical medicine},
volume = {14},
number = {17},
pages = {},
doi = {10.3390/jcm14176298},
pmid = {40944057},
issn = {2077-0383},
abstract = {Introduction: Diverticular disease is common in Western countries, and the frequency of emergency operations for acute left-sided complicated diverticulitis (ALCD) has increased over the past 15 years. Methods: A total of 49 patients aged over 80 years and 125 younger patients who underwent emergency surgery for ALCD between October 2018 and June 2025 were analyzed. Demographics and postoperative outcomes were compared between the groups. Multivariate logistic regression was used to assess the association between age and postoperative morbidity and mortality. A separate regression model was used to identify risk factors for postoperative mortality and morbidity, specifically in elderly patients. Results: Significant differences between the two groups were found in sex distribution (p < 0.001), cardiovascular comorbidities (p < 0.001), chronic renal insufficiency (CRI) (p < 0.001), ASA score (p < 0.001), ALCD severity according to the modified Hinchey classification (p = 0.006), Mannheim Peritonitis Index (MPI) (p = 0.021), postoperative complications (p < 0.001), and 90-day mortality rates (p < 0.001). Advanced age was a significant predictor of 90-day postoperative mortality and morbidity. In the elderly subgroup, an ASA score ≥ 3, MPI > 25, CRI, and COPD were identified as independent predictors of 90-day postoperative mortality and morbidity. Conclusions: Advanced age is an independent risk factor for 90-day postoperative mortality and morbidity following emergency surgery for ALCD. In patients over 80 years, an ASA score ≥ 3, CRI, COPD, and MPI ≥ 25 are associated with a poorer prognosis.},
}

@article {pmid40943824,
year = {2025},
author = {Volkert, A and Nigam, A and Stover, D and Meshram, P and Naaz, R and Onongaya, C and Nguyen, SH and Sauve, J and Gaertner, W and Harmon, JV},
title = {Comparison of Open Versus Minimally Invasive Repair of Colovesical Fistula: A Case Report and Propensity-Matched National Database Analysis.},
journal = {Journal of clinical medicine},
volume = {14},
number = {17},
pages = {},
doi = {10.3390/jcm14176065},
pmid = {40943824},
issn = {2077-0383},
abstract = {Background: Colovesical fistulas are abnormal communications between the colon and urinary bladder, most commonly caused by diverticular disease. Although colovesical fistulas are rare, they should be suspected in patients presenting with recurrent urinary tract infections, pneumaturia, or fecaluria. We integrated two case reports with a retrospective national cohort analysis to assess the surgical treatment of colovesical fistulas. Methods: We report two cases of colovesical fistulas, both secondary to sigmoid diverticulitis, treated surgically via minimally invasive approaches. A retrospective analysis using the National Inpatient Sample database from 2016 to 2022 was conducted to compare outcomes of open surgery with those of minimally invasive surgery. Propensity score matching and multivariable regression analyses were used to evaluate clinical outcomes. Results: The first patient underwent hand-assisted laparoscopic sigmoidectomy with fistula takedown and has remained asymptomatic at 8 months, while the second patient underwent robotic-assisted sigmoidectomy with staged ileostomy reversal and has remained asymptomatic at 1 month. National data analysis showed no significant difference in mortality (<1% versus <1%, p = 0.931), wound complications (1.4% versus 1.0%; p = 0.554), or postoperative sepsis or shock (7.1% versus 5.6%; p = 0.114) between open and minimally invasive surgical approaches. However, the minimally invasive surgery group had significantly shorter length of stay than the open surgery group (6.9 versus 7.3 days, p < 0.001). Conclusions: Minimally invasive repair of colovesical fistulas was associated with shorter hospital stays than open surgery, with no significant differences in major complications. Early identification and timely surgical management are critical for achieving favorable outcomes.},
}

@article {pmid40932970,
year = {2025},
author = {Katsarelas, I and Chandolias, M and Nachopoulos, P and Hussamieh, M and Dimasis, P},
title = {Sigmoid Adenocarcinoma Discovered in an Incarcerated Inguinal Hernia.},
journal = {Cureus},
volume = {17},
number = {8},
pages = {e89679},
doi = {10.7759/cureus.89679},
pmid = {40932970},
issn = {2168-8184},
abstract = {Large bowel obstruction is a known surgical emergency. Common causes include malignancies of the colon and benign conditions, including hernias, adhesions, and other less common conditions such as inflammatory bowel disease, diverticular disease, and tuberculosis. However, the coexistence of hernias and colon neoplasm is a rare finding, one that is usually identified intraoperatively. In addition, there is no consensus on the best treatment route. We present a case of an 86-year-old male who presented in an emergency setting with an initial diagnosis of intestinal obstruction and an incarcerated left inguinal hernia. Upon exploratory laparotomy, the content was discovered to be an obstructed sigmoid colon due to a sigmoid colon neoplasm.},
}

@article {pmid40858947,
year = {2025},
author = {Eskemose, SR and Selnes, O and Thorndal, C and Hansen, LØ and Al-Najami, I and Buchbjerg, T and Bjørsum-Meyer, T},
title = {Self-expanding metallic stents in colorectal obstructions caused by diverticular disease-a systematic review.},
journal = {Surgical endoscopy},
volume = {},
number = {},
pages = {},
pmid = {40858947},
issn = {1432-2218},
abstract = {AIM: The role of self-expanding metallic stents (SEMS) in colorectal obstructions caused by diverticular disease remains uncertain. We aimed to investigate the technical and clinical outcomes related to this procedure, including mortality and complications.

METHODS: Peer-reviewed and published literature was identified by searching Embase (Ovid), MEDLINE (Ovid), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov the 29th of April 2025. Methodological Index for Non-randomized Studies (MINORS) instrument was used to evaluate study quality. A synthesis without meta-analysis was conducted.

RESULTS: Twenty-seven studies (110 patients) were included, whereof 20 were observational (101 patients) and seven were case studies (9 patients). Of the observational studies, the technical and clinical success was achieved in 92.7% and 83.5% of patients, respectively. Perforation was the most common complication in 13.2% of patients and procedure related mortality was observed in 2.7%. Migration was observed in 8.5% while reobstruction was observed in 5.9%. Bridge-to-surgery was the most common indication for SEMS, with the majority of patients undergoing colorectal surgery, of whom 56.8% avoided stoma.

CONCLUSION: SEMS in diverticular obstructions are comparable to malignant obstructions besides an increased risk of perforation. Further studies are required to elucidate the role of SEMS as a short-term bridge-to-surgery in diverticular obstructions. The main strength is the identification of inadequate literature and thereby inspiring new research. The main limitation is the high risk of bias in the included literature and the low certainty of the evidence.},
}

@article {pmid40850905,
year = {2025},
author = {Ueland, TE and Shelley, JP and Mosley, JD and Robinson, JR and Gamazon, ER and Maguire, LH and Peek, R and Hawkins, AT},
title = {Plasma Proteomic Signatures for Diverticulitis Risk Stratification.},
journal = {The Journal of surgical research},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.jss.2025.06.093},
pmid = {40850905},
issn = {1095-8673},
abstract = {INTRODUCTION: Approaches for risk stratification in diverticulitis have emphasized lifestyle factors, with a possible emerging role for molecular signatures. We aimed to evaluate whether plasma proteomic profiles complement dietary and genetic factors in diverticulitis risk stratification.

MATERIALS AND METHODS: This UK Biobank study derived a plasma proteomic risk score for severe diverticulitis (operative or recurrent inpatient disease). The cohort was split into a training set for derivation and an independent testing set for evaluation. Differential expression and gene set enrichment analysis identified pathway-level differences, while least absolute shrinkage and selector operator models calculated the score. To evaluate utility in stratification, the proteomic risk score was included in Cox regression models with demographics, lifestyle factors, and genetic risk. A phenome-wide association study explored for conditions associated with diverticulitis proteomic signatures.

RESULTS: Among 43,539 patients and 1459 plasma proteins measured at enrollment, there were 551 cases of severe diverticulitis throughout follow-up. Differential expression analysis implicated extracellular matrix and neuronal pathways, while least absolute shrinkage and selector operator regression retained 151 proteins. This proteomic risk score was associated with greater risk of severe diverticulitis (hazard ratio [95% confidence interval], 1.48 [1.18-1.87]), and a full model with proteomic and genetic factors improved upon a base model with demographic and lifestyle factors (maximum at 5-y area under the receiver operating characteristics curve [95% confidence interval], training set: 0.83 [0.79-0.86] versus 0.69 [0.64-0.73]; testing set 0.75 versus 0.70; P < 0.01) In the phenome-wide association study, elevated proteomic risk for diverticulitis was associated with renal dysfunction and cardiometabolic traits.

CONCLUSIONS: Plasma proteomic profiles complemented genetic and lifestyle factors in diverticulitis risk stratification.},
}

@article {pmid40844843,
year = {2025},
author = {Flemban, AF and Kabrah, SM and Aldabagh, M and Abd Elmoneim, HM and Alharbi, S},
title = {Demographics of colonic health: Unveiling sex- and age-driven trends in a cross-sectional retrospective analysis of 2523 colonoscopy procedures.},
journal = {The Journal of international medical research},
volume = {53},
number = {8},
pages = {3000605251368331},
doi = {10.1177/03000605251368331},
pmid = {40844843},
issn = {1473-2300},
mesh = {Humans ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Retrospective Studies ; Saudi Arabia/epidemiology ; *Colonoscopy/statistics & numerical data ; Adult ; Aged ; Prevalence ; Age Factors ; Sex Factors ; Young Adult ; *Colon/pathology ; *Colonic Polyps/epidemiology/diagnosis/pathology ; Hemorrhoids/epidemiology ; },
abstract = {BackgroundColonic abnormalities, ranging from benign haemorrhoids to malignancies, pose a significant global health burden. Despite extensive research in Western populations, regional data from Saudi Arabia remain limited.ObjectiveTo evaluate the prevalence, demographic trends and clinical relevance of colonic abnormalities in a Saudi Arabian population.MethodsThis retrospective cross-sectional study analysed 2523 colonoscopy reports from Al Noor Specialist Hospital, Makkah, Saudi Arabia, between 1 March 2010 and 30 December 2020. Reports were examined for key findings, including polyps, tumours, bleeding, diverticulosis, haemorrhoids and inflammation. Statistical analyses were used to assess age- and sex-specific trends.ResultsHaemorrhoids (38.1%) and polyps (12.2%) were the most frequent abnormalities. Polyps were most common in patients aged 50-59 years. Sex differences were significant; men showed a higher prevalence of haemorrhoids (p < 0.001) and active bleeding (p = 0.04), while women exhibited a higher prevalence of ulcers and erosions (p < 0.001). Older patients exhibited a higher prevalence of diverticular disease and bleeding; younger individuals (20-39 years) had higher rates of inflammatory changes.ConclusionColonic abnormalities were prevalent in this Saudi population, with distinct age- and sex-specific patterns. These findings support the need for tailored screening strategies. Future multicentre studies should explore the effect of genetic, dietary and environmental factors on colonic health in the study region.},
}

Humans
Male
Female
Middle Aged
Cross-Sectional Studies
Retrospective Studies
Saudi Arabia/epidemiology
*Colonoscopy/statistics & numerical data
Adult
Aged
Prevalence
Age Factors
Sex Factors
Young Adult
*Colon/pathology
*Colonic Polyps/epidemiology/diagnosis/pathology
Hemorrhoids/epidemiology

@article {pmid40825895,
year = {2025},
author = {Baur, K and Brockhaus, KK and Huebner, M and Kolli, N and Cleary, RK},
title = {Pain and opioid use after robotic colectomy with natural orifice vs abdominal wall extraction: a single-institution analysis.},
journal = {Surgical endoscopy},
volume = {},
number = {},
pages = {},
pmid = {40825895},
issn = {1432-2218},
abstract = {BACKGROUND: The specimen extraction incision is the largest during minimally invasive colectomy and conceivably the most painful. We recently adopted natural orifice extraction through the rectum or vagina, leaving only port site incisions for abdominal wall pain. Previous studies demonstrating natural orifice extraction advantages are inconclusive. The study aim was to determine if natural orifice specimen extraction is associated with less pain and opioid use than abdominal wall specimen extraction after enhanced recovery robotic anterior (sigmoid) resection for benign disease.

METHODS: This is a single-institution retrospective analysis comparing abdominal wall and natural orifice extraction sites after robotic anterior resection for diverticular disease in a prospectively maintained institutional colorectal surgery database from 1/1/2021 to 11/21/2024. The primary outcomes were postoperative opioid use measured by morphine milliequivalents analyzed with generalized linear models and postoperative pain scores analyzed with ordinal logistic regression models.

RESULTS: There were 251 anterior (sigmoid) resections for diverticular disease, 136 patients with abdominal wall specimen extraction sites, and 115 patients with natural orifice extraction. Patient characteristics were well matched between groups. One-fifth (20.7%) of the study population required no postoperative opioids. There was no significant difference in postoperative opioids, measured by morphine milliequivalents, between natural orifice and abdominal wall extraction site groups (aOR1.21, p = 0.59). Lower preoperative pain (aOR0.73, p = 0.02) and better mental health (aOR1.05, p = 0.05) were associated with no postoperative opioids. Patient-reported preoperative PROMIS-10 pain scores and younger age were associated with higher postoperative numeric pain scores. There was no significant difference in postoperative complications between groups (abdominal wall 8.1% vs natural orifice 13.0%).

CONCLUSION: There was no significant difference between abdominal wall and natural orifice extraction in postoperative pain, postoperative opioids, and complications after robotic anterior resection for diverticular disease. These data may assist targeting postoperative pain solutions and counsel patients considering specimen extraction site options.},
}

@article {pmid40820634,
year = {2025},
author = {Buyukasik, K and Ari, A and Aghayeva, T and Ferlengez, E and Degerli, MS and Akay, O and Guler, M},
title = {The Association Between Diverticular Disease of the Colon and Colonic Polyps: A Cross-Sectional Study.},
journal = {Annali italiani di chirurgia},
volume = {96},
number = {8},
pages = {1084-1088},
doi = {10.62713/aic.3981},
pmid = {40820634},
issn = {2239-253X},
abstract = {AIM: This study aimed to evaluate the relationship between colonic diverticular disease (CD) and colonic polyps (CP) in Turkiye, considering age and gender distribution.

METHODS: This retrospective cross-sectional study analyzed patients who underwent total colonoscopy between 1 January 2021, and 1 January 2022. Patients with a history of colon resection, inflammatory bowel disease, or prior polypectomy were excluded. The presence of CD and CP was assessed according to age, gender, and colonic localization [right (R), left (L), bilateral (B)].

RESULTS: A total of 452 patients were included, with 248 (54.9%) males and 204 (45.1%) females. The mean age was 57.7 ± 13.0 years. Among them, 235 were in the patient group [CD (+) and/or CP (+)], and 217 were in the control group. The study found a significant association between CD and CP, particularly among older patients, with rates of CD (+) and CP (+) increasing with age (p = 0.001). Interestingly, CD (+) patients had a lower risk of CP compared to CD (-) patients (p = 0.003). Additionally, male patients exhibited significantly higher CP rates than females.

CONCLUSIONS: Our findings indicate that CD (+) patients have a significantly lower risk of CP (+) compared to CD (-) patients. These results provide valuable insights into the relationship between CD and CP, which may help guide future research.},
}

@article {pmid40806532,
year = {2025},
author = {Adam, P and Salée, C and Quesada Calvo, F and Lavergne, A and Merli, AM and Massot, C and Blétard, N and Somja, J and Baiwir, D and Mazzucchelli, G and Coimbra Marques, C and Delvenne, P and Louis, E and Meuwis, MA},
title = {S100A14 as a Potential Biomarker of the Colorectal Serrated Neoplasia Pathway.},
journal = {International journal of molecular sciences},
volume = {26},
number = {15},
pages = {},
pmid = {40806532},
issn = {1422-0067},
support = {FC 44203//Fund for Scientific Research/ ; //Fonds Léon Fredericq/ ; //HOMISTASIS PROJECT/ ; //University of Liège/ ; //CHU of Liège grants/ ; //Dr. Falk Pharma/ ; //Celltrion/ ; //Fresenius Kabi/ ; //Janssen Pharmaceuticals/ ; //AbbVie/ ; },
abstract = {Accounting for 15-30% of colorectal cancer cases, the serrated pathway remains poorly characterized compared to the adenoma-carcinoma sequence. It involves sessile serrated lesions as precursors and is characterized by BRAF mutations (BRAF[V600E]), CpG island hypermethylation, and microsatellite instability (MSI). Using label-free proteomics, we compared normal tissue margins from patients with diverticular disease, sessile serrated lesions, low-grade adenomas, and high-grade adenomas. We identified S100A14 as significantly overexpressed in sessile serrated lesions compared to low-grade adenomas, high-grade adenomas, and normal tissues. This overexpression was confirmed by immunohistochemical scoring in an independent cohort. Gene expression analyses of public datasets showed higher S100A14 expression in BRAF[V600E]-mutated and MSI-H colorectal cancers compared to microsatellite stable BRAF[wt] tumors. This finding was confirmed by immunohistochemical scoring in an independent colorectal cancer cohort. Furthermore, single-cell RNA sequencing analysis from the Human Colon Cancer Atlas revealed that S100A14 expression in tumor cells positively correlated with the abundance of tumoral CD8[+] cytotoxic T cells, particularly the CD8[+] CXCL13[+] subset, known for its association with a favorable response to immunotherapy. Collectively, our results demonstrate for the first time that S100A14 is a potential biomarker of serrated neoplasia and further suggests its potential role in predicting immunotherapy responses in colorectal cancer.},
}

@article {pmid38671294,
year = {2024},
author = {Carabotti, M and Marasco, G and Sbarigia, C and Cuomo, R and Barbara, G and Pace, F and Sarnelli, G and Annibale, B and , },
title = {Site and duration of abdominal pain discriminate symptomatic uncomplicated diverticular disease from previous diverticulitis patients.},
journal = {Internal and emergency medicine},
volume = {19},
number = {5},
pages = {1235-1245},
pmid = {38671294},
issn = {1970-9366},
mesh = {Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; *Abdominal Pain/etiology ; Diagnosis, Differential ; Diverticular Diseases/complications/diagnosis ; *Diverticulitis/complications/diagnosis ; Irritable Bowel Syndrome/complications/diagnosis ; Surveys and Questionnaires ; Prospective Studies ; Aged, 80 and over ; },
abstract = {Abdominal pain in patients with diverticular disease (DD) can be challenging in clinical practice. Patients with symptomatic uncomplicated diverticular disease (SUDD) and patients with a previous acute diverticulitis (PD) may share a similar clinical pattern, difficult to differentiate from irritable bowel syndrome (IBS). We used standardized questionnaires for DD (short and long lasting abdominal pain) and IBS (following Rome III Criteria) to assess clinical features of abdominal pain, in terms of presence, severity and length, in SUDD and PD patients. One hundred and forty-eight SUDD and 118 PD patients completed all questionnaires. Short-lasting pain was more frequent in SUDD than PD patients (p = 0.007). Number of long-lasting pain episodes was higher in SUDD (6.6 ± 11.9) compared to PD patients (3.4 ± 6.9) (p < 0.001). PD patients reported long-lasting pain more frequently in the lower left abdomen (p < 0.001), while in SUDD it was more frequently diffuse (p = 0.002) or localized in the lower right quadrant (p = 0.009). Features associated with long-lasting pain (fever, confinement to bed, consultations, antibiotic therapy, hospitalization) were more often reported in PD patients. IBS criteria were reported in 28.2% of patients and were more frequent in SUDD than PD patients (37.2% vs 17.1%, p < 0.001). SUDD and PD patients presented different pattern of abdominal pain (length, number of long lasting episodes, site and associated features), with a third reporting overlap with IBS. Further observational studies are needed to better characterize abdominal symptoms in DD patients, especially in those not fulfilling IBS criteria.Trial registration: The REMAD Registry is registered as an observational study in ClinicalTrial.gov (ID: NCT03325829).},
}

Adult
Aged
Female
Humans
Male
Middle Aged
*Abdominal Pain/etiology
Diagnosis, Differential
Diverticular Diseases/complications/diagnosis
*Diverticulitis/complications/diagnosis
Irritable Bowel Syndrome/complications/diagnosis
Surveys and Questionnaires
Prospective Studies
Aged, 80 and over

@article {pmid36910058,
year = {2023},
author = {Constantin, A and Constantinoiu, S and Achim, F and Socea, B and Costea, DO and Predescu, D},
title = {Esophageal diverticula: from diagnosis to therapeutic management-narrative review.},
journal = {Journal of thoracic disease},
volume = {15},
number = {2},
pages = {759-779},
pmid = {36910058},
issn = {2072-1439},
abstract = {BACKGROUND AND OBJECTIVE: Esophageal diverticulum (ED) is a relatively rare condition, characterized by high etio- and pathophysiological versatility, with an uncommon clinical impact, consequently requiring a complete and complex diagnostic evaluation, so that the therapeutic decision is "appropriate" to a specific case. The aim of the paper is, therefore, a reassessment of the diagnostic possibilities underlying the establishment of the therapeutic protocol and the available therapeutic resources, making a review of the literature, and a non-statistical retrospective analysis of cases hospitalized and operated in a tertiary center.

METHODS: Thus, classical investigations (upper digestive endoscopy, barium swallow) need to be correlated with complex, manometric, and imaging evaluations with direct implications in therapeutic management. Moreover, in the absence of a precise etiology, the operative indication needs to be established sparingly, with the imposition of the identification and interception of the pathophysiological mechanisms through the therapeutic gesture.

KEY CONTENT AND FINDINGS: The identification of the pathophysiological mechanisms is mandatory for the management of diverticular disease, the result obtained-restoring swallowing and comfort/good quality of life in the postoperative period-is directly related to the chosen therapeutic procedure. In addition, management appears to be a difficult goal in the context of the low incidence of ED but also of the results that emphasize important differences in the reports in the medical literature. Although ED is a benign condition, surgical techniques are demanding, impacted by significant morbidity and mortality. The causes of these results are multiple: possible localizations anywhere in the esophagus, diverticulum size/volume from a few millimeters to an impressive one, over 10-12 cm, metabolic impact in direct relation to the alteration swallowing, numerous diverticular complications but, perhaps most importantly, alteration of the quality of the diverticular wall by inflammatory phenomena, with an impact on the quality of the suture.

CONCLUSIONS: The accumulation of cases in a tertiary profile center, with volume/hospital, respectively volume/surgeon + gastroenterologist could be a solution in improving the results. One consequence would be the identification of alternative solutions to open surgical techniques, a series of minimally invasive or endoscopic variants can refine these results.},
}

@article {pmid36090626,
year = {2022},
author = {Medellin Abueta, A and Senejoa, NJ and Pedraza Ciro, M and Fory, L and Rivera, CP and Jaramillo, CEM and Barbosa, LMM and Varela, HOI and Carrera, JA and Garcia Duperly, R and Sanchez, LA and Lozada-Martinez, ID and Cabrera-Vargas, LF and Mendoza, A and Cabrera, P and Sanchez Ussa, S and Paez, C and Wexner, SD and Strassmann, V and DaSilva, G and Di Saverio, S and Birindelli, A and Florez, RJR and Kestenberg, A and Obando Rodallega, A and Robles, JCS and Carrasco, CAN and Impagnatiello, A and Cassini, D and Baldazzi, G and Roscio, F and Liotta, G and Marini, P and Gomez, D and Figueroa Avendaño, CE and Villamizar, DM and Cabrera, L and Reyes, JC and Narvaez-Rojas, A},
title = {Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.},
journal = {Health science reports},
volume = {5},
number = {5},
pages = {e788},
pmid = {36090626},
issn = {2398-8835},
abstract = {BACKGROUND: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach.

METHODS: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes.

RESULTS: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%.

CONCLUSIONS: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.},
}

@article {pmid34745597,
year = {2021},
author = {Nugroho, AN and Dina Soraya, AA and Prawirohardjo, AN and Rhatomy, S},
title = {Management of colocutaneus fistula with laparoscopic surgery: Case report.},
journal = {Annals of medicine and surgery (2012)},
volume = {70},
number = {},
pages = {102883},
pmid = {34745597},
issn = {2049-0801},
abstract = {BACKGROUND: Colocutaneous fistulas can occur as the result of complications from diverticular colon surgery. Enterocutaneous fistula is a type of fistula that accounts for about 88.2% of all fistulas. In this report, we describe a case reports of the management of colocutaneous fistula with laparoscopic surgery.

CASE PRESENTATION: In this case reports, both patients complained of increased amount of abdominal discharge after surgery. In Case 1, a 43-year-old female patient complained of a lump in her lower abdomen which had been there for three months. After removal of the lump, there was blood in the drainage tube. After three months, her surgeon advised to close the stoma. In Case 2, a 47-year-old male patient lived with colocutaneous fistula for a year. He had been involved in a traffic accident and underwent laparotomy sigmoidostomy. Both patients experienced pain, and there also were feces and bad odor coming out from the surgical incision. Then, both patients underwent colonoscopy, which revealed coloncutaneous fistulas. Laparoscopic surgery was conducted and there was adhesion between the sigmoid colon and ileum in the ventral abdomen wall. After the laparoscopic procedure, the patients were discharged 3 days later without any complaints.

CONCLUSIONS: Laparoscopic colectomy has recently replaced open resection as standard surgery. This procedure is safe, feasible, and effective for diverticular disease.},
}

@article {pmid34722720,
year = {2021},
author = {Böhm, SK},
title = {Excessive Body Weight and Diverticular Disease.},
journal = {Visceral medicine},
volume = {37},
number = {5},
pages = {372-382},
pmid = {34722720},
issn = {2297-4725},
abstract = {BACKGROUND: The worldwide proportion of overweight adults almost doubled from 22% in 1975 to 39% in 2016. Comparably, for the USA and Germany in 2016, the proportion was 68 and 56.8%, respectively. In Olmsted County, Minnesota, the prevalence of diverticulitis also doubled between 1980 and 2007, from 19 to 40%. Obesity substantially increases the risk of multiple gastrointestinal (GI) diseases and non-GI diseases. In a narrative review, we examined the evidence on whether obesity also increases the risk for the development of diverticulosis or diverticular disease and its outcome.

SUMMARY: Evidence suggests that being overweight (body mass index ≥25 kg/m[2]) or obese (≥30 kg/m[2]), especially viscerally obese, is a risk factor for diverticulosis, diverticular disease and diverticulitis, diverticular bleeding, more severe or complicated disease, recurrent disease, and for worse outcomes after surgery.

KEY MESSAGES: There is a well-founded association between overweight and diverticular disease as well as diverticulosis. It is not clear whether overweight per se or confounders linked with it are responsible for the association. However, means to fight the overweight and obesity epidemic might also help to reduce the prevalence of morbidity and mortality from diverticular disease.},
}

@article {pmid34702716,
year = {2022},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Elisei, W and Picchio, M and Allegretta, L and Annunziata, ML and Bafutto, M and Bassotti, G and Bianco, MA and Colucci, R and Conigliaro, R and Dumitrascu, D and Escalante, R and Ferrini, L and Forti, G and Franceschi, M and Graziani, MG and Lammert, F and Latella, G and Maconi, G and Nardone, G and Camara de Castro Oliveira, L and Chaves Oliveira, E and Papa, A and Papagrigoriadis, S and Pietrzak, A and Pontone, S and Poskus, T and Pranzo, G and Reichert, MC and Rodinò, S and Regula, J and Scaccianoce, G and Scaldaferri, F and Vassallo, R and Zampaletta, C and Zullo, A and Piovani, D and Bonovas, S and Danese, S and , },
title = {Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study.},
journal = {Gut},
volume = {71},
number = {7},
pages = {1350-1358},
doi = {10.1136/gutjnl-2021-325574},
pmid = {34702716},
issn = {1468-3288},
mesh = {Cohort Studies ; Colonoscopy ; *Diverticular Diseases/diagnosis ; *Diverticulitis/complications/diagnosis ; *Diverticulosis, Colonic/diagnosis ; *Diverticulum/complications ; Humans ; Inflammation/complications ; Prognosis ; Prospective Studies ; },
abstract = {OBJECTIVE: To investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA).

DESIGN: A multicentre, prospective, international cohort study.

SETTING: 43 gastroenterology and endoscopy centres located in Europe and South America.

PARTICIPANTS: 2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications.

INTERVENTIONS: A 3-year follow-up was performed.

MAIN OUTCOME MEASURES: To predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score).

RESULTS: The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p<0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p<0.001), respectively. The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10% and <2.5% in CODA B; >10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).

CONCLUSIONS: DICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score.

TRIAL REGISTRATION NUMBER: NCT02758860.},
}

Cohort Studies
Colonoscopy
*Diverticular Diseases/diagnosis
*Diverticulitis/complications/diagnosis
*Diverticulosis, Colonic/diagnosis
*Diverticulum/complications
Humans
Inflammation/complications
Prognosis
Prospective Studies

@article {pmid34541429,
year = {2021},
author = {Origi, M and Achilli, P and Calini, G and Costanzi, A and Monteleone, M and Montroni, I and Maggioni, D and Cocozza, E and Megna, S and Totis, M and Tamini, N and Ziccarelli, A and Filippone, G and Ferrari, G and Crippa, J and Spinelli, A and Mari, GM and , },
title = {The Diverticular Disease Registry (DDR Trial) by the Advanced International Mini-Invasive Surgery Academy Clinical Research Network: Protocol for a Multicenter, Prospective Observational Study.},
journal = {International journal of surgery protocols},
volume = {25},
number = {1},
pages = {194-200},
pmid = {34541429},
issn = {2468-3574},
abstract = {UNLABELLED: Diverticular disease is an increasingly common issue, with a variety of clinical presentations and treatment options. However, very few prospective cohort studies explore outcomes between the different presentations and treatments. The Diverticular Disease Registry (DDR Trial) is a multicenter, prospective, observational cohort study on behalf of the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. The DDR Trial aims to investigate the short-term postoperative and long-term quality of life outcomes in patients undergoing surgery or medical treatments for diverticular disease. DDR Trial is open to participation by all tertiary-care hospitals. DDR Trial has been registered at ClinicalTrials.gov (NCT04907383). Data collection will be recorded on Research Electronic Data Capture (REDCap) starting on June 1[st], 2021 and will end after 5 years of recruitment. All adult patients with imaging-proven colonic diverticular disease (i.e., symptomatic colonic diverticulosis including diverticular bleeding, diverticulitis, and Symptomatic Uncomplicated Diverticular Disease) will be included. The primary outcome of DDR Trial is quality of life assessment at 12-month according to the Gastrointestinal Quality of Life Index (GIQLI). The secondary outcome is 30-day postoperative outcomes according to the Clavien-Dindo classification. DDR Trial will significantly advance in identifying the optimal care for patients with diverticular disease by exploring outcomes of different presentations and treatments.

HIGHLIGHTS: Diverticular disease (i.e., diverticulitis, bleeding) has different treatments.This is a clinical protocol for the Diverticular Disease Registry (DDR Trial).DDR Trial is a multicenter, prospective, observational cohort study open to participation.DDR Trial will study short-term postoperative and long-term quality of life outcomes.Medical treatments, interventional radiology and surgery will be explored.},
}

@article {pmid29470473,
year = {2018},
author = {Osman, K and Srinivasa, S and Koea, J},
title = {Liver abscess: contemporary presentation and management in a Western population.},
journal = {The New Zealand medical journal},
volume = {131},
number = {1470},
pages = {65-70},
pmid = {29470473},
issn = {1175-8716},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drainage ; Female ; Humans ; *Liver Abscess/diagnosis/epidemiology/microbiology/therapy ; Male ; Middle Aged ; New Zealand/epidemiology ; Retrospective Studies ; Young Adult ; },
abstract = {AIM: Historically, liver abscesses (LA) affected elderly, immunocompromised patients and were characterised by high morbidity and mortality, however there are no data pertaining to a New Zealand population with little information surrounding recent management trends.

METHODS: A retrospective review of demographic characteristics, clinical management and microbiological data on patients presenting with liver abscess between 2005-2014 was conducted.

RESULTS: Fifty-seven patients [37 males, median age 64 (range 15-87)] presented with LA and most patients were not comorbid. Ethnicity included European (47%), Chinese (16%) and Pacific Island (11%). Twenty-six patients had primary abscesses, 31 patients had secondary abscesses [biliary disease, appendicitis, diverticular disease]. Presenting symptoms were non-specific. Admission white cell count was raised in 50 (88%) of patients and 43 (75%) had a CRP≥200mg/L. All patients were investigated with CT scan with 34 LA located in the right lobe, 14 in the left and eight bi-lobar. Klebsiella pneumoniae was the commonest pathogen (26% of aspirates). Percutaneous drainage (PD) was used to treat 36 of 37 patients, 17 patients were treated with intravenous antibiotics alone and three patients required open drainage for loculated collections despite PD (n=1), intra-peritoneal rupture or sepsis (n=2). Thirteen patients were readmitted within 30 days for ongoing symptoms requiring intravenous antibiotics/further PD (9) or further investigations (4). The median PD duration was 10 days (range 3-53). Twenty-six patients required follow-up imaging over one month with 16 requiring follow-up over six weeks.

CONCLUSION: In a New Zealand setting, LA affect fit patients, and primary abscesses account for almost half of all presentation. PD is effective treatment in most LA although prolonged drainage and treatment with antibiotics may be necessary.},
}

Adolescent
Adult
Aged
Aged, 80 and over
Drainage
Female
Humans
*Liver Abscess/diagnosis/epidemiology/microbiology/therapy
Male
Middle Aged
New Zealand/epidemiology
Retrospective Studies
Young Adult

@article {pmid26360947,
year = {2015},
author = {Lembcke, B and Kruis, W},
title = {[Diverticular disease - clinical patterns and treatment].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {140},
number = {18},
pages = {1353-1359},
doi = {10.1055/s-0041-102396},
pmid = {26360947},
issn = {1439-4413},
mesh = {*Diverticulitis, Colonic/diagnosis/etiology/physiopathology/therapy ; *Diverticulum/diagnosis/etiology/physiopathology/therapy ; Humans ; },
abstract = {Diverticulosis, diverticular disease and diverticulitis have come into focus again because new aspects concerning diagnosis, risk factors and treatment arose only recently which prompted a new Guideline released by the DGVS and DGAV summarising the current evidence. Along with the guideline's essentials for medical practice a diagnosis of diverticulitis is considered unsatisfactory unless a cross-sectional imaging method (either ultrasonography [US] or computed tomography [CT]) has proven that the clinical findings and inflammation (CRP considered superior to WBC and temperature) are due to diverticular inflammation. For reasons of practicability and considering relevant legislation for radiation exposure protection, US is the primary - and usually effectual - diagnostic method of choice as it is equipotent to CT. While US offers better resolution and enables precise imaging exactly at the location of pain as well as reiterative application, the latter implies advantages in the case of a deep abscess or diverticulitis in difficult locations (e. g. the small pelvis). Clinical evidence and laboratory and imaging findings allow for distinguishing a large number of differential diagnoses and also form the basis of a new classification (classification of diverticular disease, CDD) which comprises all forms of diverticular disease, from diverticulosis to bleeding and to the different facettes of diverticulitis. This classification -which should be applied in any patient with the diagnosis of diverticular disease- is independent of specific diagnostic preferences and applicable both to conservative and operative treatment options. While the number of recurrent episodes is no longer a significant indicator for surgery in diverticulitis, severity and / or complications determine treatment options along with the patients preferences. According to first data, conservative treatment may waive antibiotics under certain circumstances, however they are indispensible in complicated disease or patients bearing risk factors. Spasmoanalgetics and supportive fluid supply are individually necessary, and avoidance of potentially aggravating medications (e. g. NSAIDS) appears advisable, but many suggestions (nil by mouth, bed rest, laxatives) come along without an adaequate body of evidence. Similarly medical advice concerning prevention and secondary prophylaxis relies mainly on epidemiological plausibility. Because minor perforations (CDD type 2 a) as well as recurrent episodes of uncomplicated diverticulitis and even some abscesses > 1 cm (CDD type 2 b) respond favourably to medical treatment, the timely indication for surgery in these cases requires precise classification along with a close surveillance in trustful cooperation between the gastroenterologist and the surgeon.},
}

*Diverticulitis, Colonic/diagnosis/etiology/physiopathology/therapy
*Diverticulum/diagnosis/etiology/physiopathology/therapy
Humans

@article {pmid23983906,
year = {2013},
author = {De'angelis, N and Brunetti, F and Memeo, R and Batista da Costa, J and Schneck, AS and Carra, MC and Azoulay, D},
title = {Comparison between open and laparoscopic reversal of Hartmann's procedure for diverticulitis.},
journal = {World journal of gastrointestinal surgery},
volume = {5},
number = {8},
pages = {245-251},
pmid = {23983906},
issn = {1948-9366},
abstract = {AIM: To compare the open and laparoscopic Hartmann's reversal in patients first treated for complicated diverticulitis.

METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann's procedures for acute complicated diverticulitis. Other indications for Hartmann's procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann's reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups.

RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay.

CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR.},
}

@article {pmid20438892,
year = {2010},
author = {Ferlitsch, A and Silberhumer, GR and Noda, W and Birsan, T and Desai, D and Kumar, A and Rao, GV and Khakar, A and Gomez, NA and Gasche, C},
title = {A novel endoscopic device for repeated right-side colonic access during colonoscopy (with video).},
journal = {Gastrointestinal endoscopy},
volume = {71},
number = {6},
pages = {1052-1055},
doi = {10.1016/j.gie.2009.12.059},
pmid = {20438892},
issn = {1097-6779},
mesh = {Colonic Polyps/*therapy ; *Colonoscopes ; Colonoscopy/*methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Video Recording ; },
abstract = {BACKGROUND: Megachannel is a newly developed colonic access system allowing rapid and multiple passes of the colonoscope to the right side of the colon.

OBJECTIVE: The aim of this study was to evaluate the safety and clinical feasibility of placing a 100 cm Megachannel prototype in the right side of the colon.

SETTING: Six centers, international, both surgeons and gastroenterologists performing endoscopy.

DESIGN AND INTERVENTION: Patients scheduled for colonoscopy with suspected right-side colonic polypoid lesions were included. The prototype was loaded onto a 160 cm lower GI endoscope and introduced via colonoscopic guidance.

MAIN OUTCOME MEASUREMENT: The ability to place this device in the right side of the colon.

RESULTS: The Megachannel prototype was introduced in 41 patients (19 female, mean age 54 years) undergoing colonoscopy. The cecum was reached in 27 cases (66%) within 18 minutes (range, 3-35 minutes) and with 73 cm (range, 40-100 cm) of the device being inserted into the colon. Mild tissue bruises and mild pain were observed in 5 and 3 patients, respectively. In 14 patients, the device assisted the removal of multiple polyps (2-12) as tissue was repeatedly retrieved through the channel. The device also allowed delivery of an endoscopic US scope or suction caps to the right side of the colon.

LIMITATIONS: Prototype performance may differ from the actual product (80 cm in length, redesigned introducer plugs). Small number of patients, difficult in diverticular disease.

CONCLUSIONS: This newly developed colonic access system can be safely placed in the right side of the colon and is useful for a variety of advanced procedures that require repeated insertion of the colonoscope or delivery of bulky instruments. (

NCT00987896.).},
}

Colonic Polyps/*therapy
*Colonoscopes
Colonoscopy/*methods
Feasibility Studies
Female
Humans
Male
Middle Aged
Reoperation
Video Recording

@article {pmid12687960,
year = {2000},
author = {Perniceni, T and Burdy, G and Gayet, B and Dubois, F and Boudet, MJ and Levard, H},
title = {[Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis].},
journal = {Gastroenterologie clinique et biologique},
volume = {24},
number = {2},
pages = {189-192},
pmid = {12687960},
issn = {0399-8320},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulum, Colon/complications/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/complications/*surgery ; },
abstract = {OBJECTIVES: To analyze a unicentric series of 100 consecutive elective laparoscopic colon resections for diverticular disease and to evaluate in intention to treat the early- and middle-term postoperative results.

METHODS: From February 1993 to March 1998, 100 colon resections for complicated diverticular disease were performed through laparoscopy with systematic mobilization of the splenic flexure and resection of the rectosigmoid junction. The colorectal anastomosis was stapled or manual without proximal stoma. In 53 females and 47 males (mean age 60.4 years), indications for surgery were: one or more attacks of acute diverticulitis (n = 70), abscess (n = 17), symptomatic stenosis (n = 8), colovesical fistula (n = 4) and diverticular bleeding (n = 1).

RESULTS: Mortality was nil. The conversion rate was 9%, never for anesthetic reasons. The mean operating time was 226 +/- 68 min. There was no splenic or ureteral injury. The morbidity at 30 days was 19% with fistulae rate accounting for 2%, 2 patients were reoperated on. The median time for passage of flatus was 3 days and median length of hospital stay was 7 days. Late morbidity was 10%, one patient complained of retrograde ejaculation.

CONCLUSION: This study demonstrates that laparoscopy is a safe alternative to laparotomy for elective one-stage colectomy for complicated diverticular disease.},
}

Adult
Aged
Aged, 80 and over
Colectomy/*methods
Diverticulum, Colon/complications/*surgery
Elective Surgical Procedures
Female
Follow-Up Studies
Humans
*Laparoscopy
Male
Middle Aged
Sigmoid Diseases/complications/*surgery

@article {pmid40755984,
year = {2025},
author = {Usman, O and Imtiaz, A and Basit, MA and Tariq, M and Mujahid, R and Khan, MW and Prakash, V and Rehman, OU},
title = {Diverticular Abscess and Percutaneous Drainage Outcomes: A Review of Clinical Practice for the Primary Team.},
journal = {Journal of community hospital internal medicine perspectives},
volume = {15},
number = {3},
pages = {30-37},
pmid = {40755984},
issn = {2000-9666},
abstract = {The inflammation of the diverticular pouch is called acute diverticulitis which can result in abscess formations sometimes. Percutaneous drainage is routinely considered for the management of diverticular abscesses. Being a minimally invasive procedure employed for the removal of large collections of infected fluid from the abscesses, percutaneous drainage emerged as an appealing option. Historically, surgical removal of the abscesses has resulted in multiple hospitalizations and an increased burden on healthcare resources. With the advancement in radiological techniques, CT-guided percutaneous drainage of diverticular abscesses ensured enhanced patient satisfaction and reduced healthcare costs. The choice between surgery or percutaneous drainage of diverticular abscess remains a matter of debate among physicians. The outcomes of percutaneous drainage procedures are scattered across the literature. It is important to be familiar with the criteria regarding the choice of percutaneous drainage or colectomy during the management of diverticular abscesses. Percutaneous drainage can prevent emergent colectomy but it is not always a risk-free procedure. It can bring complications including persistent abscess, new onset abscess, abdominal wall abscess, and peritonitis. Therefore, a physician must prepare in advance to prevent these complications by selecting the right population for the procedure and ensuring good catheter care which involves readjusting the catheter, flushing the catheter and upgrading the size of the catheter. A physician not only prevents these complications but also effectively treats them. This review paper aims to summarize the important outcomes of percutaneous drainage of diverticular abscesses and their further management from a clinical standpoint.},
}

@article {pmid40745040,
year = {2025},
author = {Cadi, M and Cuenod, CA and Grenier, PA and Saltel, A and Abdulbaki, M and Manceau, G and Karoui, M},
title = {CT colonography: revisited after 30 years.},
journal = {Insights into imaging},
volume = {16},
number = {1},
pages = {160},
pmid = {40745040},
issn = {1869-4101},
abstract = {Computed tomography colonography (CTC), also known as virtual colonoscopy, is a well-tolerated, minimally invasive and effective procedure. Used for over two decades and supported by extensive studies and meta-analyses, CTC has demonstrated performance comparable to that of optical colonoscopy (OC). However, CTC remains generally underutilized in many countries, including the United States of America; in contrast, in some countries, such as the United Kingdom, it is widely used. CTC requires bowel preparation with laxative and fecal contrast-agent tagging, followed by colonic distension with low-pressure, automated, CO2 insufflation. It enables detailed image analysis with postprocessing software and is highly sensitive and specific for detecting cancers and significant benign precursors ≥ 10 mm (adenomatous and sessile-serrated polyps) years before potential malignant transformation. After reviewing the state of the art of CTC acquisition, analysis and reporting, we wrote this article to update the new, potential and emerging CTC indications. CTC is increasingly used after incomplete OC, for undetermined colonic anomalies, in elderly and/or fragile patients or when OC is refused. Recent routine clinical use has broadened CTC's applications, proving its usefulness in local colon-cancer staging, preoperative laparoscopic surgery planning, and selecting patients with severe diverticular disease for elective sigmoidectomy. CRITICAL RELEVANCE STATEMENT: Beyond its excellent performance in detecting advanced adenomas and cancers, CTC provides precise staging of locally advanced tumors, guiding decisions on neoadjuvant therapy, and coupled with contrast-enhanced thoracic-abdominal-pelvic acquisition, enables comprehensive, preoperative evaluation for laparoscopic colectomy. KEY POINTS: CT colonography (CTC) and optical colonoscopy (OC) are similarly able to detect advanced adenomas (≥ 10 mm) and early-stage colorectal cancer. CTC enables a "one-stop shop" examination for laparoscopic surgery planning, with precise localization and detailed vascular mesenteric mapping. With the rise of neoadjuvant treatments for advanced colorectal cancer, CTC may become pivotal in radiological staging.},
}

@article {pmid40726258,
year = {2025},
author = {Pau, S and Patel, A and Yap, S and Eglinton, T and Fischer, J},
title = {Colovesical Fistula Management and the Role of Cystoscopy: A Single Institution Experience.},
journal = {ANZ journal of surgery},
volume = {},
number = {},
pages = {},
doi = {10.1111/ans.70273},
pmid = {40726258},
issn = {1445-2197},
abstract = {PURPOSE: Investigations for diagnosis and assessment of colovesical fistula (CVF) include cross-sectional imaging and endoscopic evaluation. Routine pre-operative cystoscopy for CVF remains controversial. The primary aim of this study was to assess the incidence of bladder cancer and the need for routine cystoscopy during the investigation of CVF. Secondary aims were to describe the diagnosis and management of CVF and determine the value of post-operative cystograms.

METHODS: A retrospective observational study was performed at a tertiary referral hospital in New Zealand. Patients were identified from the clinical coding database between 1st January 2000 and 31st December 2021. Demographic, diagnostic, and peri-operative data were collected.

RESULTS: The 88 patients with CVF were identified and included in the analysis. 73.8% of CVF were caused by diverticular disease, followed by colorectal cancer (14.8%), iatrogenic complication (5.7%), bladder cancer (3.4%) and gynecological cancer (2.3%). All patients with CVF due to bladder cancer had a known bladder cancer at the time of CVF diagnosis, and no occult cases of bladder cancer were found during or after surgical resection. The 18 patients had a post-operative cystogram. One patient had a post-operative bladder leak, which was routinely diagnosed on a planned early post-operative cystogram.

CONCLUSION: CVF due to bladder cancer is rare, and when it occurs, it is likely to be in those with a pre-existing diagnosis of bladder cancer. Pre-operative cystoscopy should be used selectively and is not routinely required. Post-operative cystogram may be reserved for cases with large bladder defects or complex bladder repair.},
}

@article {pmid40705318,
year = {2025},
author = {Brown, RF and Lopez, K and Smith, CB and Charles, A},
title = {Diverticulitis: A Review.},
journal = {JAMA},
volume = {},
number = {},
pages = {},
doi = {10.1001/jama.2025.10234},
pmid = {40705318},
issn = {1538-3598},
abstract = {IMPORTANCE: Diverticulosis is defined by the presence of multiple outpouchings (diverticula) originating from the intestinal lumen. Diverticulitis is defined as inflammation of these diverticula. The annual incidence of diverticulitis in the US is approximately 180 per 100 000 people, resulting in approximately 200 000 hospital admissions annually and an estimated health care expenditure of more than $6.3 billion/year.

OBSERVATIONS: Risk factors for diverticular disease include age older than 65 years, genetic factors such as variant in the tumor necrosis factor superfamily member 15 (TNFSFI5) gene; connective tissue diseases such as polycystic kidney disease, Marfan syndrome, or Ehlers-Danlos syndrome; body mass index 30 or greater; use of opioids, steroids, and nonsteroidal anti-inflammatory medications; hypertension; and type 2 diabetes. Approximately 1% to 4% of patients with diverticulosis will develop acute diverticulitis in their lifetime, which typically presents as left lower quadrant pain associated with nausea, vomiting, fever, and leukocytosis. A contrast-enhanced abdominal and pelvic computed tomography scan is the recommended diagnostic test and has a sensitivity of 98% to 99% and specificity of 99% to 100%. Approximately 85% of people with acute diverticulitis have uncomplicated diverticulitis (absence of abscess, colon strictures, colon perforation, or fistula formation). Management of patients with uncomplicated diverticulitis consists of observation with pain management (typically acetaminophen) and dietary modification with a clear liquid diet. Antibiotics should be reserved for patients with systemic symptoms such as persistent fever or chills, those with increasing leukocytosis, those older than 80 years, those who are pregnant, those who are immunocompromised (receiving chemotherapy, or high-dose steroids, or have received an organ transplant), and those with chronic medical conditions (such as cirrhosis, chronic kidney disease, heart failure, or poorly controlled diabetes). First-line antibiotics consist of oral amoxicillin/clavulanic acid or cefalexin with metronidazole. For patients who cannot tolerate oral intake, intravenous antibiotic therapy (ie, cefuroxime or ceftriaxone plus metronidazole or ampicillin/sulbactam) is appropriate. Complicated diverticulitis is managed with intravenous antibiotics such as ceftriaxone plus metronidazole or piperacillin-tazobactam and additional invasive management as indicated (ie, percutaneous drainage of associated intra-abdominal abscess or colon resection). Patients with generalized peritonitis should undergo emergent laparotomy with colonic resection. Postoperative mortality for diverticulitis managed electively or emergently is 0.5% for elective colon resection and 10.6% for emergent colon resection.

CONCLUSIONS AND RELEVANCE: In the US, diverticulitis affects approximately 180 per 100 000 people annually. For uncomplicated diverticulitis, first-line therapy is observation and pain control, and antibiotics should be initiated for patients with persistent fevers, increasing leukocytosis, sepsis or septic shock, advanced age, pregnancy, immunocompromise, and certain chronic medical conditions. Treatment of complicated diverticulitis includes intravenous antibiotics, such as ceftriaxone plus metronidazole or piperacillin-tazobactam, and, if indicated, percutaneous drainage of abscess or resection of diseased segment of colon.},
}

@article {pmid40703297,
year = {2025},
author = {Jono, T and Kasai, Y and Kessoku, T and Tanaka, K and Iwaki, M and Kobayashi, T and Takahashi, K and Seita, K and Kato, T and Sakai, E and Kurihashi, T and Nakatogawa, M and Oyamada, S and Futagami, S and Gwee, KA and Nakajima, A and Tursi, A},
title = {Patients with symptomatic uncomplicated diverticular disease have high fecal bile acid concentrations.},
journal = {Frontiers in medicine},
volume = {12},
number = {},
pages = {1533644},
pmid = {40703297},
issn = {2296-858X},
abstract = {BACKGROUND AND AIM: Symptomatic uncomplicated diverticular disease (SUDD) causes persistent pain and impairs patient quality of life; however, its pathogenesis remains unknown. This study investigated the relationship between SUDD and the inflammatory effects of intestinal bile acids (BAs).

METHODS: Five institutional cohorts with 361 total patients who received outpatient treatment for abdominal symptoms (from 2020 to 2022) were included in this prospective cohort study. All patients underwent colonoscopy. SUDD was defined as the presence of recurrent abdominal symptoms-pain in the lower quadrant lasting >24 h-in patients with diverticulosis at the site of pain. Patients with diverticula were classified into SUDD and non-SUDD groups. The healthy control (HC) group comprised people with no history of medications and no evidence of colonic diverticula. Liquid chromatography-mass spectrometry determined the concentration of fecal BAs. Fecal calprotectin and blood endotoxin activity assay (EAA) levels were measured.

RESULTS: Total fecal BA concentrations did not differ between HC and non-SUDD patients; however, BA levels were significantly higher in patients with SUDD. Fecal calprotectin and blood EAA levels were significantly higher in the SUDD and non-SUDD groups than in the HC group, and in the SUDD group than in the non-SUDD group. Total BA was mildly positively correlated with fecal calprotectin and blood EAA.

CONCLUSION: Fecal BA concentrations were significantly increased in patients with SUDD compared with patients without SUDD or healthy subjects, suggesting that fecal BAs might be involved in the pathogenesis of SUDD and that controlling fecal BA levels may be therapeutic for SUDD.},
}

@article {pmid40697434,
year = {2025},
author = {Koo, TH and Sunkesula, V and Chowdhary, R and Leong, XB and Fass, R and Jalil, AAA},
title = {Trends and disparities of diverticular disease mortality in the United States before and during the COVID-19 era: estimates from the Centers for Disease Control WONDER database.},
journal = {Annals of gastroenterology},
volume = {38},
number = {4},
pages = {428-439},
pmid = {40697434},
issn = {1108-7471},
abstract = {BACKGROUND: Diverticular disease (DD) is a common gastrointestinal condition in the United States (US) associated with significant morbidity and mortality. The COVID-19 pandemic posed new challenges that might exacerbate DD-related outcomes. This study analyzed the trends in all-cause, digestive system (DGS), and cardiovascular system (CVS) mortality associated with DD from 1999-2020, focusing on the impact of COVID-19 on age-adjusted mortality rates (AAMRs) and disparities across demographics and geography.

METHODS: Data from adults aged ≥25 years were extracted from the Centers for Disease Control WONDER database. AAMRs per 100,000 people were standardized using the 2000 US census. AAMRs were assessed from 1999-2020 for context, while the primary comparative analysis focused on the pre-COVID-19 (2016-2019) and post-COVID-19 (2019-2022) periods using linear regression models. AAMRs were stratified by age, sex, race/ethnicity and geographic region. Note: 2021-2022 trends were extrapolated, as finalized mortality records were not available at the time of analysis.

RESULTS: Between 1999 and 2020, 115,009 DD-related deaths occurred (AAMR 2.4/100,000), including 70,648 DGS-related deaths (AAMR 1.5) and 17,405 CVS-related deaths (AAMR 0.4). Females (AAMR 2.6), elderly individuals (AAMR 11.1), and non-Hispanic whites (AAMR 2.5) had the highest mortality rates. Post-COVID-19, AAMRs increased from 1.8 to 2.0, with significant increases among rural populations. DGS-related deaths were most prevalent, particularly in non-metropolitan areas.

CONCLUSIONS: DD-related mortality has increased in the post-COVID-19 period, especially in vulnerable populations, such as the elderly, rural residents and females. These findings highlight the need for equitable healthcare interventions and the continued monitoring of pandemic-era health disparities.},
}

@article {pmid40694019,
year = {2025},
author = {Guo, CG and Wang, J and Liu, Y and Yu, W and Shao, C and Zhang, F},
title = {Lifestyle, genetic susceptibility, and risk of diverticular disease: a prospective cohort study.},
journal = {International journal of surgery (London, England)},
volume = {},
number = {},
pages = {},
doi = {10.1097/JS9.0000000000003087},
pmid = {40694019},
issn = {1743-9159},
abstract = {BACKGROUND: Emerging evidence indicates diverticular disease is attributed to both environmental and genetic factors. The impact of modifiable lifestyle factors on diverticular disease has not been fully elucidated, particularly regarding the role of genetic predisposition.

MATERIALS AND METHODS: We performed a prospective cohort study using data from the UK Biobank, which included 472,612 participants. The impacts of 17 lifestyle factors on diverticular disease were evaluated using Cox regression models. Sensitivity analysis was performed with a specific focus on complicated diverticulitis with perforation and/or abscess. Stratified analyses were performed according to polygenic risk score (PRS) tertiles.

RESULTS: Over a median follow-up of 13.6 years, we identified 23,742 cases of diverticular disease, including 832 cases of complicated diverticulitis. After adjusting for age, sex, BMI, ethnicity, household income and PRS tertiles, smoking, alcohol, frequent insomnia, sedentary behavior and tea consumption were associated with an increased risk of diverticular disease. Conversely, intermediate sleep duration, coffee consumption, and a healthy diet were associated with a lower diverticular disease risk. For complicated diverticulitis, smoking and frequent sleeplessness/insomnia remained significant risk factors. A healthy diet, particularly one rich in fruits and wholegrains, was associated with reduced risk of complicated diverticulitis. The effects of smoking, sleeplessness or insomnia, and consumption of refined grains, processed meats, and unprocessed red meats on diverticular disease can be modified by genetic predisposition.

CONCLUSIONS: Adopting an optimal lifestyle is associated with a lower risk of developing diverticular disease, while the impact of certain lifestyle factors may be modified by genetic predisposition.},
}

@article {pmid40667761,
year = {2025},
author = {Hawkins, AT and Younan, SA and Bonnet, K and Schlundt, D and Gordon, EJ and Ye, F and Irlmeier, R and Cavanaugh, KL and , },
title = {A Novel Decision Aid for Colectomy in Diverticulitis: Cluster Randomized Pilot and Feasibility Study.},
journal = {Diseases of the colon and rectum},
volume = {},
number = {},
pages = {},
doi = {10.1097/DCR.0000000000003836},
pmid = {40667761},
issn = {1530-0358},
abstract = {BACKGROUND: Shared decision-making is crucial in choosing the ideal treatment for recurrent diverticulitis as it involves balancing medical management and surgical interventions in the context of patient preferences.

OBJECTIVE: Describe the feasibility of a pre-visit patient online diverticulitis decision aid and explore the effect on patient-centered outcomes.

DESIGN: Cluster randomized pilot trial.

SETTING: Single tertiary care center.

PATIENTS: Patients with recurrent diverticulitis being seen in a colorectal surgery clinic.

INTERVENTION: Diverticulitis Decision Aid.

MAIN OUTCOME MEASURES: The primary outcome was decisional conflict. Secondary outcomes included decision regret and quality of shared decision making. Feasibility outcomes included recruitment timing, enrollment cadence, and participant retention.

RESULTS: Six colorectal surgeons were enrolled in the study with three randomized to have their patients use the decision aid and three randomized to usual care. Among the 57 eligible patients approached for participation in the trial, 31 (control n=15, intervention n=16) provided informed consent and were enrolled. The median age of participants was 57.0 years and 51.6% were female. We observed baseline pre-consultation decisional conflict scores of (median [interquartile range]) 48.4 [36.7, 54.7], indicating high baseline levels of conflict. Marked reductions in conflict scales in both groups were observed between pre-visit and post-visit, but a greater median reduction was observed in the decision aid group (34.4 [19.5, 49.2]) versus control group (7.8 [-2.3, 34.8]).

LIMITATIONS: Short duration of follow up.

CONCLUSIONS: Patient use of an online diverticulitis decision aid prior to their visit with a surgeon was feasible. Results suggest a greater difference in decisional conflict score reductions with use of the decision aid compared to routine care. See Video Abstract.},
}

@article {pmid40652869,
year = {2025},
author = {Shahrahmani, F and Asghari, Y and Nikbakhsh, N and Salamatfar, H and Ahangar, SK},
title = {Foreign body-induced Colovesical fistula: A case report.},
journal = {International journal of surgery case reports},
volume = {133},
number = {},
pages = {111662},
pmid = {40652869},
issn = {2210-2612},
abstract = {BACKGROUND: Colovesical fistula (CVF) is a rare condition characterized by an abnormal connection between the colon and the urinary bladder. While diverticular disease is the most common cause, this report describes a unique case of CVF resulting from an ingested foreign body.

CASE PRESENTATION: A 78-year-old woman with a history of COPD and chronic lymphocytic leukemia presented with prolonged urinary symptoms, including dysuria, frequency, hematuria, and a history of pneumaturia and fecaluria. A CT scan with rectal contrast revealed thickening of the sigmoid colon, contrast material extending into the bladder, and an associated air-fluid level. Cystography and colonoscopy confirmed the presence of a CVF with inflammation and narrowing of the sigmoid colon. Remarkably, the patient spontaneously passed a "bone-like" object through the urethra, later identified as a chicken bone. She underwent a single-stage resection of the affected sigmoid colon with primary anastomosis and bladder repair. Histopathology confirmed chronic inflammatory changes consistent with fistula formation. The patient recovered uneventfully.

DISCUSSION: CVF most commonly arises from diverticulitis, but migration of ingested foreign bodies leading to erosion into the urinary system is rare. This case highlights the importance of considering foreign body ingestion in CVFs without an identifiable cause.

CONCLUSION: Although rare, ingested foreign bodies-such as a chicken bone-can erode the bowel wall and cause a CVF. The spontaneous urethral passage of such objects is an even rarer event. This case underscores the importance of thorough history-taking and imaging studies to identify unusual causes of CVF.},
}

@article {pmid40651334,
year = {2025},
author = {Veronese, N and Gianfredi, V and Solmi, M and Barbagallo, M and Dominguez, LJ and Mandalà, C and Di Palermo, C and Carruba, L and Solimando, L and Stubbs, B and Castagna, A and Maggi, S and Zanetti, M and Al-Daghri, N and Sabico, S and Nucci, D and Gosling, C and Fontana, L},
title = {The impact of dietary fiber consumption on human health: An umbrella review of evidence from 17,155,277 individuals.},
journal = {Clinical nutrition (Edinburgh, Scotland)},
volume = {51},
number = {},
pages = {325-333},
doi = {10.1016/j.clnu.2025.06.021},
pmid = {40651334},
issn = {1532-1983},
mesh = {Humans ; *Dietary Fiber/administration & dosage ; Cardiovascular Diseases/mortality/prevention & control ; Meta-Analysis as Topic ; *Diet ; Observational Studies as Topic ; Female ; Pancreatic Neoplasms/mortality/prevention & control ; },
abstract = {BACKGROUND: Dietary fiber plays a crucial role in disease prevention through multiple protective mechanisms. While previous reviews have examined its health effects, recent advances necessitate an updated synthesis of the evidence.

OBJECTIVES: This umbrella review systematically evaluates meta-analyses of observational studies to assess the strength and credibility of associations, and the quality of evidence linking dietary fiber intake to diverse health outcomes, providing a comprehensive assessment of these associations.

METHODS: We updated our previous umbrella review by searching major databases (October 21, 2017-December 1, 2024) for meta-analyses on dietary fiber and health outcomes. Methodological quality was assessed using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews), and evidence credibility was classified based on predefined criteria, accounting for heterogeneity (I[2]), small-study effects, and excess significance bias.

RESULTS: Thirty-three meta-analyses covering 38 health outcomes and 17,155,277 individuals were included. Of these, 29 (76 %) reported significant inverse associations (p < 0.05) between higher fiber intake and disease risk. Convincing evidence (Class I) was identified for cardiovascular disease (CVD) mortality, pancreatic cancer, and diverticular disease. Highly suggestive evidence (Class II) supported associations with all-cause mortality, CVD, coronary heart disease and ovarian cancer. Suggestive evidence (Class III) was observed for 16 outcomes, while six outcomes (16 %) exhibited weak evidence (Class IV). Quality assessment indicated that six meta-analyses were of high methodological quality, while others had some methodological limitations.

CONCLUSIONS: Higher dietary fiber intake is associated with lower risk of multiple chronic diseases, particularly CVD mortality, pancreatic cancer, and diverticular disease. Despite these benefits, intake remains below recommended levels worldwide. Public health strategies should promote fiber-rich diets, and future research should further elucidate the role of specific fiber types in disease prevention.

https://osf.io/37tyc/.},
}

Humans
*Dietary Fiber/administration & dosage
Cardiovascular Diseases/mortality/prevention & control
Meta-Analysis as Topic
*Diet
Observational Studies as Topic
Female
Pancreatic Neoplasms/mortality/prevention & control

@article {pmid40647227,
year = {2025},
author = {Voniatis, C and Csupor, T and Szijártó, A},
title = {Are Nuts Safe in Diverticulosis? A Mixed-Methods Systematic Review of Available Evidence.},
journal = {Nutrients},
volume = {17},
number = {13},
pages = {},
pmid = {40647227},
issn = {2072-6643},
mesh = {Humans ; *Nuts/adverse effects ; *Diverticulum/prevention & control/epidemiology ; *Diet ; },
abstract = {Background: Diverticulosis is defined as the presence of diverticula in the intestinal tract. While asymptomatic in most cases, severe complications can arise. The precise etiology of diverticulosis is still being investigated, but its correlation to dietary exposures has been proven. While certain diet recommendations have cemented themselves throughout the years, others seem to be always disputed. Nut consumption has been highly questioned among researchers and clinicians alike for decades. Objectives: This review aims to examine all available data regarding nut consumption and diverticulosis. Methods: We performed a systematic literature review from various databases (PubMed, Web of Science, Embase, and the Cochrane Library). We followed a multi-modal approach, incorporating both qualitative and quantitative techniques to assess and evaluate studies that investigated nut exposure and diverticulosis. Results: Nine observational studies encompassing over two million person-years were included. The qualitative synthesis and risk-of-bias assessments align with a neutral to modestly protective effect of moderate nut intake. Analysis of nut-specific cohorts revealed no significant increase in diverticulitis risk (HR 0.89, 95% CI 0.71-1.12). A sensitivity analysis including a prudent dietary pattern yielded a significant risk reduction (HR 0.75, 0.58-0.97). Dose-response modelling indicated a linear 5% reduction in risk per additional weekly serving. Robustness checks (leave-one-out analysis, tripping point analysis, etc.) confirmed the stability of these findings, with no single study unduly influencing the pooled estimates. Conclusions: Although limitations are present, current evidence suggests that moderate nut consumption is safe and may be protective against diverticulosis, while showing no adverse effect on diverticulitis incidence.},
}

Humans
*Nuts/adverse effects
*Diverticulum/prevention & control/epidemiology
*Diet

@article {pmid40595170,
year = {2025},
author = {Ogawa-Ochiai, K and Tsuji, S and Maeda, A and Ikehara, H and Kawabata, K and Dohmen, T and Ojima, E and Nakayama, G and Hisabe, T and Suenaga, M and Kagaya, T and Ishigure, K and Okochi, O and Hattori, M and Hirai, H and Kasai, T and Takeda, T and Yamada, T and Yoshida, I and Sakai, M and Takehara, A and Munemoto, Y and Esaki, M and Mochizuki, Y and Nishijima, K and Kitamura, S and Sakai, S and Hara, T and Honyang, L and Doyama, H and Uchita, K and Kodera, Y and Yoshimura, K and Mori, K and Ishikawa, H},
title = {A prospective, randomized, double-blind, placebo-controlled trial of the Kampo formula daiobotanpito combined with antibiotic therapy for acute diverticulitis.},
journal = {Scientific reports},
volume = {15},
number = {1},
pages = {21069},
pmid = {40595170},
issn = {2045-2322},
support = {17lk0310031h0001//Japan Agency for Medical Research and Development/ ; },
mesh = {Humans ; Male ; Female ; Double-Blind Method ; Middle Aged ; *Anti-Bacterial Agents/therapeutic use/administration & dosage ; Aged ; Medicine, Kampo ; Treatment Outcome ; Prospective Studies ; Acute Disease ; *Diverticulitis/drug therapy ; *Drugs, Chinese Herbal/therapeutic use/administration & dosage ; Drug Therapy, Combination ; *Plant Extracts/therapeutic use ; Adult ; Japan ; Aged, 80 and over ; },
abstract = {Daiobotanpito (DBT) is a Kampo formula traditionally used to treat abscesses in intestinal disorders. This double-blind, multicenter, randomized controlled trial was conducted at participating hospitals in Japan. Patients with CT-proven moderate acute diverticulitis received conventional therapy along with an oral DBT (treatment group) or placebo (control group) administered thrice a day for 10 days (Registration: jRCTs041180063). The primary outcome was the treatment success rate: fever reduction to < 37.5 °C within 3 days or/and elimination of abdominal pain within 4 days. Secondary endpoints included hospitalization days, changes in the inflammatory response, number of days before food intake, recurrence rate within 1-year, and adverse event rate. 171 participants were included in this study. No significant difference was observed in the treatment success rates between the DBT and placebo groups (P = .348). However, the DBT group showed a significant reduction in CRP levels on day 5 (P = .023), and patients with abscesses started oral intake significantly earlier than those in the placebo group (P = .046). In conclusion, the results of this study do not suggest that an add-on treatment with DBT in patients with moderate acute diverticulitis provides additional benefit., However, DBT may offer clinical benefits in cases involving abscesses or severe inflammation. Further prospective studies focusing on complicated diverticulitis are necessary.},
}

Humans
Male
Female
Double-Blind Method
Middle Aged
*Anti-Bacterial Agents/therapeutic use/administration & dosage
Aged
Medicine, Kampo
Treatment Outcome
Prospective Studies
Acute Disease
*Diverticulitis/drug therapy
*Drugs, Chinese Herbal/therapeutic use/administration & dosage
Drug Therapy, Combination
*Plant Extracts/therapeutic use
Adult
Japan
Aged, 80 and over

@article {pmid40592564,
year = {2025},
author = {Ma, W and Ha, J and Neylan, CJ and Munro, H and Skerrett, D and Downie, JM and Sevilla-González, M and Steinwandel, M and Mumma, M and Zheng, W and Maguire, LH and Giovannucci, EL and Strate, LL and Chan, AT},
title = {Lifestyle factors, genetic susceptibility and risk of incident diverticulitis: an integrated analysis of four prospective cohort studies and electronic health records-linked biobank.},
journal = {Gut},
volume = {},
number = {},
pages = {},
doi = {10.1136/gutjnl-2025-335364},
pmid = {40592564},
issn = {1468-3288},
abstract = {BACKGROUND: Both lifestyle factors and genetic predisposition contribute to the development of diverticulitis.

OBJECTIVE: To examine whether lifestyle modification can reduce the genetic risk of diverticulitis.

DESIGN: We derived an overall healthy lifestyle score for diverticulitis based on smoking, body mass index (BMI), physical activity, fibre and red meat among 179 564 participants in three prospective cohorts-the Nurses' Health Study (NHS), NHSII and the Health Professionals Follow-Up Study. The association between the healthy lifestyle score and incident diverticulitis was confirmed among 30 750 participants in the Southern Community Cohort Study (SCCS). We assessed genetic risk using a polygenic risk score among 36 077 individuals with genotype data available. We further validated our findings in the Mass General Brigham Biobank (MGBB).

RESULTS: A healthy lifestyle score was associated with a decreased risk of diverticulitis. Compared with a score of 0, the multivariable-adjusted HR for a score of 5 was 0.50 (95% CI, 0.44 to 0.57; p trend<0.0001). This association was consistent across the SCCS in both non-Hispanic black and white populations. Each unit increase in the healthy lifestyle score was associated with a reduced diverticulitis risk similarly across genetic risk categories, with HRs of 0.89 (95% CI, 0.83 to 0.95) for low, 0.86 (0.81 to 0.92) for mid and 0.87 (0.83 to 0.91) for high genetic risk. In the MGBB cohort, a higher BMI was associated with an increased diverticulitis risk across genetic risk categories.

CONCLUSION: Maintaining a healthy lifestyle was associated with a reduced risk of developing diverticulitis, regardless of population differences and genetic susceptibilities.},
}

@article {pmid40585790,
year = {2025},
author = {Obidike, PC and Lain, WJ and Hoang, SC},
title = {Robotic Surgical Management of Complicated Diverticulitis.},
journal = {Current trauma reports},
volume = {11},
number = {1},
pages = {14},
pmid = {40585790},
issn = {2198-6096},
abstract = {PURPOSE OF REVIEW: Complicated diverticulitis is a common gastrointestinal pathology. Historically, surgical management involved multi-stage open resection and stoma creation, which were often associated with more significant morbidity, low stoma reversal rates, and postoperative complications.

RECENT FINDINGS: Minimally invasive techniques, including laparoscopy and robotics, have emerged as alternative options for surgically managing complicated diverticulitis. While high conversion rates may deter surgeons from minimally invasive approaches, robotics offer several technical advantages, including three-dimensional visualization, increased instrument range of motion, reduced conversion rates compared to laparoscopy, and improved postoperative patient outcomes.

SUMMARY: In this review, we discuss robotic surgery as a safe and feasible approach to the surgical management of complicated diverticulitis both electively and emergently in select patients. We present recommendations for intraoperative robotics setup and patient positioning and propose solutions that address the limitations of robotics, such as longer operative times and specialized training, that affect the adoption of robotics for surgically managing complicated diverticulitis.},
}

@article {pmid40585097,
year = {2025},
author = {Li, AT and Burns, S and Martinez, D and Wang, P and Aggarwal, S and Potter, M and Sarkar, U and Somsouk, M},
title = {CLINICAL DIAGNOSIS CODES IDENTIFY PATIENTS UNLIKELY TO RECEIVE ORDERS FOR FECAL IMMUNOCHEMICAL TESTS.},
journal = {medRxiv : the preprint server for health sciences},
volume = {},
number = {},
pages = {},
pmid = {40585097},
support = {R01 CA271031/CA/NCI NIH HHS/United States ; },
abstract = {INTRODUCTION: Organized screening programs automate fecal immunochemical test (FIT) outreach based on chronological age. However, providers and patients may defer screening due to coexisting conditions, which can be captured by International Classification of Disease, 10[th] revision (ICD-10) codes. We sought to identify codes associated with not having a FIT order.

METHODS: We included screen-eligible patients with a primary care visit between June 2022 and June 2023. We enumerated and compared the frequency of each ICD-10 code between patients with and without a FIT ordered. We conducted a subgroup analysis including only those with a Charlson comorbidity index (CCI) <5.

RESULTS: We identified 15,020 screen-eligible patients, with 10,187 (67.8%) patients having had a FIT order and 4,833 (32.3%) patients without a FIT order. Of the 1,215 ICD-10 codes examined, 96 were significantly associated with not having a FIT order. One broad category of codes pertained to digestive diseases such as benign and malignant colonic neoplasms (ICD-10 code C18, odds ratio (OR) 0.06, 95% CI [0.001-0.44]) and diverticular disease (K57, OR 0.26 [0.18-0.36]). Another category was comorbid conditions which included frailty (R54, OR 0.14 [0.03-0.55]) and paralysis (G82, OR 0.14 [0.03-0.55]). Those with acute conditions such as cervical fractures (S12, OR 0.23 [0.10-0.48]) and cryptococcosis (B45, OR 0.05 [0.001-0.38]) were also less likely to have a FIT order. Among the patients with CCI<5, 41 codes were significantly associated with not having a FIT order, including heart failure (I50, OR 0.55 [0.43-0.71]) and chronic kidney disease (N18, OR 0.58 [0.43-0.77]).

CONCLUSION: Patients deferred from screening were more likely to have ICD-10 codes signifying digestive diseases, comorbidities, and acute conditions. Even among patients with fewer co-morbid conditions, we identified health conditions that were associated with screening deferral. Future work should consider whether screening programs could incorporate ICD-10 codes to align FIT outreach more closely with provider and patient preferences.},
}

@article {pmid40579645,
year = {2025},
author = {Dalby, HR and Erichsen, R and Gotschalck, KA and Emmertsen, KJ},
title = {The DIVIPACT cohort profile: Evaluating the impact of colonic diverticulosis on daily life.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {27},
number = {7},
pages = {e70155},
pmid = {40579645},
issn = {1463-1318},
support = {//Novo Nordisk Fonden/ ; },
mesh = {Humans ; Female ; Male ; *Quality of Life ; Denmark/epidemiology ; *Diverticulosis, Colonic/psychology/complications/physiopathology/epidemiology ; Cross-Sectional Studies ; Aged ; Middle Aged ; *Activities of Daily Living/psychology ; Adult ; Self Report ; Surveys and Questionnaires ; Aged, 80 and over ; Cohort Studies ; Registries ; },
abstract = {AIM: Colonic diverticulosis is asymptomatic in most subjects but can impact daily life. The DIVIPACT study comprehensively explores the impact of diverticulosis on daily life. The aim of this publication is to introduce the DIVIPACT cohort, present self-reported data from a cross-sectional survey and outline the potential for further research.

METHOD: The DIVIPACT cohort comprises subjects diagnosed with diverticulosis (K572-9) in the Central Denmark Region (five hospitals, ~1.3 million residents) between 2010 and 2022 who responded to an online questionnaire survey conducted in 2023 assessing health factors and quality of life (QoL). Self-reported data were linked to Danish health registries for consenting responders. Responders were categorized according to previous hospital management (inpatient, outpatient or diverticulosis) and characterized based on self-reported health factors.

RESULTS: Of the 20 961 responders (74% response rate), 19 244 (92%) consented to data linkage. Among these, 4184 (22%) were inpatients, 8666 (45%) were outpatients and 6394 (33%) had diverticulosis only. Overall, 1596 (10%) reported restrictions on activity due to diverticulosis in the past 4 weeks. Bowel function affected QoL in 66% of inpatients, 54% of outpatients and 44% of diverticulosis-only individuals.

CONCLUSION: The DIVIPACT cohort provides one of the most extensive datasets available for evaluating the impact of colonic diverticulosis on daily life, addressing important knowledge gaps and providing a foundation for patient-centred management strategies.},
}

Humans
Female
Male
*Quality of Life
Denmark/epidemiology
*Diverticulosis, Colonic/psychology/complications/physiopathology/epidemiology
Cross-Sectional Studies
Aged
Middle Aged
*Activities of Daily Living/psychology
Adult
Self Report
Surveys and Questionnaires
Aged, 80 and over
Cohort Studies
Registries

@article {pmid40542969,
year = {2025},
author = {Phan, HS and Strate, LL},
title = {Management of Colonic Diverticular Disease in the Older Adult.},
journal = {Current gastroenterology reports},
volume = {27},
number = {1},
pages = {42},
pmid = {40542969},
issn = {1534-312X},
mesh = {Humans ; Aged ; *Diverticulitis, Colonic/therapy/diagnosis/complications ; *Gastrointestinal Hemorrhage/therapy/etiology ; Age Factors ; },
abstract = {PURPOSE OF REVIEW: While societal guidelines help direct management of diverticulitis and diverticular bleeding broadly, our review focuses on the latest data for nuanced care of older patients affected by these conditions.

RECENT FINDINGS: Diverticulitis in older patients can present with non-specific symptoms so a broad work up is recommended. Once diagnosed, those with uncomplicated disease (Hinchey Class 0 or 1a) can be safely managed without antibiotics or admission depending on frailty and comorbidities. Most older patients with complicated diverticulitis (abscess, perforation or obstruction) should be hospitalized. Elective or emergent surgery for complicated disease (Hinchey Class 1b-4) is associated with higher morbidity and mortality, particularly in older patients. The risk of diverticular bleeding and re-bleeding significantly increases with age, potentially due to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants. Diverticular disease and its associated complications disproportionately affect older adults. Management should focus on resuscitation, having low threshold for comprehensive work up and re-evaluating medication use for comorbid conditions to prevent recurrence.},
}

Humans
Aged
*Diverticulitis, Colonic/therapy/diagnosis/complications
*Gastrointestinal Hemorrhage/therapy/etiology
Age Factors

@article {pmid40542583,
year = {2025},
author = {Sakowitz, S and Bakhtiyar, SS and Ali, K and Vadlakonda, A and Balian, J and Lee, H and Benharash, P},
title = {Impact of Psychosocial Risk Factors on Acute Clinical Outcomes Following Colectomy: A National Perspective.},
journal = {The American surgeon},
volume = {},
number = {},
pages = {31348251353072},
doi = {10.1177/00031348251353072},
pmid = {40542583},
issn = {1555-9823},
abstract = {BackgroundA growing body of work has considered the significance of patients' psychosocial support and surrounding socioeconomic milieu on surgical outcomes. The presence of such psychosocial risk factors (PSRFs) may define both access to and engagement with care, particularly for access-sensitive conditions, such as colon resection. Yet, the impact of PSRF on outcomes following colectomy remains to be delineated.MethodsWe queried the Nationwide Readmissions Database for all adults undergoing elective/emergent colectomy for benign neoplasms, colon cancer, diverticular disease, or inflammatory bowel disease from 2016 to 2022. The presence of PSRF across 5 domains (low-income or uninsured status, substance use, psychiatric disease, and cognitive limitations) was identified using validated administrative codes. Patients with ≥1 PSRF comprised the At-Risk cohort (others: Not-At-Risk).ResultsAmong ∼1,130,803 records, 497,336 (44.0%) had ≥1 documented PSRF. The At-Risk cohort was younger and of greater comorbidity burden, and more frequently underwent open resection at non-metropolitan centers. Following comprehensive risk adjustment, the presence of PSRF remained associated with greater likelihood of in-hospital mortality (AOR 1.17, CI 1.11-1.22) and any major complication (AOR 1.09, CI 1.07-1.11), as well as non-home discharge (AOR 1.41, CI 1.37-1.44) and non-elective readmission within 30 days (AOR 1.10, CI 1.08-1.12). These associations persisted when evaluating only patients treated at high colectomy volume hospitals.DiscussionIn this national study, the presence of PSRF was associated with significantly inferior outcomes following colectomy. Notably, this association was not mitigated by care at high volume hospitals. Psychosocial risk factors should be considered as part of risk stratification and care optimization efforts across institutions.},
}

@article {pmid40530108,
year = {2025},
author = {Frias, J and Martins, M and Peixoto, A and Macedo, G},
title = {Rifaximin as a Therapeutic Ally in the Modulation of Dysbiosis: A Narrative Review of Its Applicability in Gastrointestinal Disorders.},
journal = {GE Portuguese journal of gastroenterology},
volume = {},
number = {},
pages = {1-15},
pmid = {40530108},
issn = {2341-4545},
abstract = {BACKGROUND: The gastrointestinal microbiota is vital for a well-functioning digestive tract, nutrient metabolism, immune support, and protection against pathogenic microorganisms. Disruption of this balance is known as dysbiosis. Rifaximin, an oral antibiotic with selective action, reduces harmful gut bacteria while preserving beneficial species, aiding in microbiota restoration.

SUMMARY: Alterations in the intestinal microbiota are implicated in many gastrointestinal disorders. Rifaximin, by targeting and modulating the microbiota, may serve as a powerful tool in the approach of these conditions.

KEY MESSAGES: This narrative review summarizes the main uses of rifaximin in gastrointestinal disorders like irritable bowel syndrome, diverticular disease, small intestinal bacterial overgrowth, traveler's diarrhea, hepatic encephalopathy, Clostridioides difficile infection, and inflammatory bowel disease.},
}

@article {pmid40501530,
year = {2025},
author = {Neylan, CJ and Kim, A and Amy, M and Hernandez, PT},
title = {The Epidemiology of Diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {38},
number = {4},
pages = {241-248},
pmid = {40501530},
issn = {1531-0043},
abstract = {Diverticular disease consists of diverticulosis and diverticulitis. Diverticulosis is commonly encountered, and approximately 4% of patients with diverticulosis will progress to develop diverticulitis, which represents a significant health care burden in the United States. Diverticular disease has an increasing incidence both in the United States and globally as important risk factors, including obesity, are becoming more prevalent. The pathophysiology of diverticular disease remains incompletely understood, although geographic and population-based differences in its prevalence and anatomic distribution have generated several hypotheses as to the impact of genetic and environmental factors on development and disease progression. Uncomplicated diverticulitis has had a low mortality rate for the last several decades, but in-hospital mortality approaches 7% for patients with complicated diverticulitis who require emergent surgery. For patients that develop diverticulitis, recent population-based data have led to an improved understanding of which patients will suffer recurrent episodes. This knowledge has facilitated informed discussions with patients and has changed practice in terms of elective surgery.},
}

@article {pmid40501529,
year = {2025},
author = {Lopez, K and Maguire, LH},
title = {Structural Alterations in Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {38},
number = {4},
pages = {249-252},
pmid = {40501529},
issn = {1531-0043},
abstract = {Clinicians appreciate the structural alterations of diverticular disease when navigating narrow, angulated colons with a colonoscope or removing stiff, fixed sigmoid colons at surgery. Investigation of these tissues reveals increased thickness of smooth muscle, alterations in the amount and structure of the extracellular matrix, and changes to the motility of the colon. More sophisticated technologies now allow scientists to unravel the connections between these alterations and the individual genetic background. This article explores the structural alterations of diverticular disease including collagen, smooth muscle, the enteric nervous system, and the interstitial cells of Cajal.},
}

@article {pmid40501526,
year = {2025},
author = {Troester, A and Weaver, L and Jahansouz, C},
title = {The Emerging Role of the Microbiota and Antibiotics in Diverticulitis Treatment.},
journal = {Clinics in colon and rectal surgery},
volume = {38},
number = {4},
pages = {269-276},
pmid = {40501526},
issn = {1531-0043},
abstract = {Diverticular disease is the leading cause of elective colon surgery. With a rising incidence in younger populations, it continues to pose a significant burden on the health care system. Traditional etiopathogenesis implicated an infectious mechanism, while recent challenges to this theory have demonstrated the microbiome playing a significant role, along with genetic predispositions and associations with obesity and diet. Therefore, the role of antibiotics in uncomplicated disease merits reconsideration. In this review, we aim to outline the current knowledge regarding antibiotics for diverticulitis treatment, broadly define the microbiome components, functions, and modifiability, and discuss newly proposed pathogenetic mechanisms for diverticular disease that incorporate information regarding the microbiome. Analytic techniques for microbiota characterization and function continue to advance at a rapid pace. As emerging technology advances, we will continue to elucidate the role of the microbiome in diverticular disease development.},
}

@article {pmid40501523,
year = {2025},
author = {Velez-Padilla, J and Pastrana Del Valle, J and Cavallaro, P},
title = {Risk Prediction in Diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {38},
number = {4},
pages = {263-268},
pmid = {40501523},
issn = {1531-0043},
abstract = {Acute diverticulitis is a common sequela of colonic diverticulosis that often poses a significant dilemma for surgeons and patients considering surgical management of the disease. Importantly, the decision to recommend surgery for patients with diverticular disease hinges on identifying those who will benefit most in terms of preventing future disease-related complications. This review focuses on identifying patient risk factors that are predictive of onset of diverticulitis, recurrence of disease, and progression to complicated disease, such as abscess, fistula, or stricture, and aims to assist clinicians with counseling patients who are considering surgery versus medical management. Specifically, a variety of modifiable and nonmodifiable risk factors have been identified across several studies that have strong associations with the development of diverticulitis, recurrence of uncomplicated disease, and progression to complicated disease. A handful of clinical scores have been described to guide surgeons and patients on their individual risk; however, none have been adopted into wider clinical practice. A novel polygenic risk score does show promise in potentially fulfilling this role. Nevertheless, there is significant room for innovation and development of new methods to risk-stratify patients presenting with the spectrum of diverticular disease.},
}

@article {pmid40491034,
year = {2025},
author = {Sassun, R and Roufael, F and Crippa, J and Magistro, C and Bertoglio, C and Achilli, P and Dinuzzi, VP and Montroni, I and Maggioni, D and Spinelli, A and Costanzi, A and Siracusa, C and Dominici, R and Leoni, V and Larson, DW and Mari, G and , },
title = {Impact of elective surgery on tumor necrosis factor-α, interleukin-6 and quality of life in uncomplicated diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {27},
number = {6},
pages = {e70132},
doi = {10.1111/codi.70132},
pmid = {40491034},
issn = {1463-1318},
mesh = {Humans ; *Interleukin-6/blood ; Female ; *Elective Surgical Procedures ; Male ; *Tumor Necrosis Factor-alpha/blood ; Middle Aged ; Prospective Studies ; *Quality of Life ; Aged ; *Diverticular Diseases/surgery/blood ; *Diverticulitis, Colonic/surgery/blood ; Adult ; Recurrence ; },
abstract = {AIM: Growing evidence suggests that immune/inflammatory pathways play a crucial role in the persistence of symptoms in diverticular disease (DD). We hypothesize that chronic diverticulitis triggers a self-sustained inflammatory status which can be detected by measuring the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). The aim of this study was to investigate the systemic levels of TNF-α and IL-6 before and after elective surgery in patients with DD, and their relationship with the gastrointestinal quality of life index (GIQLI) score.

METHOD: This prospective multicentric study enrolled patients from the Diverticular Disease Registry (DDR-Trial, NCT04907383). All adult patients diagnosed with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated recurrent diverticulitis (URD) and smouldering diverticulitis (SmD) between 1st December 2022 and 31st December 2023 were included in this study. Exclusion criteria were as follows: no surgery, a concurrent chronic immunomodulated systemic disease, a SARS-CoV-2-positive test in the previous 12 months, a history of cancer in the previous 5 years, patients treated with immunomodulators, an American Society of Anesthesiologists category of class IV, and complicated acute diverticulitis.

RESULTS: Seventy-two patients were included: 52 (72%) with URD, 11 (15%) with SUDD, and nine (13%) with SmD. The median postsurgery - presurgery (Δ)IL-6 and ΔTNF-α levels were -16.8 and -17.3 pg/mL, respectively (p < 0.001 for both; Wilcoxon test). Spearman correlation revealed a significant, negative association between the ΔGIQLI and the ΔIL-6, as well as the ΔTNF-α (p < 0.001 for both). Greater reduction in the levels of IL-6 and TNF-α following surgery are associated with higher GIQLI scores postoperatively.

CONCLUSION: Patients with chronic diverticulitis may experience persistent systemic inflammation driven by a colonic trigger. Surgical removal of this trigger appears to enhance GIQLI outcomes reducing IL-6 and TNF-α across surgery.},
}

Humans
*Interleukin-6/blood
Female
*Elective Surgical Procedures
Male
*Tumor Necrosis Factor-alpha/blood
Middle Aged
Prospective Studies
*Quality of Life
Aged
*Diverticular Diseases/surgery/blood
*Diverticulitis, Colonic/surgery/blood
Adult
Recurrence

@article {pmid40487372,
year = {2025},
author = {Rodríguez Acosta, IJ and Peralta Pérez, JJ and González Rosero, FJ and Ríos Giraldo, AM and Rincón Carrillo, LD and Tanaka Takegami, M and Dussan Tovar, CA and Quiroz Alfaro, AJ},
title = {Complicated Diverticular Disease of the Small Bowel: A Rare Cause of Acute Abdomen in a Critically Ill Patient-A Case Report.},
journal = {Clinical medicine insights. Case reports},
volume = {18},
number = {},
pages = {11795476251346608},
pmid = {40487372},
issn = {1179-5476},
abstract = {Diverticular disease of the small bowel is a rare, generally asymptomatic condition with a challenging diagnostic approach and the potential for life-threatening complications. While diverticular disease can manifest in any part of the gastrointestinal tract, its occurrence in the jejunum is exceptionally uncommon, with an incidence of up to 1%. Although rare, complications from diverticular disease of the small bowel can arise in up to 10% of cases, usually manifesting as signs and symptoms mimicking other etiologies or an acute abdomen. In this case report, we present the management of an elderly male patient with multiple comorbidities who developed an acute abdomen during his intensive care unit stay. The patient required surgical intervention, which revealed numerous complicated diverticula of the small bowel, affecting the jejunum, as the underlying cause of his symptoms.},
}

@article {pmid40480391,
year = {2025},
author = {Yan, F and Huang, H and Li, Y},
title = {Mood instability and 22 gastrointestinal disorders: investigating the causal relationships and the mediating factors by Mendelian randomization analysis.},
journal = {Journal of affective disorders},
volume = {388},
number = {},
pages = {119591},
doi = {10.1016/j.jad.2025.119591},
pmid = {40480391},
issn = {1573-2517},
mesh = {Humans ; *Mendelian Randomization Analysis ; Genome-Wide Association Study ; *Gastrointestinal Diseases/genetics/psychology/epidemiology ; *Mood Disorders/genetics ; Genetic Predisposition to Disease ; Gastroesophageal Reflux/genetics ; Risk Factors ; Male ; },
abstract = {BACKGROUND: Observational studies have suggested correlations between mood instability and gastrointestinal (GI) disorders, however, the causal relationships remain unclear.

METHODS: We conducted a two-sample Mendelian randomization (MR) analysis to investigate the causal relationships between mood instability and 22 GI disorders using genome-wide association study (GWAS) data from disease-relevant GWAS studies, the UK Biobank, and the FinnGen project. To ensure the robustness of causal estimates, we applied multiple MR methods and extensive sensitivity analyses. Additionally, multivariable MR (MVMR) and two-step mediation analyses were performed to explore direct causal effects and potential mediating factors.

RESULTS: After multiple-testing correction, genetic liability to mood instability was significantly associated with an increased risk of four GI disorders: gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), diverticular disease, and cholelithiasis. Reverse MR analysis further suggested that genetically predicted GERD and IBS also increased the risk of mood instability. These findings were consistent across sensitivity analyses and were validated in independent datasets. Moreover, MVMR and mediation analyses indicated that smoking and depression may partially mediate the causal effects on GERD.

CONCLUSIONS: Mood instability, as a personality trait, may play a causal role in the development of multiple GI disorders. Our findings suggest that behavioral interventions, such as smoking cessation, may help reduce GI risk among individuals prone to mood instability. This highlights the potential for integrated behavioral-gastrointestinal risk stratification, where psychological profiling could help to identify individuals at high-risk and inform targeted prevention and intervention strategies.},
}

Humans
*Mendelian Randomization Analysis
Genome-Wide Association Study
*Gastrointestinal Diseases/genetics/psychology/epidemiology
*Mood Disorders/genetics
Genetic Predisposition to Disease
Gastroesophageal Reflux/genetics
Risk Factors
Male

@article {pmid40459895,
year = {2025},
author = {Khan, A and Sellyn, GE and Ali, D and Moazzam, Z and Samaras, H and McChesney, SL and Hopkins, MB and Ford, MM and Muldoon, RL and Geiger, TM and Martin, D and Chu, DI and VanKoevering, KK and Hawkins, AT},
title = {Three-Dimensional-Printed Models and Shared Decision-Making: A Cluster Randomized Clinical Trial.},
journal = {JAMA network open},
volume = {8},
number = {6},
pages = {e2513187},
pmid = {40459895},
issn = {2574-3805},
mesh = {Humans ; *Printing, Three-Dimensional ; Female ; Male ; Middle Aged ; *Decision Making, Shared ; Anxiety/prevention & control/psychology ; Adult ; *Patient Participation/psychology ; Aged ; *Models, Anatomic ; },
abstract = {IMPORTANCE: Patients undergoing surgery report a lack of involvement in health care decisions and increased anxiety. Three-dimensional (3D)-printed models serve as educational tools to encourage patient engagement, reduce anxiety levels, and aid understanding.

OBJECTIVE: To determine the impact of 3D-printed anatomic models on shared decision-making (SDM) and patient anxiety during the preoperative surgical consultation for colon or rectal resection.

This single-center cluster randomized clinical trial was conducted from March 2022 to June 2023 at a colorectal surgery clinic at an academic medical institution and included adult patients scheduled for partial or complete colon and/or rectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease.

INTERVENTION: Six surgeons (clusters) were randomized to counsel patients using a modular 3D-printed model or providing usual care during preoperative clinic visits.

MAIN OUTCOMES AND MEASURES: The primary outcome was the patient's perception of involvement in decision-making using the 9-item Shared Decision Making Questionnaire. The secondary outcome was the change in anxiety level measured using the State-Trait Anxiety Inventory. Patient characteristics were compared between the 3D-printed model and usual care arms using a χ2 test for categorical variables and a t test for comparisons between continuous variables.

RESULTS: Among the 51 patients enrolled (mean [SD] age, 50.7 [14.5] years; 28 female [54.9%]), 28 (54.9%) were in the 3D-printed model arm and 23 (45.1%) were in the usual care arm. Patients counseled with the 3D-printed model reported a significantly higher involvement in SDM compared with those in the usual care group (mean [SD] score, 89.5 [17.6] vs 80.5 [14.4]; P = .01). Additionally, using a 3D-printed model significantly reduced mean anxiety scores (from 53.5 [SD, 21.2] to 44.1 [SD, 15.8]) compared with conventional methods (from 50.4 [SD, 18.3] to 48.0 [SD, 15.3]) (P = .04).

CONCLUSIONS AND RELEVANCE: This cluster randomized clinical trial found that counseling aided with 3D models during preoperative clinic visits improved SDM among patients undergoing colorectal surgery. This study highlights the potential of 3D-printed models as a tool to enhance patient-clinician collaborations. Given the findings, further research into the effectiveness and implementation of these tools is recommended in more diverse clinical settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06625008.},
}

Humans
*Printing, Three-Dimensional
Female
Male
Middle Aged
*Decision Making, Shared
Anxiety/prevention & control/psychology
Adult
*Patient Participation/psychology
Aged
*Models, Anatomic

@article {pmid40441205,
year = {2025},
author = {Zhou, J and Xu, Y and Wang, H and Wang, K and Chen, C},
title = {Investigating the causal links among gut microbiome features, inflammation-related proteins, and diverticular disease: Insights from a mediation Mendelian randomization study.},
journal = {Medicine},
volume = {104},
number = {22},
pages = {e42676},
pmid = {40441205},
issn = {1536-5964},
support = {No. JDY2023018//Jiangsu University Medical Education Collaborative Innovation Fund Project/ ; No. Z2021010//Medical Research Project of Jiangsu Health Commission/ ; },
mesh = {Humans ; *Gastrointestinal Microbiome/genetics ; Mendelian Randomization Analysis ; *Diverticular Diseases/microbiology/genetics ; *Inflammation/genetics ; Genome-Wide Association Study ; Mediation Analysis ; },
abstract = {The pathophysiological mechanisms underlying diverticular disease (DD) remain incompletely understood, and there is considerable debate regarding the roles of gut microbiome features and inflammation-related proteins in the development of the disease. In this study, we employed mediation Mendelian randomization (MR) analysis to investigate the causal relationships among these 3 factors. In this study, we conducted a MR analysis on the genome-wide association studies data of 412 gut microbiome features (207 microbial taxa and 205 pathways), 91 inflammation-related proteins, and DD. We employed the inverse-variance weighted (IVW) method as our primary screening approach, followed by a mediation MR analysis to explore potential causal relationships among these 3 aspects. Our findings were further reinforced by comprehensive heterogeneity analyses, horizontal pleiotropy testing, outlier detection, and "leave-one-out" sensitivity analysis. Through our screening process, we identified potential causal relationships between DD and 18 gut microbiome features, as well as 6 inflammation-related proteins. These include s_Oscillibacter_unclassified (IVW odds ratio (OR): 1.139; 95% confidence interval (CI): 1.044-1.241, P = .003), g_Bilophila (IVW OR: 1.107, 95% CI: 1.016-1.206, P = .020), T-cell surface glycoprotein CD5 levels (IVW OR: 1.065, 95% CI: 1.011-1.123, P = .019), and inosine 5'-phosphate biosynthesis I (IVW OR: 0.882, 95% CI: 0.800-0.973, P = .012), etc. In the mediation MR analysis, we found that the genetic predictors of g_Bilophila and inosine 5'-phosphate biosynthesis I could explain 23.956% and 24.630% of the variation in T-cell surface glycoprotein CD5 levels, respectively. This study detailed analysis of the links between gut microbiome features, inflammation-related proteins, and DD offers key insights into DD pathogenesis and prevention.},
}

Humans
*Gastrointestinal Microbiome/genetics
Mendelian Randomization Analysis
*Diverticular Diseases/microbiology/genetics
*Inflammation/genetics
Genome-Wide Association Study
Mediation Analysis

@article {pmid40438722,
year = {2025},
author = {Christodoulidis, G and Tsagkidou, K and Bartzi, D and Prisacariu, IA and Agko, ES},
title = {Endoscopic management of upper non-variceal and lower gastrointestinal bleeding: Where do we stand?.},
journal = {World journal of gastrointestinal endoscopy},
volume = {17},
number = {5},
pages = {105580},
pmid = {40438722},
issn = {1948-5190},
abstract = {Non-variceal upper gastrointestinal bleeding (GIB) remains a significant clinical challenge with a 30-day mortality of up to 11%. Peptic ulcers are the most common cause, followed by other conditions like Mallory-Weiss syndrome, Dieulafoy's lesions, and gastric neoplasms. Treatment strategies include acid-suppressive therapy, endoscopic interventions, and surgical or radiological procedures. Endoscopic techniques such as over-the-scope clips, coagulation graspers, and endoscopic ultrasound-guided treatments have significantly improved outcomes, reducing rebleeding rates and the need for surgery. Injectable therapies, mechanical hemostasis via clips, and thermal modalities (e.g., electrocoagulation, argon plasma coagulation) remain standard approaches for active bleeding. Newer hemostatic powders, such as TC-325, offer promising non-contact treatments, particularly in cases of refractory bleeding or malignancy. Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow, improving the efficacy of endoscopic therapy and reducing rebleeding risks. For small bowel bleeding, endoscopic management with enteroscopy and thermal therapies remains key, though medical therapies are evolving. Lower GIB, which often involves conditions like diverticular disease and angioectasia, requires a comprehensive approach combining endoscopic, radiologic, and surgical interventions. Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks, with reversal agents playing a crucial role in life-threatening bleeding episodes. This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.},
}

@article {pmid40436407,
year = {2025},
author = {Gagliardi, M and Abbatiello, C and Sica, M and Soldaini, C and Fusco, M and Maurano, A and Zulli, C},
title = {Endoscopic septotomy for a rare colorectal anastomotic complication after elective laparoscopic sigmoidectomy for diverticular disease.},
journal = {Endoscopy},
volume = {57},
number = {S 01},
pages = {E513-E514},
pmid = {40436407},
issn = {1438-8812},
}

@article {pmid40418426,
year = {2025},
author = {Alsourani, A and Pastor, C and Arredondo, J and Colombari, RC and Pellino, G and Tejedor, P and , },
title = {Surveillance and follow-up in acute diverticulitis with pericolic free gas (ADiFas II): an age-specific analysis.},
journal = {Updates in surgery},
volume = {77},
number = {4},
pages = {1039-1049},
pmid = {40418426},
issn = {2038-3312},
mesh = {Humans ; Male ; Female ; Aged ; Acute Disease ; Middle Aged ; Follow-Up Studies ; Age Factors ; Prospective Studies ; Tomography, X-Ray Computed ; *Diverticulitis, Colonic/surgery/complications ; Colonoscopy ; *Gases ; Adult ; *Diverticulitis/surgery/complications ; Aged, 80 and over ; Propensity Score ; },
abstract = {The objective of this study was to examine the differences in clinical presentation and complications during the first year of follow-up in patients who experienced an episode of acute diverticulitis (AD) with pericolic free gas, comparing outcomes across different age groups. A prospective subanalysis was conducted on a cohort from the ADiFAS study, which originally included 1099 patients. After excluding 289 patients who did not meet the inclusion criteria, 810 patients remained for analysis. From this cohort, 330 patients with AD and pericolic free gas were selected using propensity score matching and divided into two age groups: < 65 years and ≥ 65 years. The groups were matched based on sex, BMI, diabetes mellitus (DM), cardiovascular disease, previous episodes of AD, and the presence of free fluid on CT scan. Data were assessed for Hinchey classification, surgical procedures, complications, and the frequency of surveillance through colonoscopy and CT scans. The study found a significantly higher rate of surgery in the older group during the index episode (17% vs. 4.2%, p = 0.000). A higher proportion of patients in the older group were misclassified as Hinchey II (18.2% vs. 6.4%, p = 0.007) and Hinchey III (2.3% vs. 0.7%, p = 0.304). All patients classified as Hinchey III (1 in the younger group and 3 in the older group) underwent emergency surgery. In the younger group, 2 out of 8 emergency surgeries were for patients classified as Hinchey II, compared to 11 out of 28 in the older group. Only 58% of patients underwent any form of imaging or endoscopic surveillance during the first year of follow-up. Among those, complications such as abscess, fistula, or stenosis were observed in 17% of patients, occurring more frequently in the older group (16.9% vs. 5.7%, p = 0.089). Nearly 50% of these patients required surgery, with 6 cases in the younger group and 9 in the older group. Emergency surgeries were more common in the older group (2.4% vs. 0.6%, p = 0.186), as was elective surgery (10.3% vs. 7.9%, p = 0.283). A conservative approach, combined with meticulous monitoring through regular follow-ups and imaging, can be effectively employed in managing patients with acute diverticulitis and pericolic free gas. However, our findings highlight the critical need for rigorous surveillance, especially in older patients, due to the higher prevalence of long-term complications.},
}

Humans
Male
Female
Aged
Acute Disease
Middle Aged
Follow-Up Studies
Age Factors
Prospective Studies
Tomography, X-Ray Computed
*Diverticulitis, Colonic/surgery/complications
Colonoscopy
*Gases
Adult
*Diverticulitis/surgery/complications
Aged, 80 and over
Propensity Score

@article {pmid40418063,
year = {2025},
author = {Pascual-Mato, M and Gárate Viñas, G and Muñoz San Martín, M and González-Quintanilla, V and Crespo, J and Rivero Tirado, M and Pascual Gómez, J},
title = {Calcitonin gene-related peptide (CGRP) in the pathophysiology of gastrointestinal disorders - A key mediator in the gut-brain axis.},
journal = {Revista espanola de enfermedades digestivas},
volume = {},
number = {},
pages = {},
doi = {10.17235/reed.2025.11310/2025},
pmid = {40418063},
issn = {1130-0108},
abstract = {The concept "gut-brain axis" means a bidirectional communication between the central nervous system and the gastrointestinal (GI) tract. This axis is key in keeping the physiological homeostasis of the GI tract and its dysfunction has been implicated in a number of neuropsychiatric and gut conditions. A number of neurotransmitters are known to be involved in the performance of gut-brain axis. Our objective has been to review and critically analyze the contribution of the calcitonin gene-related peptide (CGRP) in the physiology and pathophysiology of the gut-brain axis, with emphasis in the fresh, basic, and clinical evidence supporting an outstanding role of this neuropeptide. CGRP is considered the pivotal molecule and the first biomarker of migraine, a debilitating disease combining digestive and neurological symptoms. A number of recent experimental and clinical data support a relevant protective role for CGRP, and in particular for beta-CGRP, the isoform located in the enteric nervous system, in the gut-brain axis proper functioning and in the pathophysiology of several gut diseases, including conditions such as diverticular disease, acute infectious diarrhea or inflammatory bowel disease. As examples of its adaptable behavior, circulating beta-CGRP levels are increased in patients with acute diarrhea in COVID-19 infection or reduced already in the early phases of inflammatory bowel disease. In addition, beta-CGRP antagonism could explain the constipation seen with the new CGRP antagonists used in the preventive treatment of frequent migraine. These evidences indicate a relevant role of CGRP in gut-brain axis functioning and call for analyzing a potential role of CGRP in other common diseases of the GI tract, comorbid with brain conditions, such as irritable bowel syndrome or chronic constipation.},
}

@article {pmid40413682,
year = {2025},
author = {Eltyeb, HA and Mohamedahmed, AYY and Mills, GA and Khan, J},
title = {Left colectomy for diverticular disease: systematic review and meta-analysis comparing robotic and laparoscopic resections.},
journal = {Techniques in coloproctology},
volume = {29},
number = {1},
pages = {121},
pmid = {40413682},
issn = {1128-045X},
mesh = {Humans ; *Laparoscopy/methods/adverse effects ; *Robotic Surgical Procedures/methods/adverse effects ; *Colectomy/methods/adverse effects ; Postoperative Complications/etiology/epidemiology ; Length of Stay/statistics & numerical data ; Middle Aged ; Female ; Conversion to Open Surgery/statistics & numerical data ; Treatment Outcome ; Male ; Aged ; *Diverticular Diseases/surgery ; },
abstract = {BACKGROUND: Around 50% of people aged 60 years and above are affected by diverticular disease, and 25% of these individuals will require surgical intervention. Our objective is to compare the results of left colonic resection for sigmoid diverticular disease using both robotic and laparoscopic approaches. Our primary aim is to conduct a meta-analysis while investigating the rates of conversion to open surgery, stoma and complications between the two methods.

METHODOLOGY: A systematic review was conducted following the PRISMA guidelines. A meta-analysis was performed using RevMan Version 5.4 software. The random-effect model was employed to pool dichotomous outcomes and estimate risk and odds ratios (OR).

RESULTS: Eight studies were thought to fulfil the eligibility criteria: 1892 patients (49.2%) had robotic surgery, and 1952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group (P < 0.00001), a lower rate of postoperative ileus (P = 0.005), shorter length of stay (mean difference (MD) 0.18 P = 0.003) and fewer morbidities (P = 0.002). There were similar rates of stoma formation (4.7%, P = 1.00), anastomotic leak (2.6%, P = 0.85) and mortality (0.3% vs 0.2%, P = 0.59). The operative time was shorter in the robotic approach, although the difference was not significant (P = 0.47).

CONCLUSION: Robotic surgery is feasible for diverticular disease compared to laparoscopic left colectomy. Our study observed a reduction in the conversion to open rate, reduced morbidity, and less ileus while demonstrating similar rates of stoma formation, anastomotic leak, and mortality. However, more high-quality research needs to be conducted to investigate this further. The study is registered in Prospero (reg # CRD42023440509).},
}

Humans
*Laparoscopy/methods/adverse effects
*Robotic Surgical Procedures/methods/adverse effects
*Colectomy/methods/adverse effects
Postoperative Complications/etiology/epidemiology
Length of Stay/statistics & numerical data
Middle Aged
Female
Conversion to Open Surgery/statistics & numerical data
Treatment Outcome
Male
Aged
*Diverticular Diseases/surgery

@article {pmid40401718,
year = {2025},
author = {Crouch, GM and Hendren, S and Brockhaus, KK and Weng, W and Boyd, JL and Rocker, C and Cleary, RK},
title = {Ileus After Colectomy in the Modern Era: A Population-Based Analysis.},
journal = {Diseases of the colon and rectum},
volume = {68},
number = {8},
pages = {1001-1009},
doi = {10.1097/DCR.0000000000003825},
pmid = {40401718},
issn = {1530-0358},
mesh = {Humans ; *Colectomy/adverse effects/methods ; Male ; Female ; *Ileus/epidemiology/etiology ; Retrospective Studies ; *Postoperative Complications/epidemiology/etiology ; Aged ; Risk Factors ; Middle Aged ; Michigan/epidemiology ; Elective Surgical Procedures/adverse effects ; Piperidines ; },
abstract = {BACKGROUND: Postoperative ileus after colectomy is common and associated with increased health care costs and patient morbidity. Although most Michigan hospitals have implemented enhanced recovery pathways, we hypothesized that ileus would still be clinically relevant.

OBJECTIVE: To understand the current burden of and risk factors for postoperative ileus.

DESIGN: Retrospective analysis of patients undergoing elective colectomy. Patient, hospital, perioperative care, and surgical risk factors were tested for association. Multivariable logistic regression was performed to identify independent risk factors for ileus. Risk-adjusted hospital rates of ileus were compared.

SETTING: Seventy hospitals in the Michigan Surgical Quality Collaborative.

PATIENTS: Prospective database between 2018 and 2023.

MAIN OUTCOME MEASURE: The primary outcome was postoperative ileus, defined as "no oral intake for 4 or more postoperative days or the need for nasogastric tube insertion within 30 days after surgery."

RESULTS: Of 9571 patients who underwent elective colectomy, there were 9393 partial and 178 total colectomies. Ileus was diagnosed in 6.56% of the cohort, and hospital crude rates ranged from 0.79% to 22.0%. Ileus was associated with other complications (29.62% for those with postoperative ileus vs 7.68% for those without postoperative ileus, p < 0.0001), mortality (1.75% vs 0.59%, p = 0.0006), reoperation (16.72% vs 4.92%, p < 0.0001), and readmissions (27.39% vs 6.50%, p < 0.0001). Multivariable analysis revealed risk factors for ileus to be total colectomy (27.5% versus 6.2% for partial colectomy), hospital size of more than 500 beds, male sex, immunosuppressant medications, non-White race, chronic obstructive pulmonary disease, sleep apnea, and age older than 65 years. Factors associated with decreased ileus included a minimally invasive surgical approach (5.2% vs 10.1% for open approach), alvimopan use, ambulation within 24 postoperative hours, and diverticular disease. There was significant hospital variation in risk-adjusted ileus rates.

LIMITATIONS: Retrospective study design.

CONCLUSIONS: The low observed rate of ileus may reflect the modern era of enhanced recovery and minimally invasive colectomy. Total colectomy is associated with high rate of ileus compared to partial colectomy. Increased implementation of minimally invasive surgery, perioperative alvimopan, and early ambulation might further reduce ileus rates. See Video Abstract.

ANTECEDENTES:El íleo postoperatorio tras una colectomía es frecuente y se asocia con un aumento de los costos de atención médica y la morbilidad del paciente. Si bien la mayoría de los hospitales de Michigan han implementado vías de recuperación mejoradas, nuestra hipótesis fue que el íleo seguiría siendo clínicamente relevante.OBJETIVO:Comprender la causa actual y los factores de riesgo del íleo postoperatorio.DISEÑO:Análisis retrospectivo de pacientes sometidos a colectomía electiva. Se evaluó la asociación entre el paciente, el hospital, la atención perioperatoria y los factores de riesgo quirúrgicos. Se realizó una regresión logística multivariable para identificar los factores de riesgo independientes del íleo. Se compararon las tasas hospitalarias de íleo ajustadas al riesgo.ESCENARIO:Setenta hospitales del Michigan Surgical Quality Collaborative.PACIENTES:Base de datos prospectiva entre 2018 y 2023.MEDIDA DE RESULTADOS PRINCIPAL:El resultado primario fue el íleo postoperatorio, definido como «ausencia de ingesta oral durante ≥4 días postoperatorios o necesidad de inserción de sonda nasogástrica dentro de los 30 días posteriores a la cirugía». RESULTADOS: De 9571 pacientes sometidos a colectomía electiva, se realizaron 9393 colectomías parciales y 178 totales. Se diagnosticó íleo en el 6,56 % de la cohorte, y las tasas brutas hospitalarias oscilaron entre el 0,79 % y el 22,0 %. El íleo se asoció con otras complicaciones (29,62 % frente al 7,68 %, p < 0,0001), mortalidad (1,75 % frente al 0,59 %, p = 0,0006), reintervención (16,72 % frente al 4,92 %, p < 0,0001) y reingresos (27,39 % frente al 6,50 %, p < 0,0001). El análisis multivariable mostró que los factores de riesgo de íleo fueron la colectomía total (27,5%) frente a la parcial (6,2%), el tamaño del hospital >500 camas, el sexo masculino, los inmunosupresores, la raza no blanca, la EPOC, la apnea del sueño y la edad >65 años. Los factores asociados con una disminución del íleo incluyeron el abordaje quirúrgico mínimamente invasivo (5,2%) frente al abierto (10,1%), el alvimopán, la deambulación en las 24 horas posteriores a la operación y la enfermedad diverticular. Se observó una variación significativa entre hospitales en las tasas de íleo ajustadas al riesgo.LIMITACIONES:Diseño retrospectivo del estudio.CONCLUSIÓN:La baja tasa observada de íleo podría reflejar la era moderna de la recuperación mejorada y la colectomía mínimamente invasiva. La colectomía total se asocia con una alta tasa de íleo en comparación con la colectomía parcial. Una mayor implementación de la cirugía mínimamente invasiva, el alvimopán perioperatorio y la deambulación temprana podrían reducir aún más las tasas de íleo. (Traducción-Dr Yolanda Colorado).},
}

Humans
*Colectomy/adverse effects/methods
Male
Female
*Ileus/epidemiology/etiology
Retrospective Studies
*Postoperative Complications/epidemiology/etiology
Aged
Risk Factors
Middle Aged
Michigan/epidemiology
Elective Surgical Procedures/adverse effects
Piperidines

@article {pmid40394329,
year = {2025},
author = {Sarofim, M and Mui, J and Cartmill, J and Gilmore, A},
title = {Natural orifice specimen extraction for diverticular disease: technique, outcomes and role of inflammatory markers.},
journal = {Surgical endoscopy},
volume = {39},
number = {7},
pages = {4245-4252},
pmid = {40394329},
issn = {1432-2218},
mesh = {Humans ; Female ; Male ; Middle Aged ; Prospective Studies ; *Colectomy/methods ; Aged ; *Natural Orifice Endoscopic Surgery/methods/adverse effects ; Postoperative Complications/epidemiology/etiology ; Length of Stay/statistics & numerical data ; Biomarkers/blood ; *Laparoscopy/methods ; Adult ; Treatment Outcome ; *Diverticular Diseases/surgery ; Operative Time ; Aged, 80 and over ; },
abstract = {BACKGROUND: Minimally invasive colectomy is common for diverticular disease. Natural orifice specimen extraction (NOSE) is an innovative adjunct that avoids the morbidity of abdominal incisions. The aim of this study is to evaluate the outcome of NOSE in laparoscopic surgery for complications of diverticular disease, and assess the role of post-operative inflammatory markers.

METHODS: A multi-centre prospective study was conducted from 2012 to 2024. Consecutive patients who underwent emergency and elective NOSE colectomy for diverticular disease were included. Demographics, surgical techniques, post-operative complications and biochemical results were analysed.

RESULTS: NOSE colectomy was successful in 99.4% of patients (171/172), with a mean age of 59.9 years. Indications for surgery were phlegmon (35%), recurrent diverticulitis (27%), stricture (21%), fistulae (14%) and haemorrhage (2%). Mean length of stay was 5.7 days (SD 3.8), and anastomotic leak rate was 1.8%. Specimen longitudinal splitting increased operative time (254 vs. 220 min, p < 0.01) and length of stay (6.6 vs. 5.3 days, p = 0.02). Significantly higher inflammatory markers were observed in the longitudinal split group on post-operative days 2-4 without increased complication or anastomotic leak rates.

CONCLUSION: NOSE colectomy demonstrates excellent perioperative outcomes in this large series and is an effective approach for diverticular disease. Specimen debulking facilitates successful NOSE procedures, with expected increases in inflammatory markers which are not associated with higher complication rates.},
}

Humans
Female
Male
Middle Aged
Prospective Studies
*Colectomy/methods
Aged
*Natural Orifice Endoscopic Surgery/methods/adverse effects
Postoperative Complications/epidemiology/etiology
Length of Stay/statistics & numerical data
Biomarkers/blood
*Laparoscopy/methods
Adult
Treatment Outcome
*Diverticular Diseases/surgery
Operative Time
Aged, 80 and over

@article {pmid40392051,
year = {2025},
author = {Real Noval, H and Fernández Fernández, J and Castelo Álvarez, E and Fernández Mallo, J},
title = {[Do patients with diverticula have a higher risk of developing polyps and colorectal cancer? Study in a spanish population].},
journal = {Revista espanola de salud publica},
volume = {99},
number = {},
pages = {},
pmid = {40392051},
issn = {2173-9110},
mesh = {Humans ; Male ; Female ; Cross-Sectional Studies ; Spain/epidemiology ; Middle Aged ; *Colorectal Neoplasms/epidemiology ; Aged ; *Colonic Polyps/epidemiology ; Colonoscopy ; Adult ; Prevalence ; *Diverticulum/epidemiology/complications ; Risk Factors ; Aged, 80 and over ; },
abstract = {OBJECTIVE: Diverticulosis, colorectal polyps and colorectal cancer are frequently encountered in colonoscopies. The aim of this study was to evaluate the possible relationship between these three conditions.

METHODS: A cross-sectional study between January 2019 and December 2023 was done at Jarrio Hospital (Asturias, Spain). We included all patients with a first complete colonoscopy. Exclusion criteria were: previous colonoscopy or colorectal resection; age under sixteen years old; incomplete colonoscopy or insufficient bowel preparation. Information about age, sex, BMI, location and histology of polyps and location of diverticula and cancer was recorded. Logistic regression was carried out to identify the association between diverticulosis with polyps and neoplasms, as well as with other variables.

RESULTS: A total of 2,328 patients were recruited. Prevalence of diverticular disease, polyps and colorectal cancer was 36.5%, 26.7% and 9.4%. Patients with polyps, diverticulosis and cancer were older and had higher BMI. Polyps and cancer were more common in men but no differences in prevalence of diverticular disease were found between men and women. Patients with diverticula had a higher risk of having polyps (Odds Ratio=1.3) but did not have an increased risk of colorectal cancer. Diverticula, polyps and cancer were found more frequently in distal colon.

CONCLUSIONS: A positive association between the presence of diverticula and the appearance of polyps in the colon is found in this study. However, no significant statistical association is found between the presence of diverticula and colorectal cancer.},
}

Humans
Male
Female
Cross-Sectional Studies
Spain/epidemiology
Middle Aged
*Colorectal Neoplasms/epidemiology
Aged
*Colonic Polyps/epidemiology
Colonoscopy
Adult
Prevalence
*Diverticulum/epidemiology/complications
Risk Factors
Aged, 80 and over

@article {pmid40382446,
year = {2025},
author = {Dalby, HR and Erichsen, R and Gotschalck, KA and Emmertsen, KJ},
title = {Reoperation and mortality following elective surgery for chronic and recurrent colonic diverticular disease: A nationwide population-based cohort study.},
journal = {International journal of colorectal disease},
volume = {40},
number = {1},
pages = {123},
pmid = {40382446},
issn = {1432-1262},
support = {NNF21OC0071125//Novo Nordisk Fonden/ ; NNF21OC0071125//Novo Nordisk Fonden/ ; },
mesh = {Humans ; *Elective Surgical Procedures/mortality/adverse effects ; Female ; Male ; *Reoperation/statistics & numerical data ; Recurrence ; Aged ; Middle Aged ; Aged, 80 and over ; Denmark/epidemiology ; Chronic Disease ; Cohort Studies ; Risk Factors ; Adult ; },
abstract = {PURPOSE: The ideal treatment for chronic and recurrent colonic diverticular disease (crDD) remains unresolved, partly due to lacking evidence regarding surgical safety. This study evaluated 90-day reoperation and mortality rates following elective surgery for crDD and explored predictors for reoperation and mortality.

METHODS: This national cohort study included all patients with crDD undergoing elective colonic resection or stoma formation in Denmark from 1996-2021. Outcomes were the 90-day cumulative incidence proportion (CIP) of reoperation and mortality, and predictors were explored in Cox proportional hazard models.

RESULTS: Among 35,174 patients with crDD, 3,584 (10%) underwent elective surgery. The 90-day reoperation rate was 18.0%; mortality was 1.6%. During the 25-year period, the reoperation rate declined 30%, from 19.5% to 13.8%, and mortality declined 74%, from 2.7% to 0.7%. Among 2,942 patients with colonic resection and no stoma formation, the reoperation rate due to anastomotic leak was 3.0% overall and 0.9% in the most recent years. Mortality was 18 times higher in patients aged ≥ 80 years versus those aged < 60 years (CIP 8.0% versus 0.4%). The reoperation rate was increased in patients with ≥ 4 hospital contacts or ≥ 3 admissions compared to patients with fewer contacts, while mortality was not associated with the number of hospital contacts before surgery.

CONCLUSION: Elective surgery in crDD was safe with careful patient selection. The risk of reoperation due to anastomotic leak was very low. Patients with most hospital contacts had an increased reoperation rate, supporting consideration for elective surgery early in patients with disabling diverticular disease.},
}

Humans
*Elective Surgical Procedures/mortality/adverse effects
Female
Male
*Reoperation/statistics & numerical data
Recurrence
Aged
Middle Aged
Aged, 80 and over
Denmark/epidemiology
Chronic Disease
Cohort Studies
Risk Factors
Adult

@article {pmid40375540,
year = {2025},
author = {Sakowitz, S and Bakhtiyar, SS and Vadlakonda, A and Aguayo, E and Lee, H and Benharash, P},
title = {Outcomes Following Colectomy at For-Profit Hospitals: A National Analysis.},
journal = {The American surgeon},
volume = {},
number = {},
pages = {31348251337162},
doi = {10.1177/00031348251337162},
pmid = {40375540},
issn = {1555-9823},
abstract = {BackgroundOne of the most commonly performed operations in the US, colectomy remains associated with a substantial incidence of postoperative complications. While there is increasing recognition that hospital for-profit financial structure may be linked with variation in morbidity, the impact of care at for-profit (FP) hospitals on outcomes following colectomy remains to be elucidated.MethodsAll adults undergoing elective/emergent colectomy for diverticular disease, inflammatory bowel disease, benign colonic neoplasms, or colon cancer, ≤2days of admission, were tabulated from the Nationwide Readmissions Database. Patients were stratified by care at FP centers into the FP and Non-FP cohorts. Following entropy balancing, multivariable models were developed to consider the independent association of FP status with key outcomes.ResultsOf ∼1,130,803 admissions for colectomy, 862 495 (76.3%) were elective. Among electively admitted patients, 74 933 (8.7%) were grouped as FP. After risk adjustment, care at FP institutions was associated with greater odds of major morbidity (AOR 1.27, CI 1.22-1.32), non-home discharge (AOR 1.20, CI 1.13-1.27), and non-elective readmission (AOR 1.26, CI 1.12-1.32), but lower per-patient expenditures (β-$2430/patient, CI -2,860, -2010). Considering the 268 308 emergent cases, 38 568 (14.4%) were managed at FP hospitals. Following multivariable adjustment, treatment at FP hospitals remained associated with increased morbidity (AOR 1.16, CI 1.11-1.21) and decreased costs (β-$5,630, CI -6,210, -5,050).DiscussionUndergoing colectomy at FP hospitals was associated with greater complications and readmissions, but reduced per-patient expenditures. Future research should consider the factors contributing to inferior clinical outcomes at these centers. Best practices should be shared across institutions, irrespective of financial structure.},
}

@article {pmid40369874,
year = {2025},
author = {McGrath, IM and Rukins, V and Laisk, T and , and Mortlock, S and Montgomery, GW},
title = {Interaction between genetic risk and comorbid conditions in endometriosis.},
journal = {HGG advances},
volume = {6},
number = {3},
pages = {100456},
pmid = {40369874},
issn = {2666-2477},
mesh = {Humans ; *Endometriosis/genetics/epidemiology ; Female ; Comorbidity ; *Genetic Predisposition to Disease ; Adult ; Risk Factors ; Genome-Wide Association Study ; Middle Aged ; United Kingdom/epidemiology ; Prevalence ; Estonia/epidemiology ; Case-Control Studies ; },
abstract = {Endometriosis is a complex disease, and many genetic and environmental risk factors contribute to disease risk. The genetic risk of endometriosis has been well characterized in genome-wide association studies. While few physiological risk factors are known, endometriosis is associated with many comorbid disorders. This study examines the interplay between genetic risk factors, comorbid disorders, and endometriosis. Genetic and health record data from the UK Biobank (5,432 cases; 92,344 controls) and Estonian Biobank (3,824 cases; 15,296 controls) was used to estimate the correlation between comorbidity burden, endometriosis and genetic risk, and to estimate the interactive effects between endometriosis polygenic risk score (PRS) and diagnosis of prevalent comorbidities (uterine fibroids, heavy menstrual bleeding, dysmenorrhea, irritable bowel syndrome, diverticular disease, and asthma) on endometriosis prevalence. The comorbidity burden was significantly higher in endometriosis cases and was positively correlated with endometriosis PRS in women without endometriosis but negatively correlated in women with endometriosis. The absolute increase in endometriosis prevalence conveyed by the presence of several comorbidities (uterine fibroids, heavy menstrual bleeding, dysmenorrhea) was greater in individuals with a high endometriosis PRS compared to a low endometriosis PRS. These findings, consistent across two biobanks, highlight significant interactions between polygenic risk for endometriosis and the diagnosed comorbidities in endometriosis susceptibility that have implications for understanding the underlying mechanisms contributing to disease risk.},
}

Humans
*Endometriosis/genetics/epidemiology
Female
Comorbidity
*Genetic Predisposition to Disease
Adult
Risk Factors
Genome-Wide Association Study
Middle Aged
United Kingdom/epidemiology
Prevalence
Estonia/epidemiology
Case-Control Studies

@article {pmid40369270,
year = {2025},
author = {Dalby, HR and Emmertsen, KJ},
title = {Quality of life in diverticular disease: translation and validation of the Danish version of the diverticulitis quality of life instrument (DV‑QOL).},
journal = {International journal of colorectal disease},
volume = {40},
number = {1},
pages = {117},
pmid = {40369270},
issn = {1432-1262},
support = {NNF21OC0071125//Novo Nordisk Fonden/ ; NNF21OC0071125//Novo Nordisk Fonden/ ; },
mesh = {Humans ; *Quality of Life ; Female ; Male ; Denmark ; Middle Aged ; Surveys and Questionnaires ; Reproducibility of Results ; *Diverticular Diseases/psychology ; Aged ; *Translating ; *Translations ; *Diverticulitis/psychology ; Cross-Sectional Studies ; Adult ; Psychometrics ; },
abstract = {PURPOSE: This study aimed to translate and validate the Danish version of the DV-QOL questionnaire, originally developed in 2015, to assess the impact of diverticular disease on quality of life (QOL) in Danish-speaking patients with diverticulosis.

METHODS: Following international standards, the DV-QOL was translated. A cross-sectional survey was conducted in 2023 with Danish-speaking subjects. The survey included the Danish DV-QOL, an anchor QOL question, and the EuroQol visual analogue scale. Psychometric properties were evaluated for validity, internal consistency, and the ability to identify significant impacts on QOL.

RESULTS: The validation cohort included 16,766 subjects. The DV-QOL score showed a strong correlation with overall QOL (p < 0.001) and high discriminative validity (p < 0.001). Reliability was confirmed with an inter-item correlation of 0.41 and a Cronbach's α of 0.92. The score accurately identified patients with a significant impact of bowel function on QOL, achieving 82% sensitivity and 79% specificity.

CONCLUSION: The Danish DV-QOL is a valid and reliable tool for measuring diverticular disease-specific QOL, beneficial for both clinical and research applications in understanding the impact of the disease and patient outcomes.},
}

Humans
*Quality of Life
Female
Male
Denmark
Middle Aged
Surveys and Questionnaires
Reproducibility of Results
*Diverticular Diseases/psychology
Aged
*Translating
*Translations
*Diverticulitis/psychology
Cross-Sectional Studies
Adult
Psychometrics

@article {pmid40365700,
year = {2025},
author = {Bosch, J and O'Donnell, M and Yi, Q and Moayyedi, P and Alings, M and Avezum, A and Bangdiwala, SI and Barkun, A and Cassella, F and Marchi da Rocha, A and Duzen, I and Enns, R and Forbes, N and Hamilton, L and Kilickap, M and Kruger, P and Liang, Y and Nicolau, JC and Nunes, RB and Oliviera, G and Rey, A and Shofiqul, I and Sun, Y and Vanassche, T and Verhamme, P and Walsh, M and Wang, Z and Wu, C and Zhao, L and Zhu, J and Eikelboom, JW},
title = {Risk factors associated with Gastrointestinal Bleeding in Patients with Cardiovascular Disease (INTERBLEED): a case control study.},
journal = {European journal of preventive cardiology},
volume = {},
number = {},
pages = {},
doi = {10.1093/eurjpc/zwaf300},
pmid = {40365700},
issn = {2047-4881},
abstract = {AIMS: This study aimed to identify and quantify the importance of risk factors for gastrointestinal (GI) bleeding in patients with CV disease.

METHODS: We conducted a case-control study in 9 countries in Asia, America, Europe, and Australia. Cases were patients with CV disease with GI bleeding. Controls were patients with CV without a history of GI bleeding. All participants completed a baseline standardized assessment. We calculated adjusted odds ratios (ORs) and average population attributable fractions (aPAFs) with 95% confidence intervals (CIs).

RESULTS: Between September 2015 and December 2022, we enrolled 2,519 cases and 2,202 controls. Independent risk factors for GI bleeding were age (age 71+: OR 4.16, 95% CI 3.48-4.97; age 61-70: OR 1.69, 95% CI 1.39-2.04; age ≤60 as reference), underweight (OR 3.38, 95% CI 2.24-5.10; aPAF 1.6%, 95% CI 1.0-2.0%), current smoker (OR 1.31; 95% CI 1.09-1.58; aPAF 1.5%, 95% CI 0.6-2.5); chronic kidney disease (OR 1.86, 95% CI 1.62-2.14; aPAF 8.8%, 95% CI 7.0-9.6%), prior stroke (OR 1.56, 95% CI 1.30-1.88, aPAF 2.6%, 95% CI 1.2-4.0%), glucocorticoids (OR 1.71, 95% CI 1.34-2.16, aPAF 1.8%, 95% CI 1.3-2.9%), NSAIDs or COX-2 inhibitors (OR 1.82, 95% CI 1.45-2.29; aPAF 2.2%, 95% CI 1.3-3.0%), liver disease (OR 3.68, 95% CI 2.77-4.89; aPAF 3.5%, 95% CI 2.8-4.2%), peptic ulcer disease (OR 3.38, 95% CI 2.66-4.31; aPAF 4.8%, 95% CI 3.8-5.7%), diverticular disease (OR 1.81, 95% CI 1.46-2.24; aPAF 2.8%, 1.9-3.6%) and antithrombotic therapy within 6 months (aPAF 7.6%, 95% CI 4.3-12.8%). Overall aPAF adjusted for age, sex and region was 37.3% (95% CI 33.0-42.2%).

CONCLUSION: Potentially modifiable risk factors are associated with only about one third of the aPAF for GI bleeding.},
}

@article {pmid40359349,
year = {2025},
author = {Malekout, S and Govindarajah, N and Livingstone, D and Norman, R and Mitchell, R and Farrell-Dillon, K and Belchita, R and Kalasthry, J and Patel, N and Wale, A},
title = {Incidental Findings and Their Significance in Rectal MRI: UK Experience.},
journal = {Topics in magnetic resonance imaging : TMRI},
volume = {34},
number = {1},
pages = {e0317},
doi = {10.1097/RMR.0000000000000317},
pmid = {40359349},
issn = {1536-1004},
mesh = {Humans ; *Incidental Findings ; Male ; *Magnetic Resonance Imaging/statistics & numerical data ; Aged ; Female ; *Rectal Neoplasms/epidemiology/pathology/diagnosis ; United Kingdom/epidemiology ; Middle Aged ; Retrospective Studies ; Aged, 80 and over ; Prevalence ; Adult ; *Rectum/pathology ; Reproducibility of Results ; Sensitivity and Specificity ; },
abstract = {ABSTRACT: Rectal MRI studies used to stage and guide surgical or nonsurgical management of rectal cancer may harbor incidental findings (IFs) of varying significance. St George's Hospital uses a four-sequence MRI protocol which does not employ diffusion-weighted imaging (DW-MRI).

OBJECTIVES: To determine the frequency and significance of incidental findings identified when using a rectal MRI protocol which does not employ DW-MRI.

METHODS: Retrospective analysis of rectal MRI study reports for IFs and stratifying their significance. Medical records were reviewed to clarify IFs of interest.

RESULTS: One hundred thirty-four studies met the inclusion criteria for the study (75 men, mean age 65). 51/134 (38%) of studies had IFs. Fifteen percent (n = 7/46) of baseline studies for a new cancer had significant IFs. The commonest IF was diverticular disease (n = 10); however, a bladder malignancy was also identified.

CONCLUSION: Clinically significant IFs exist in 12% of patients undergoing rectal MRI, and any type of IFs exist in 38% of patients undergoing rectal MRI studies. The rate of significant IFs is comparable with other authors both in rectal and prostate MRI but with fewer overall IFs, possibly due to the lack of DW-MRI sequences in our local protocol. Our study is the first to assess IFs using a rectal MRI protocol which does not employ DW-MRI, and the results should be considered by centers when planning their rectal MRI protocol.},
}

Humans
*Incidental Findings
Male
*Magnetic Resonance Imaging/statistics & numerical data
Aged
Female
*Rectal Neoplasms/epidemiology/pathology/diagnosis
United Kingdom/epidemiology
Middle Aged
Retrospective Studies
Aged, 80 and over
Prevalence
Adult
*Rectum/pathology
Reproducibility of Results
Sensitivity and Specificity

@article {pmid40357078,
year = {2025},
author = {Dadigamuwage, SD and Macaulay, A and Jaufer, M},
title = {Massive Lower Gastrointestinal Bleeding From Colonic Submucosal Lipoma and Diverticular Disease: A Rare Case Requiring Surgical Interventions and Postoperative Management Challenges.},
journal = {Cureus},
volume = {17},
number = {4},
pages = {e82133},
pmid = {40357078},
issn = {2168-8184},
abstract = {Massive lower gastrointestinal (GI) bleeding (LGIB) is a life-threatening condition requiring prompt diagnosis and management. While diverticular disease is a common cause, rare entities such as colonic submucosal lipomas may complicate the presentation. This case highlights the diagnostic and therapeutic challenges in managing such a scenario, particularly with recurrent bleeding and postoperative complications. A 61-year-old patient presented with recurrent episodes of massive LGIB over a five-day period. Initial evaluations, including CT angiography and nuclear medicine imaging, identified diverticular disease but failed to localize the bleeding source definitively. Despite receiving 15 units of blood transfusions, the patient experienced persistent bleeding, ultimately necessitating emergency surgery. A right hemicolectomy revealed a submucosal lipoma and diverticular disease in the ascending colon with significant intraluminal hemorrhage. Postoperative management was complicated by pulmonary embolism, requiring therapeutic anticoagulation. This case emphasizes the importance of integrating multiple diagnostic modalities when evaluating massive LGIB, especially in patients with uncommon etiologies. It also highlights the complexities of managing massive transfusion protocols and postoperative thromboembolic events in high-risk patients. This report underscores the need for timely surgical intervention in unresolved cases of massive LGIB and the importance of vigilant postoperative care to prevent complications. Enhanced strategies for early mobilization and hydration are critical for improving outcomes in these patients.},
}

@article {pmid40356947,
year = {2025},
author = {Ambe, PC and Karanikas, M and Sokmen, S},
title = {Editorial: Surgical management of colorectal pathologies.},
journal = {Frontiers in surgery},
volume = {12},
number = {},
pages = {1607005},
doi = {10.3389/fsurg.2025.1607005},
pmid = {40356947},
issn = {2296-875X},
}

@article {pmid40355739,
year = {2025},
author = {Sassun, R and Sileo, A and Ng, JC and Mari, G and Behm, KT and Shawki, SF and Larson, DW},
title = {Diverticular disease complicated by colovesical and colovaginal fistulas: not so complex robotically.},
journal = {Surgical endoscopy},
volume = {39},
number = {6},
pages = {3941-3946},
pmid = {40355739},
issn = {1432-2218},
mesh = {Humans ; Female ; *Robotic Surgical Procedures/methods/adverse effects ; Middle Aged ; *Intestinal Fistula/surgery/etiology/complications ; *Vaginal Fistula/surgery/etiology/complications ; Aged ; Adult ; Retrospective Studies ; *Laparoscopy/methods ; *Diverticular Diseases/complications/surgery ; Postoperative Complications/epidemiology ; Aged, 80 and over ; *Diverticulitis, Colonic/complications/surgery ; Feasibility Studies ; },
abstract = {INTRODUCTION: Fistulizing diverticulitis occurs in only 2% of diverticular disease cases, but its symptoms, such as urinary tract infections (UTI), pneumaturia, fecaluria, or vaginal discharge, are highly disruptive to patients. Therefore, surgery is commonly recommended. Laparoscopy has been proven feasible and safe for fistulizing diverticulitis, although revealing a conversion rate of 36%. Robotic surgery might reduce the conversion rate due to advanced instrumentation and improved optics.

METHODS: All consecutive patients diagnosed with diverticulitis complicated by a colovesical or/and colovaginal fistula who underwent robotic surgical resection at Mayo Clinic Rochester (January 2018-June 2024) were included. Exclusion criteria were concurrent Crohn's disease, colorectal cancer, isolated coloovarian fistula, and less than one month of follow-up.

RESULTS: Eighty-nine patients were included in the study: fifty-eight (65%) patients presented with a colovesical fistula, 26 (29%) patients with a colovaginal fistula, and 5 (6%) patients with both. Ureteral ICG was utilized in 44% of cases. There were no intraoperative complications and one conversion secondary to loss of planes. Fourteen (16%) and 8 (9%) received an end colostomy or a loop ileostomy, respectively. Overall, 30-days complications were 35%, with anastomotic leak and abscess occurring in 3% and 6% of cases, respectively. One patient experienced a postoperative bladder leak, managed with a Foley catheter for 14 days, leaving no sequelae. With a median follow-up of 16.5 months, one (1%) fistula recurred after 14 days.

CONCLUSIONS: Robotic surgery for fistulizing diverticulitis is feasible, with an acceptable complication rate and extremely low conversion and recurrence rates.},
}

Humans
Female
*Robotic Surgical Procedures/methods/adverse effects
Middle Aged
*Intestinal Fistula/surgery/etiology/complications
*Vaginal Fistula/surgery/etiology/complications
Aged
Adult
Retrospective Studies
*Laparoscopy/methods
*Diverticular Diseases/complications/surgery
Postoperative Complications/epidemiology
Aged, 80 and over
*Diverticulitis, Colonic/complications/surgery
Feasibility Studies

@article {pmid40338318,
year = {2025},
author = {Ono, Y and Gonzalez, RS},
title = {Crypt abscesses, crypt distortion, and crypt rupture may help distinguish inflammatory bowel disease from segmental colitis associated with diverticulosis.},
journal = {Virchows Archiv : an international journal of pathology},
volume = {},
number = {},
pages = {},
pmid = {40338318},
issn = {1432-2307},
abstract = {The histologic distinction of segmental colitis associated with diverticulosis (SCAD) from inflammatory bowel disease (IBD) is difficult; however, distinguishing the two is important for patient management. This study aimed to examine histologic changes in SCAD and compare them to those in IBD. We retrospectively identified patients with highly likely SCAD and known IBD who were biopsied at our institution. With diagnosis blinded, H&E slides were reviewed for cryptitis, crypt abscesses, lamina propria (LP) neutrophils, erosion/ulceration, LP expansion by mononuclear cells, prominent basal lymphoid aggregates, basal lymphoplasmacytosis, crypt distortion, crypt dilation, granulomatous reaction to damaged crypts, increased intraepithelial lymphocytes, mucin depletion, Paneth cell metaplasia, LP smooth muscle wisps, and crypt rupture. Features between groups were compared by chi-squared analysis, with statistical significance set at P < 0.05. There were 81 SCAD cases (79% in the sigmoid colon) and 166 IBD cases. A separate cohort of 27 patients had both IBD and diverticulosis. Compared to the IBD cohort, the SCAD cohort was significantly less likely to demonstrate crypt abscesses (20% vs. 45%, P < 0.0001), prominent basal lymphoid aggregates (37% vs. 51%, P = 0.042), crypt distortion (7% vs. 25%, P = 0.00090), Paneth cell metaplasia (37% vs. 57%, P = 0.0061), and crypt rupture (1% vs. 11%, P = 0.0089). These histologic features, although not entirely specific, may be of value in distinguishing IBD from SCAD, particularly when clinical context is unclear or not readily available.},
}

@article {pmid40330996,
year = {2025},
author = {Lu, A and Sambandam, S and Gadda, M and Ratcliff, T and Huerta, S},
title = {Risk Factors and Outcomes Associated with Emergency Abdominal Surgery following Lower Extremity Total Joint Arthroplasty.},
journal = {The archives of bone and joint surgery},
volume = {13},
number = {4},
pages = {196-203},
pmid = {40330996},
issn = {2345-4644},
abstract = {OBJECTIVES: This study aims to identify potential risk factors and assess postoperative outcomes associated with requiring emergency abdominal surgery (EAS) within 30 days following total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that patients requiring EAS would carry a higher morbidity and mortality rates compared to patients that underwent the index operation alone.

METHODS: We conducted a retrospective analysis using TriNetX, examining data from 2016-2024 from patients over 18 years old who underwent THA/TKA and required EAS within 30 days. Postoperative outcomes, including mortality and hospital readmission, were compared between patients requiring EAS and those who did not. Statistical analyses included measures of association and chi-squared tests. Patient demographic data, including age, sex, and comorbidities were analyzed.

RESULTS: Patients requiring EAS within 30 days of a joint arthroplasty were significantly more likely to be older, overweight or obese, and to be diagnosed with comorbidities including diverticular disease, cholelithiasis, alcohol use disorders, and tobacco use. These patients had significantly higher mortality rates within 60 days of joint arthroplasty compared to patients without EAS, suggesting that the second operation contributed significantly to the increase in adverse outcomes.

CONCLUSION: This study emphasizes the importance of recognizing key risk factors for severe GI complications that require EAS. These findings highlight the need for careful patient selection, pre-operative evaluation of risk, and vigilant post-operative management, especially in those with many risk factors. Improved identification and management of high-risk patients may help reduce the likelihood of EAS and its associated mortality.},
}

@article {pmid40330635,
year = {2025},
author = {Kühn, F and Bianchi, PP},
title = {Current Role of Robotic Surgery in Colorectal Disease.},
journal = {Visceral medicine},
volume = {},
number = {},
pages = {1-7},
pmid = {40330635},
issn = {2297-4725},
abstract = {BACKGROUND: Robot-assisted surgery aims to combine the advantages of open surgery with those of minimally invasive surgery to overcome the previous limitations of laparoscopy. Compared to conventional laparoscopic methods, robot-assisted techniques offer significant advantages, which are currently increasingly employed despite mostly longer operating times and higher costs. The aim of this review was to describe the current role of robotics in the treatment spectrum of colorectal surgery.

SUMMARY: A comprehensive literature review was conducted using PubMed, Medline, and Embase to identify studies, systematic reviews, and meta-analyses on robotic surgery for colorectal benign and malignant disease, focusing on studies and meta-analyses comparing the laparoscopic with the robotic approach; articles published between 2004 and 2024 were screened: results of studies on surgical techniques must always be interpreted with caution, taking into account the technical skills and preferences of the participating surgeons. Compared to conventional laparoscopic methods and independent of the indication, robot-assisted techniques offer obvious technical and ergonomic advantages. Most colorectal procedures can safely be conducted via robotic-assisted surgery. Throughout the various indications described in this manuscript, the most evident advantage of robotic surgery remains a lower conversion rate, followed by less blood loss and a shorter hospital stay at the price of a longer operating time. For malignant disease, robotic surgery seems to be additionally associated with a higher lymph node yield in the majority of the studies. In acute or chronic inflammatory colorectal diseases, robotic-assisted surgery may facilitate interventions through improved visibility and a potentially more precise dissection of the correct plane; furthermore, robotic-assisted surgery offers advantages for performing complex intracorporal anastomoses. Last but not least, the surgeon's well-being and preferences make a relevant impact on the utilization of the system in colorectal surgery.

KEY MESSAGES: The use of robot-assisted procedures has increased significantly in the last decade across the various surgical specialties, with the largest increase in colorectal surgery. Next to the surgeons' preferences, capacity and costs will define the future role of robotic surgery in colorectal disease. As robotic surgery is becoming a mainstream surgical approach, there is a crying need for implementable training concepts of robotic techniques in colorectal surgery.},
}

@article {pmid40326086,
year = {2025},
author = {Wrona, A and Dziedzic, M and Gliwa, J and Bonczar, M and Ostrowski, P and Wojciechowski, W and Walocha, JA and Koziej, M},
title = {The sigmoid arteries - an imaging-based anatomical study with clinical implications.},
journal = {Folia morphologica},
volume = {},
number = {},
pages = {},
doi = {10.5603/fm.105194},
pmid = {40326086},
issn = {1644-3284},
abstract = {BACKGROUND: The sigmoid arteries (SAs) are essential for supplying blood to the sigmoid colon and exhibit considerable anatomical variability in their number, origin, and branching patterns. A precise understanding of SA anatomy is crucial for colorectal surgical procedures, particularly in oncological and diverticular disease resections.

MATERIALS AND METHODS: A retrospective analysis was performed on 75 consecutive Polish patients who underwent abdominal computed tomography angiography (CTA) at the Radiology Department of Jagiellonian University Medical College between 2018 and 2022. The study assessed SA origin, diameter, cross-sectional area, and distance from the inferior mesenteric artery (IMA).

RESULTS: The first SA most commonly originated directly from the IMA (69.01%), whereas the second and third SAs predominantly arose from the sigmoid trunk. The analysis of SA types, based on the Cirocchi et al. classification, revealed that Type 1 configurations were the most common, accounting for 50.70% of cases. Among them, Type 1B was the predominant subtype (35.21%). The median number of observed SAs per patient was 1, with a maximum of 6. The first SA had a median diameter of 1.97 mm at its origin, with a range from 0.70 mm to 3.32 mm. The distance from the origin of the IMA to the first SA exhibited a wide range, with a median of 52.76 mm and a maximum of 82.77 mm.

CONCLUSIONS: The sigmoid arteries, which serve as the primary source of blood supply to the sigmoid colon, exhibit significant variability in their origin and number of branches. The present study provides a detailed and comprehensive analysis of the morphometric characteristics and branching patterns of the sigmoid arteries, aiming to enhance current knowledge. This data may be particularly valuable for physicians, as it is clinically relevant to various colorectal surgical procedures, such as malignancy resections.},
}

@article {pmid40316749,
year = {2025},
author = {Sheehan, E and Brockhaus, KK and Huebner, M and Ma, W and Kolli, N and Cleary, RK},
title = {Risk factors for ileus after enhanced recovery robotic colectomy mediated by postoperative opioids: a single institution analysis.},
journal = {Surgical endoscopy},
volume = {39},
number = {6},
pages = {3727-3736},
pmid = {40316749},
issn = {1432-2218},
mesh = {Humans ; *Colectomy/adverse effects/methods ; *Ileus/etiology/epidemiology ; *Robotic Surgical Procedures/adverse effects/methods ; Male ; Female ; *Analgesics, Opioid/adverse effects/administration & dosage ; Retrospective Studies ; Risk Factors ; Middle Aged ; Aged ; *Postoperative Complications/epidemiology/etiology ; Enhanced Recovery After Surgery ; Length of Stay/statistics & numerical data ; *Pain, Postoperative/drug therapy ; },
abstract = {BACKGROUND: Postoperative ileus (POI) after colorectal surgery is associated with prolonged hospital length of stay, readmission, and higher costs of care. POI may be unpredictable and even uncomplicated enhanced recovery elective minimally invasive colorectal operations may be complicated by ileus and readmission related to ileus. Determining if there are modifiable factors associated with ileus may suggest quality improvement interventions designed to decrease ileus. The aim of this study was to identify patient characteristics associated with ileus and the relationship with postoperative opioids.

METHODS: This is a single institution retrospective analysis of robotic right and left colectomy in a prospectively maintained institutional colorectal surgery database from 1/1/2018 to 7/31/2024. The primary outcome was postoperative ileus. Mediation analysis was used to examine the association of patient factors with ileus mediated by postoperative opioids.

RESULTS: There were 394 left and 267 right colectomies that met inclusion criteria. Neoplasia was the operative diagnosis for 89.5% of right colectomies and diverticular disease for 78.7% of left colectomies (p < 0.001). Median postoperative hospital length of stay was 2.0 days. Ileus occurred in 5.6% of the patient population. An analysis with postoperative opioids (intravenous or oral) as mediating variable showed that postoperative opioids were associated with ileus (OR 2.83, CI 1.18-14.67). While older patients had less opioid requirements (OR 0.96, CI 0.95-0.98), the risk of ileus (OR 1.03, CI 1.00-1.06) was the same for older patients with and without opioids. A decrease in opioid prescriptions at discharge was seen over time (p < 0.001).

CONCLUSION: Postoperative opioids were the only modifiable risk factor for ileus after robotic segmental colectomy. The risk of ileus for other factors associated with ileus did not increase when opioids were added postoperatively. Considering other opioid-sparing enhanced recovery pathway options and increased adoption of the minimally invasive surgical approach may lessen this vexing postoperative complication.},
}

Humans
*Colectomy/adverse effects/methods
*Ileus/etiology/epidemiology
*Robotic Surgical Procedures/adverse effects/methods
Male
Female
*Analgesics, Opioid/adverse effects/administration & dosage
Retrospective Studies
Risk Factors
Middle Aged
Aged
*Postoperative Complications/epidemiology/etiology
Enhanced Recovery After Surgery
Length of Stay/statistics & numerical data
*Pain, Postoperative/drug therapy

@article {pmid40312905,
year = {2025},
author = {Costa, PHP and Rodrigues, P and Takemura, LS and Germano, MA and Sales, MES and de Paulo, GA and Bianco, B and Lemos, MB and Lemos, GC and Carneiro, A},
title = {Neural crosstalk and symptom overlap: The correlation between urinary and intestinal symptoms in patients undergoing colonoscopy.},
journal = {Investigative and clinical urology},
volume = {66},
number = {3},
pages = {251-260},
pmid = {40312905},
issn = {2466-054X},
mesh = {Humans ; Male ; Middle Aged ; Cross-Sectional Studies ; Female ; *Colonoscopy ; *Lower Urinary Tract Symptoms/physiopathology/diagnosis ; Aged ; Adult ; *Urinary Bladder, Overactive/physiopathology/diagnosis ; Surveys and Questionnaires ; },
abstract = {PURPOSE: Neural crosstalk in the pelvis involves intrinsic communication networks among pelvic structures that direct afferent inputs to converge on neurons, leading to viscerovisceral and somatovisceral reflexes. We aimed to explore the overlap between intestinal and urinary symptoms and their correlations in patients undergoing colonoscopy.

MATERIALS AND METHODS: Cross-sectional study with 167 participants who underwent colonoscopy and were assessed using three self-administered questionnaires: the International Prostate Symptom Score (IPSS) for lower urinary tract symptoms, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for overactive bladder symptoms, and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal (GI) symptoms.

RESULTS: Among the participants, 55.1% were male, and the median age was 57 years. Most colonoscopies (80.8%) were performed for screening, and the most common finding was diverticular disease (DD) (35.9%). The IPSS and ICIQ-OAB were strongly correlated (rho=0.544, p<0.001), while the IPSS and GSRS scores showed a moderate correlation (rho=0.304, p<0.001). In the DD subgroup, both ICIQ-OAB and IPSS (rho=0.568, p<0.001), and IPSS and GSRS (rho=0.493, p<0.001) showed strong correlations. In contrast, the subgroup without DD showed a strong correlation between the ICIQ-OAB and IPSS (rho=0.510, p<0.001), but only a weak correlation between the IPSS and GSRS (rho=0.188, p=0.057), suggesting that the urinary-GI connection is influenced by the presence of DD.

CONCLUSIONS: The findings revealed intrinsic relationships between urinary and GI symptoms, with DD as a significant factor influencing these relationships, suggesting that a more integrated approach to evaluate and manage these patients can potentially improve diagnostic accuracy and treatment outcomes.},
}

Humans
Male
Middle Aged
Cross-Sectional Studies
Female
*Colonoscopy
*Lower Urinary Tract Symptoms/physiopathology/diagnosis
Aged
Adult
*Urinary Bladder, Overactive/physiopathology/diagnosis
Surveys and Questionnaires

@article {pmid40303443,
year = {2025},
author = {Rebic, AD and Souza, DLS and Fellner, AN and Guend, H},
title = {Robotic Management of Diverticular Colovaginal and Colovesical Fistulas.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {29},
number = {2},
pages = {},
pmid = {40303443},
issn = {1938-3797},
mesh = {Humans ; Female ; *Robotic Surgical Procedures/methods ; Retrospective Studies ; Middle Aged ; *Intestinal Fistula/surgery/etiology ; Aged ; *Vaginal Fistula/surgery/etiology ; Laparoscopy/methods ; Operative Time ; Treatment Outcome ; Adult ; Postoperative Complications/epidemiology ; Conversion to Open Surgery/statistics & numerical data ; },
abstract = {BACKGROUND AND OBJECTIVES: Colovesical and colovaginal fistulas are a complication of diverticular disease that often requires surgical intervention. Minimally invasive surgery is associated with improved postoperative outcomes, but reported laparoscopic rates of conversion to open for these patients have been relatively high. There are limited studies evaluating robotic-assisted management of these fistulas. This study aims to report our single-center experience of robotic management of such fistulas, with the primary outcome being the conversion rate to open.

METHODS: All elective robotic sigmoid resections for diverticular colovaginal and colovesical fistulas performed from January 2018 to August 2023 were included. Patient demographic variables and 30-day postoperative outcomes were retrospectively collected.

RESULTS: Thirty-five patients were included, 21 with colovesical and 14 with colovaginal fistulas. Overall, the conversion to open rate was 8.6% (3 out of 35). All patients converted to open were patients with colovesical fistulas. Operating time (median of 354 vs 347 minutes, P = .583) and estimated blood loss (median of 100 vs 100 mL, P = .538) were similar for colovesical and colovaginal fistulas, respectively. Two patients required ostomy creation, both in the colovaginal group. Three patients in the colovesical group developed an ileus compared to one in the colovaginal group. There were 2 urinary tract infections (UTIs), both in the colovesical group. Thirty-day readmission (2 vs 1, P = .652) and length of stay (median 2 vs 2 days, P = .855) were similar for colovesical and colovaginal fistulas, respectively.

CONCLUSION: Diverticular fistulas can be managed successfully with a robotic approach and appropriate surgeon experience, having minimal morbidity or complications.},
}

Humans
Female
*Robotic Surgical Procedures/methods
Retrospective Studies
Middle Aged
*Intestinal Fistula/surgery/etiology
Aged
*Vaginal Fistula/surgery/etiology
Laparoscopy/methods
Operative Time
Treatment Outcome
Adult
Postoperative Complications/epidemiology
Conversion to Open Surgery/statistics & numerical data

@article {pmid40279471,
year = {2025},
author = {Ávalos-Herrera, VJ and Borunda-Escudero, GE and Núñez-Cabrera, JE and Rizo-Guzmán, L and Gómez-Arciniega, KD},
title = {[Jejunal diverticular disease: a rare cause of gastrointestinal bleeding].},
journal = {Revista medica del Instituto Mexicano del Seguro Social},
volume = {63},
number = {2},
pages = {e6421},
pmid = {40279471},
issn = {2448-5667},
mesh = {Humans ; Male ; Middle Aged ; *Gastrointestinal Hemorrhage/etiology ; *Jejunal Diseases/complications/diagnosis ; *Diverticular Diseases/complications/diagnosis ; *Diverticulum/complications ; },
abstract = {BACKGROUND: Digestive bleeding is an important cause of hospital admission; however, the mortality rate in these patients has not been reduced. Digestive bleeding has a multiple etiology; specifically, bleeding from the small intestine accounts for 5 to 10% of gastrointestinal hemorrhages, of which between 0.06% and 5% of cases are caused by diverticula of the small intestine. Most cases are asymptomatic; however, the symptomatic form is highly variable and can present with multiple complications, such as massive bleeding. Therefore, the objective of this study was to explore the approach to jejunal diverticular disease (JDD) with gastrointestinal bleeding.

CLINICAL CASE: A 48-year-old male patient presented with massive digestive bleeding of unknown origin, initially treated with angiography and embolization, with a satisfactory outcome. However, six days after discharge, the patient experienced new massive bleeding that required an urgent exploratory laparotomy, during which jejunal diverticular disease (JDD) of the small intestine was identified.

CONCLUSIONS: Diverticula of the small intestine are usually asymptomatic, and complications are rare; however, they can affect the patient's survival. Therefore, an appropriate approach, accurate and timely diagnosis, and a multidisciplinary management strategy are required to offer the best therapeutic options for the patient.},
}

Humans
Male
Middle Aged
*Gastrointestinal Hemorrhage/etiology
*Jejunal Diseases/complications/diagnosis
*Diverticular Diseases/complications/diagnosis
*Diverticulum/complications

@article {pmid40212861,
year = {2025},
author = {Patel, A and Bhushan, S},
title = {Recurrent Diverticulitis Complicated by Actinomyces turicensis Abscess.},
journal = {ACG case reports journal},
volume = {12},
number = {4},
pages = {e01658},
pmid = {40212861},
issn = {2326-3253},
abstract = {Actinomyces turicensis is an uncommon cause of intra-abdominal infection. We present a patient with diverticulitis complicated by A. turicensis abscess formation. Our patient required multiple admissions and a prolonged course of antibiotics. To our knowledge, this case represents the first instance of A. turicensis complicating diverticular disease. This case highlights the challenges in managing Actinomycotic infections and will hopefully prompt clinicians to consider atypical pathogens in other cases of refractory diverticulitis.},
}

@article {pmid40202732,
year = {2025},
author = {Myers, S and Davids, JS},
title = {LASER Focus on Long-Term Outcomes for Diverticular Disease.},
journal = {JAMA surgery},
volume = {160},
number = {6},
pages = {622-623},
doi = {10.1001/jamasurg.2025.0615},
pmid = {40202732},
issn = {2168-6262},
}

@article {pmid40201108,
year = {2025},
author = {Schardey, J and von Ahnen, T and Crispin, A and Knoblauch, M and Zimmermann, P and Kühn, F and Andrassy, J and Werner, J and Rau, BM and Wirth, U},
title = {Efficacy of a Shortened Oral Antibiotic Bowel Decontamination in Minimally Invasive Surgery for Diverticular Disease.},
journal = {Visceral medicine},
volume = {41},
number = {2},
pages = {92-99},
pmid = {40201108},
issn = {2297-4725},
abstract = {INTRODUCTION: Infectious complications, such as anastomotic leakage (AL) and surgical site infections (SSIs), remain a significant challenge in colorectal surgery. Consequently, there is growing interest in oral antibiotic bowel decontamination with nonabsorbable antibiotics (selective digestive decontamination or SDD), which can reduce perioperative complications while also minimizing antibiotic use. This study aimed to determine whether a 3-day SDD regimen is as effective as a 7-day regimen in preventing postoperative complications in laparoscopic diverticular surgery.

METHODS: A bicenter data analysis of prospectively and retrospectively collected patient data was performed. A 3-day versus 7-day perioperative use of an SDD-based regimen (polymyxin B, gentamicin, vancomycin, and amphotericin B) in patients undergoing minimally invasive surgery for diverticular disease was compared using noninferiority analysis.

RESULTS: A total of 469 patients were included in the analysis: 101 patients received a 3-day perioperative SDD regimen, while 368 patients received a 7-day regimen. Due to the use of routine clinical data, no control cohort is available. The overall complication rate was 16.5% in both groups. AL and SSI occurred in 2.0% and 6.0% of the 3-day group, and in 1.4% and 6.3% of the 7-day group, respectively, with no significant differences between the groups. However, for wound infections and overall infectious complications, the 3-day regimen can be considered noninferior to the 7-day regimen. Our data did not confirm the noninferiority of the SDD3 regimen compared to the SDD7 regimen for AL.

DISCUSSION: We report low rates of AL and other surgical and nonsurgical complications in minimally invasive diverticular disease surgery. The low complication rates demonstrate noninferiority regarding SSI. Our findings are consistent with recent evidence, highlighting the positive impact of perioperative SDD treatment on SSI and infectious complications.},
}

@article {pmid40196262,
year = {2025},
author = {Neylan, CJ and Levin, MG and Hartmann, K and Beigel, K and Khodursky, S and DePaolo, JS and Abramowitz, S and Furth, EE and Heuckeroth, RO and Damrauer, SM and Maguire, LH},
title = {Genome-wide association meta-analysis identifies 126 novel loci for diverticular disease and implicates connective tissue and colonic motility.},
journal = {medRxiv : the preprint server for health sciences},
volume = {},
number = {},
pages = {},
pmid = {40196262},
support = {K08 DK124687/DK/NIDDK NIH HHS/United States ; UL1 TR001878/TR/NCATS NIH HHS/United States ; IK2 CX001780/CX/CSRD VA/United States ; R01 DK128282/DK/NIDDK NIH HHS/United States ; TL1 TR001880/TR/NCATS NIH HHS/United States ; },
abstract = {Diverticular disease is a common and morbid complex phenotype influenced by both innate and environmental risk factors. We performed the largest genome-wide association study meta-analysis for diverticular disease, identifying 126 novel loci. Employing multiple downstream analytic strategies, including tissue and pathway enrichment, statistical fine-mapping, allele-specific expression, protein quantitative trait loci and drug-target investigations, and linkage disequilibrium score regression, we prioritized causal genes and produced several lines of evidence linking diverticular disease to connective tissue biology and colonic motility. We substantiated these findings by integrating single-cell RNA sequencing data, showing that prioritized diverticular disease-associated genes are enriched for expression in colonic smooth muscle, fibroblasts, and interstitial cells of Cajal. In quantitative analysis of surgical specimens, we found a substantial reduction in the density of elastin present in the sigmoid colon in severe diverticulitis.},
}

@article {pmid40195019,
year = {2025},
author = {Mirande, MD and Bews, KA and Brady, JT and Colibaseanu, DT and Shawki, SF and Perry, WR and Behm, KT and Mathis, KL and McKenna, NP},
title = {Does timing of ileostomy closure impact postoperative morbidity?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {27},
number = {4},
pages = {e70088},
doi = {10.1111/codi.70088},
pmid = {40195019},
issn = {1463-1318},
mesh = {Humans ; *Ileostomy/adverse effects/methods ; Female ; Retrospective Studies ; Male ; Middle Aged ; *Postoperative Complications/etiology/epidemiology ; Time Factors ; Aged ; Adult ; },
abstract = {AIM: Reversal of diverting loop ileostomy (DLI) traditionally occurs at ≥12 weeks after formation. Early closure has been performed in attempts to reduce DLI-associated morbidity. Therefore, the aim of this study was to determine whether time to stoma reversal impacts postoperative morbidity.

METHOD: A retrospective review was conducted using institutional-level American College of Surgeons National Surgical Quality Improvement Program data for adult patients who underwent DLI closure between January 2012 and December 2021 across a multistate health system. Time to DLI closure was stratified into three groups: ≤12, 12-24 or 24-36 weeks. Additional data were obtained from the electronic medical record. The primary outcome was major morbidity after DLI closure.

RESULTS: A total of 482 patients underwent DLI closure. Eighty four patients underwent closure at ≤12 weeks (17.4%), 300 at 12-24 weeks (62.2%) and 98 at 24-36 weeks (20.3%). The most common diagnosis at DLI formation was cancer (n = 211, 43.8%). Patients in the ≤12 weeks closure group more commonly had ulcerative colitis or diverticular disease and a lower American Society of Anesthesiologists class than patients with closure at 24-36 weeks (p < 0.05). There were no significant differences in complication severity, overall major morbidity or its individual components amongst the time to DLI closure groups. There were no differences in anastomotic leaks or need for laparotomy. On multivariable analysis, immunosuppressive therapy and preoperative haematocrit <30% were significant risk factors for major morbidity after DLI closure.

CONCLUSION: Major morbidity did not differ by time to DLI closure group, indicating that closure at ≤12 weeks is safe in selected patients.},
}

Humans
*Ileostomy/adverse effects/methods
Female
Retrospective Studies
Male
Middle Aged
*Postoperative Complications/etiology/epidemiology
Time Factors
Aged
Adult

@article {pmid40191509,
year = {2025},
author = {Piotrowicz, G and Ossowska-Dorosz, B and Dorosz, Ł and Kaszubowski, MF and Małgorzewicz, S and Stępień, B and Rudnik, A and Synowiecka, A and Rydzewska, G},
title = {Managing diverticula: dietary changes for a more comfortable life.},
journal = {Przeglad gastroenterologiczny},
volume = {20},
number = {1},
pages = {92-101},
pmid = {40191509},
issn = {1895-5770},
abstract = {INTRODUCTION: Diverticulosis is an anatomical condition with increasing incidence. Diverticula are common findings during screening colonoscopies, making diagnosis and treatment challenging in routine clinical practice. Nutritional factors have been identified as significant risk factors, and it has been suggested that diets recommended for the prevention of cardiovascular and other chronic diseases may also positively influence the clinical course of diverticulosis.

AIM: To analyse dietary patterns in various groups of patients with diverticular disease and to identify potential differences that may affect the types of symptoms presented.

MATERIAL AND METHODS: A group of 100 patients, including 71 women and 29 men aged 40 to 90 years, were analysed using the FFQ-6 form and a 24-hour nutritional interview. The most common condition among individuals with diverticulosis was symptomatic uncomplicated diverticular disease (SUDD), which occurred with similar frequency in both sexes.

RESULTS: Analysis of dietary components revealed higher fat intake in the SUDD group and reduced vitamin E consumption, particularly in the group with segmental colitis associated with diverticulosis (SCAD). Additionally, there was a significant reduction in the intake of calcium, magnesium, and zinc across all analysed groups, along with a nearly one-third reduction in dietary fibre intake.

CONCLUSIONS: Based on the nutritional data, the factors that may contribute to the development of diverticular disease include high intake of animal protein, fat, cholesterol, deficiencies in microelements such as zinc, excess sodium, and excessive consumption of B vitamins, particularly vitamin B6.},
}

@article {pmid40186629,
year = {2025},
author = {Altıner, S and Aydoğdu, YF and Kosmaz, K and Durhan, A and Senlikci, A and Suleyman, M and Ersak, C and Pekcici, MR},
title = {The association between colonic diverticulosis and colorectal polyps in a retrospective cohort study.},
journal = {International journal of colorectal disease},
volume = {40},
number = {1},
pages = {88},
pmid = {40186629},
issn = {1432-1262},
mesh = {Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; *Colonic Polyps/complications ; *Diverticulosis, Colonic/complications ; Risk Factors ; Aged ; Colorectal Neoplasms ; Adult ; Colonoscopy ; Age Factors ; },
abstract = {OBJECTIVE: This study aimed to investigate the relationship between colonic diverticulosis, colorectal polyps, and colorectal cancer.

MATERIAL AND METHODS: A total of 648 patients (275 females, 373 males) who underwent complete colonoscopy between January 2016 and June 2020 were retrospectively analyzed. The presence and localization of diverticula, polyps, and cancer were recorded, and the association between diverticular disease and the formation of polyps and cancer was evaluated.

RESULTS: Diverticula were identified in 53 patients (8.2%), while 595 patients (91.8%) had no diverticula. Polyps were detected in 148 patients (22.8%), and no polyps were found in 500 patients (77.2%). Adenocarcinoma was diagnosed in 67 patients (10.3%), with no malignancy observed in 581 patients (89.7%). The mean age of patients with polyps was 59.5 years, compared to 53.3 years in those without polyps (p < 0.001). Multivariate logistic regression analysis revealed that diverticulum status did not significantly influence the risk of polyp formation, whereas advanced age was identified as a significant risk factor (p < 0.001).

CONCLUSION: Advanced age is a significant risk factor for colorectal polyp formation, whereas diverticulosis is not an independent risk factor. These findings highlight the importance of age-based screening strategies for colorectal neoplasia.},
}

Humans
Male
Female
Middle Aged
Retrospective Studies
*Colonic Polyps/complications
*Diverticulosis, Colonic/complications
Risk Factors
Aged
Colorectal Neoplasms
Adult
Colonoscopy
Age Factors

@article {pmid40182848,
year = {2025},
author = {Papagrigoriadis, S and Brandimarte, G and Tursi, A},
title = {Fistulating diverticulitis: a distinct clinical entity?.},
journal = {Frontiers in medicine},
volume = {12},
number = {},
pages = {1500053},
pmid = {40182848},
issn = {2296-858X},
abstract = {INTRODUCTION: Diverticular disease (DD) of the colon has a number of phenotypes, including asymptomatic diverticulosis and complicated diverticulitis with bowel perforation or bleeding. The factor that affects the phenotype of this condition and leads to a wide range of clinical presentations is unknown. The formation of fistulas associated with diverticulitis has long been recognized, and they are treated according to ad hoc indications. We hypothesized that the formation of fistulas in diverticular disease exhibits such a wide range of variable anatomic features that it may be considered a distinct form of the condition, fistulating diverticulitis (FD).

METHODS: We conducted a narrative review based on 50 years of publications covering a wide range of diverticulitis-associated fistulas, both common and uncommon.

RESULTS: While there is abundant literature on common fistulas, such as colovesical and colovaginal fistulas, little is known about rarer fistulas, such as coloenteric fistulas, colocutaneous fistulas, and genitourinary tract fistulas. The majority of these fistulas are treated surgically, which is in contrast to the trend toward conservative management that is predominant in acute or chronic diverticulitis.

DISCUSSION: Epidemiological and histological evidence support the hypothesis that FD may be a feature of chronic DD that requires individual management. Histopathology shows similarities with Crohn's disease. It remains unknown which underlying immune or genetic factors may be affecting the clinical presentation of these patients, leading to fistulation. We contend that there is adequate published evidence to characterize a distinct phenotype of FD that can involve the entire GI tract and other organs. Surgical guidelines may need to be modified to treat this small but important group, which predominantly requires surgical treatment.},
}

@article {pmid40182832,
year = {2025},
author = {Murdock, PMW and Venero, AC and Heidel, RE and Hale, BW and Russ, AJ},
title = {Laparoscopic Versus Robotic Elective Sigmoid Resection for Complicated Diverticulitis.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {29},
number = {1},
pages = {},
pmid = {40182832},
issn = {1938-3797},
mesh = {Humans ; *Robotic Surgical Procedures/methods ; *Laparoscopy/methods ; Male ; Female ; Retrospective Studies ; Middle Aged ; *Colectomy/methods ; *Elective Surgical Procedures/methods ; Aged ; Operative Time ; *Colon, Sigmoid/surgery ; *Diverticulitis, Colonic/surgery/complications ; Treatment Outcome ; Length of Stay/statistics & numerical data ; Postoperative Complications/epidemiology ; Adult ; Blood Loss, Surgical/statistics & numerical data ; Reoperation/statistics & numerical data ; },
abstract = {OBJECTIVE: Minimally invasive surgical techniques for colorectal surgery have continued to grow in prevalence with robotic surgery potentially providing advantages in complex pelvic operations. We sought to examine the outcomes of laparoscopic versus robotic elective sigmoid colon resection for complicated diverticulitis.

METHODS: We performed a retrospective review of patients at an academic tertiary care center from 2018-2023 who underwent elective minimally invasive sigmoid colon resections for complicated diverticulitis. Multiple regression analysis was performed with primary outcomes being reoperation within 30 days and overall complications. Secondary outcomes included conversion to open, estimated blood loss, operative time, days until return of bowel function, and length of stay.

RESULTS: In this cohort of 131 patients, 38 underwent laparoscopic colectomy and 93 patients underwent robotic colectomy. There were no significant differences between rate of reoperation (7.7% vs 2.1%, P = .42), complications (5.1% vs 8.4%, P = .52), conversion to open (5.1% vs 2.1%, P = .25), days until return of bowel function (1.87 vs 2.01, P = .41), or length of stay (5.2 vs 5.2, P = .92). There were significant differences in operative time and estimated blood loss. Robotic approach was 128.11 minutes longer (β = 128.11, SE = 12, p < .001) and had 33.4 cc less estimated blood loss (β = -33.4, SE = 16.6, P = .046), when adjusting for other confounders.

CONCLUSION: Robotic sigmoid colectomy for complicated diverticulitis had mostly equivalent outcomes at this institution. There was some decrease in estimated blood loss, however, operative time was increased in the robotic group.},
}

Humans
*Robotic Surgical Procedures/methods
*Laparoscopy/methods
Male
Female
Retrospective Studies
Middle Aged
*Colectomy/methods
*Elective Surgical Procedures/methods
Aged
Operative Time
*Colon, Sigmoid/surgery
*Diverticulitis, Colonic/surgery/complications
Treatment Outcome
Length of Stay/statistics & numerical data
Postoperative Complications/epidemiology
Adult
Blood Loss, Surgical/statistics & numerical data
Reoperation/statistics & numerical data

@article {pmid40140081,
year = {2025},
author = {Mui, J and Sarofim, M and Cheng, E and Gilmore, A},
title = {Laparoscopic natural orifice specimen extraction for diverticular disease: a systematic review.},
journal = {Surgical endoscopy},
volume = {39},
number = {5},
pages = {3049-3056},
pmid = {40140081},
issn = {1432-2218},
mesh = {Humans ; *Laparoscopy/methods ; *Natural Orifice Endoscopic Surgery/methods ; Length of Stay/statistics & numerical data ; *Diverticular Diseases/surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease is extremely common in the Western world, with a proportion of complications requiring colonic resection. Whilst laparoscopic surgery has its benefits, a large wound for specimen extraction predisposes to surgical site infection, prolonged pain and prolonged hospital admission. Natural orifice specimen extraction (NOSE) is an alternative technique that has not yet been widely adopted in diverticular disease surgery. The aim of this systematic review is to evaluate the evidence on the outcomes of NOSE in left sided resections for diverticular disease.

METHODS: A systematic review of PubMed, Ovid MEDLINE and EMBASE was performed to identify studies that reported outcomes for left sided resections with NOSE in diverticular disease. The studies reviewed were all human studies published in a peer-reviewed journal after 2010. The participants had to be over the age of 18 and the extraction site had to be transanal/transrectal. Articles that were not full text or not in English were excluded. These studies were assessed independently by two reviewers using a standardised pre-piloted form.

RESULTS: One hundred and eighty-seven articles were screened, with 9 articles meeting the inclusion criteria. The study sample size ranged from 8 to 157 participants, with a pooled total of 428 patients who had NOSE. Hospital length of stay varied from 4 to 6 days. Only 2 patients required conversion to transabdominal extraction. Pain scores were lower post-NOSE compared to traditional abdominal extraction in 2 out of 3 studies. The anastomotic leak rate varied from 0 to 18%. Six studies reported no surgical site infections and there was only 1 mortality.

CONCLUSION: NOSE is a safe and feasible option for patients requiring left sided resection for diverticular disease based on the current available data. The literature demonstrates low rates of surgical site infection, mortality and reduced hospital length of stay.},
}

Humans
*Laparoscopy/methods
*Natural Orifice Endoscopic Surgery/methods
Length of Stay/statistics & numerical data
*Diverticular Diseases/surgery
Treatment Outcome

@article {pmid40134640,
year = {2025},
author = {Khan, A and Mushtaq, M and Movva, G and Sohal, A and Yang, J},
title = {Gastrointestinal disease in end-stage renal disease.},
journal = {World journal of nephrology},
volume = {14},
number = {1},
pages = {101917},
pmid = {40134640},
issn = {2220-6124},
abstract = {When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy (i.e. renal transplant or dialysis), it is called end-stage renal disease (ESRD). Patients with ESRD often experience a range of gastrointestinal (GI) symptoms, with prevalence rates reported as high as 77%-79%. These symptoms and pathologies arise from various factors, including electrolyte imbalance, fluid imbalance, toxin buildup, uremia, medications, dietary and lifestyle restrictions, and the effects of dialysis. GI diseases in patients with renal failure can be further categorized into upper GI, small bowel, and lower GI issues. Common conditions include gastroesophageal reflux disease, nausea and vomiting, dysmotility within the esophagus and stomach, upper GI bleeding, peptic ulcer bleeding, angioectasia, irritable bowel syndrome, mesenteric ischemia, angiodysplasia, diverticular disease, constipation, pancreatitis, and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis. This review assesses the existing literature on the different GI diseases among individuals with ESRD, shedding light on their pathophysiology and prevalence.},
}

@article {pmid40115966,
year = {2025},
author = {Cossais, F and Hörnke, MC and Schröder, K and Lucius, R and Böttner, M and Egberts, JH and Richter, F and Wedel, T},
title = {Phosphorylated alpha-synuclein distribution in the colonic enteric nervous system of patients with diverticular disease.},
journal = {IBRO neuroscience reports},
volume = {18},
number = {},
pages = {384-388},
pmid = {40115966},
issn = {2667-2421},
abstract = {BACKGROUND: Phosphorylated alpha-synuclein (P-aSyn) is a biomarker for Parkinson's disease (PD), with potential relevance in intestinal inflammatory disorders.

OBJECTIVES: This study examines the distribution of P-aSyn in colonic tissues of patients with diverticular disease (DD) compared to age-matched controls.

METHODS: P-aSyn distribution was analyzed in colon samples of 45 patients with diverticulitis (D-itis), 12 with diverticulosis (D-osis), and 30 controls via immunohistochemistry.

RESULTS: P-aSyn immunoreactivity was found along enteric neurons of the myenteric and submucosal plexus in 93.1 % of participants, with similar distribution across D-itis, D-osis, and controls. Elevated reactivity appeared in 16.7 % of D-osis, 19.6 % of D-itis, and 30.0 % of controls.

CONCLUSION: P-aSyn presence in colonic tissue did not significantly differ between DD patients and controls, suggesting that DD-related inflammation does not notably affect P-aSyn expression. Further research is warranted to explore aSyn roles within the enteric nervous system in intestinal inflammatory disorders and their relation with neurodegenerative diseases.},
}

@article {pmid40094139,
year = {2025},
author = {Lubanda, TJ and Schaeffer, HD},
title = {Re: "The Prevalence and Management Outcomes of Diverticular Disease in a Tertiary Facility in Ghana".},
journal = {Journal of the West African College of Surgeons},
volume = {15},
number = {2},
pages = {243},
pmid = {40094139},
issn = {2992-5827},
}

@article {pmid40091957,
year = {2025},
author = {O'Rorke, J and Butler, G and Moss, JA},
title = {Management of Acute Diverticulitis and Incidental Abdominal Aortic Aneurysm in a 67-Year-Old Male: A Case Report of Balancing Priorities in a High-Risk Patient.},
journal = {Cureus},
volume = {17},
number = {2},
pages = {e78987},
pmid = {40091957},
issn = {2168-8184},
abstract = {Diverticular disease and abdominal aortic aneurysms (AAAs) represent distinct but significant clinical entities often associated with advanced age. Diverticulitis, a common complication of diverticular disease, can result in perforation and systemic complications, while AAAs, frequently asymptomatic, carry substantial morbidity and mortality risks if undetected or untreated. Advances in imaging have improved the early identification of these conditions, yet the simultaneous management of both presents unique challenges requiring multidisciplinary coordination. A 67-year-old male with a history of ST-elevation myocardial infarction, hypertension, hyperlipidemia, and smoking presented with left lower quadrant abdominal pain and abnormal outpatient computed tomography (CT) findings. Imaging revealed Hinchey 1a diverticulitis with a microperforation and an incidental 6.5 cm saccular AAA. The patient received conservative treatment for diverticulitis with intravenous antibiotics and transitioned to oral antibiotics upon clinical improvement. Following resolution, the patient underwent successful endovascular aneurysm repair (EVAR) for the AAA, which was complicated by a type II endoleak identified postoperatively. Blood pressure management and hydration addressed acute kidney injury, and the patient recovered well with a multidisciplinary follow-up planned. This case underscores the importance of imaging in diagnosing coexisting conditions, particularly in high-risk populations. Management required balancing the risks of treating acute diverticulitis with the need for prompt intervention for a large, saccular AAA. The conservative approach to diverticulitis, followed by elective EVAR, reflects a patient-centered strategy consistent with current guidelines. Furthermore, it underscores the critical role of adhering to screening recommendations for high-risk populations, as timely detection of asymptomatic conditions like AAAs can prevent life-threatening complications.},
}

@article {pmid40091500,
year = {2025},
author = {Cameron, RA and Jones, MP and Eslick, GD and Talley, NJ},
title = {Colonic Diverticulosis and Uncomplicated Diverticulitis Are Associated With a Lower Not Higher Risk of Mortality When Confounding Factors Are Held Constant.},
journal = {Journal of gastroenterology and hepatology},
volume = {40},
number = {5},
pages = {1221-1229},
pmid = {40091500},
issn = {1440-1746},
support = {//National Health and Medical Research Council/ ; },
mesh = {Humans ; Male ; Female ; Middle Aged ; *Diverticulosis, Colonic/mortality/complications ; Adult ; United Kingdom/epidemiology ; *Diverticulitis, Colonic/mortality ; Aged ; Cohort Studies ; Confounding Factors, Epidemiologic ; Risk Factors ; Time Factors ; },
abstract = {BACKGROUND AND AIM: The association between colonic diverticulosis, diverticulitis, and mortality is controversial. This study evaluated the association between diverticular disease and mortality over a prolonged period in a GP cohort.

METHODS: GP records were sourced from the United Kingdom medical database (THIN). Diverticulosis and diverticulitis were identified via Read codes. The overall patient cohort (n = 1 274 260) included patients with colonic diverticula (n = 39 521 [3.1%], mean age 54) and no diverticula (control group) (n = 1 234 739 [96.9%], mean age 38). Poisson regression estimated relative rates, and durational time at risk and survival probability were calculated.

RESULTS: Colonic diverticula are associated with an increased mortality risk when compared with nondiverticular patients (OR = 1.89, 95% CI 1.84-1.94; p < 0.001). However, controlling for age, sex, and potential confounding variables yielded a decreased mortality risk overall for colonic diverticula patients (HR = 0.66, 95% 0.64-0.6; p < 0.001). When the diverticulitis cohort is separated into uncomplicated and complicated, increased mortality is observed in both uncomplicated diverticulitis (HR = 0.64, 95% CI 0.61-0.66; p < 0.001) and complicated diverticulitis (HR = 1.14, 95% CI 1.02-1.28; p = 0.024), but on controlling for confounding, there is a decreased risk of mortality for uncomplicated diverticulitis (HR = 0.65, 95% CI 0.63-0.66; p < 0.001) but almost two times increased mortality risk for complicated diverticulitis (HR = 1.18, 95% CI 1.05-1.32; p = 0.006).

CONCLUSIONS: In this large UK GP sample, controlling for age, sex, and comorbidities, patients with uncomplicated diverticula are associated with a lower mortality risk. However, complicated diverticulitis still carries two times the risk of mortality than those with no or uncomplicated colonic diverticula.},
}

Humans
Male
Female
Middle Aged
*Diverticulosis, Colonic/mortality/complications
Adult
United Kingdom/epidemiology
*Diverticulitis, Colonic/mortality
Aged
Cohort Studies
Confounding Factors, Epidemiologic
Risk Factors
Time Factors

@article {pmid40085006,
year = {2025},
author = {Ueland, TE and Younan, SA and Evans, PT and Sims, J and Shroder, MM and Hawkins, AT and Peek, R and Niu, X and Bastarache, L and Robinson, JR},
title = {Unmet social needs and diverticulitis: a phenotyping algorithm and cross-sectional analysis.},
journal = {Journal of the American Medical Informatics Association : JAMIA},
volume = {32},
number = {5},
pages = {866-875},
pmid = {40085006},
issn = {1527-974X},
support = {U24 OD023176/OD/NIH HHS/United States ; 5 U2C OD023196//Data and Research Center/ ; HHSN 263201600085U//Federally Qualified Health Centers/ ; UL1 TR002243/TR/NCATS NIH HHS/United States ; 1 OT2 OD026549//Office of the Director: Regional Medical Centers/ ; K23 DK118192/DK/NIDDK NIH HHS/United States ; //National Institute of Diabetes and Digestive and Kidney Disease/ ; 1 U24 OD023163//Participant Technology Systems Center/ ; K23DK118192/NH/NIH HHS/United States ; OT2 OD026555/OD/NIH HHS/United States ; /TR/NCATS NIH HHS/United States ; U24 OD023163/OD/NIH HHS/United States ; OT2 OD026549/OD/NIH HHS/United States ; OT2 OD026554/OD/NIH HHS/United States ; OT2 OD026557/OD/NIH HHS/United States ; OT2 OD026556/OD/NIH HHS/United States ; OT2 OD026550/OD/NIH HHS/United States ; OT2 OD026552/OD/NIH HHS/United States ; OT2 OD026553/OD/NIH HHS/United States ; OT2 OD026548/OD/NIH HHS/United States ; OT2 OD026551/OD/NIH HHS/United States ; U24 OD023121/OD/NIH HHS/United States ; OT2 OD023205/OD/NIH HHS/United States ; OT2 OD023206/OD/NIH HHS/United States ; OT2 OD025277/OD/NIH HHS/United States ; OT2 OD025315/OD/NIH HHS/United States ; OT2 OD025337/OD/NIH HHS/United States ; OT2 OD025276/OD/NIH HHS/United States ; },
mesh = {Humans ; *Algorithms ; Cross-Sectional Studies ; Male ; Female ; Middle Aged ; Severity of Illness Index ; *Diverticulitis/diagnosis/classification ; Phenotype ; Aged ; Health Services Accessibility ; Food Insecurity ; Logistic Models ; Adult ; },
abstract = {OBJECTIVE: To validate a phenotyping algorithm for gradations of diverticular disease severity and investigate relationships between unmet social needs and disease severity.

MATERIALS AND METHODS: An algorithm was designed in the All of Us Research Program to identify diverticulosis, mild diverticulitis, and operative or recurrent diverticulitis requiring multiple inpatient admissions. This was validated in an independent institution and applied to a cohort in the All of Us Research Program. Distributions of individual-level social barriers were compared across quintiles of an area-level index through fold enrichment of the barrier in the fifth (most deprived) quintile relative to the first (least deprived) quintile. Social needs of food insecurity, housing instability, and care access were included in logistic regression to assess association with disease severity.

RESULTS: Across disease severity groups, the phenotyping algorithm had positive predictive values ranging from 0.87 to 0.97 and negative predictive values ranging from 0.97 to 0.99. Unmet social needs were variably distributed when comparing the most to the least deprived quintile of the area-level deprivation index (fold enrichment ranging from 0.53 to 15). Relative to a reference of diverticulosis, an unmet social need was associated with greater odds of operative or recurrent inpatient diverticulitis (OR [95% CI] 1.61 [1.19-2.17]).

DISCUSSION: Understanding the landscape of social barriers in disease-specific cohorts may facilitate a targeted approach when addressing these needs in clinical settings.

CONCLUSION: Using a validated phenotyping algorithm for diverticular disease severity, unmet social needs were found to be associated with greater severity of diverticulitis presentation.},
}

Humans
*Algorithms
Cross-Sectional Studies
Male
Female
Middle Aged
Severity of Illness Index
*Diverticulitis/diagnosis/classification
Phenotype
Aged
Health Services Accessibility
Food Insecurity
Logistic Models
Adult

@article {pmid40078388,
year = {2025},
author = {Tursi, A and Procaccianti, G and De Bastiani, R and Turroni, S and D'Amico, F and Allegretta, L and Antonino, N and Baldi, E and Casamassima, C and Casella, G and Ciuffi, M and De Bastiani, M and Lazzarotto, L and Licci, C and Mancuso, M and Penna, A and Pranzo, G and Sanna, G and Tosetti, C and Zamparella, M and Picchio, M},
title = {Micro-encapsulated and colonic-release sodium butyrate modulates gut microbiota and improves abdominal pain in patients with symptomatic uncomplicated diverticular disease.},
journal = {Frontiers in medicine},
volume = {12},
number = {},
pages = {1487892},
pmid = {40078388},
issn = {2296-858X},
abstract = {The role of gut microbiota (GM) in the pathogenesis of Symptomatic Uncomplicated Diverticular Disease (SUDD) remains controversial. Here, we assessed the efficacy of a butyrate formulation in modulating GM and abdominal pain in patients with SUDD. A retrospective study was conducted in patients with SUDD who were treated with a delayed- and colonic-release formulation of butyrate (two capsules bid, for a total dose of 400 mg butyrate) for 3 months. GM was profiled before (T0) and after 90 days of treatment (T2) using 16S rRNA amplicon sequencing. The primary endpoint was change in GM at T2; secondary endpoints were reduction in abdominal pain severity according to VAS (Visual Analog Scale, 0: absence; 10: maximum severity) at T1 (45 days) and T2, stool characteristics according to the Bristol stool form scale at T0, T1 and T2, and safety of treatment. Fifty-nine patients with SUDD (59.3% male; median age 65.5 years, interquartile range 55-71 years) completed treatment. The butyrate formulation increased GM diversity and resulted in several compositional changes that were closely related to baseline abdominal pain severity. Regarding secondary endpoints, abdominal pain decreased significantly over time, while the Bristol stool form scale did not. Mild adverse events were recorded in 3 (5.08%) patients. This study showed that a microencapsulated and colonic-release formulation of butyrate favorably modulates GM and reduces abdominal pain in patients with SUDD.},
}

@article {pmid40070644,
year = {2025},
author = {Flores, R and Calvo, PA and Antunes, C and Duarte, R and Lérias, G},
title = {Ruminococcus gnavus Bacteremia in a SARS-CoV-2 Patient With Diverticulosis.},
journal = {Cureus},
volume = {17},
number = {2},
pages = {e78784},
pmid = {40070644},
issn = {2168-8184},
abstract = {Ruminococcus gnavus is a constituent of the human intestinal microbiota, found in the commensal flora of healthy individuals. Changes in the intestinal microflora associated with chronic conditions and immunosuppression promote the bacterial translocation of R. gnavus. We present a case of bacteremia due to R. gnavus in an elderly man with multiple comorbidities, including diverticular disease and moderate SARS-CoV-2 infection requiring corticosteroid therapy. He had a prolonged hospital stay and multiple infectious complications. According to the literature review in databases such as PubMed (the last search was conducted in August 2023), a total of 17 cases were described. The reported cases had in common gastrointestinal symptoms such as gastrointestinal bleeding, diverticular disease, ulcerative colitis, cholecystitis, gastrointestinal fistula, or infection due to an orthopedic prosthesis. There was also a case in a patient with hemato-oncological disease, previously treated with a cycle of corticosteroids. It was considered that, alongside the history of diverticular disease, the immunosuppression secondary to the corticosteroid therapy for the SARS-CoV-2 infection may have contributed to the imbalance of the intestinal microbiome, leading to the occurrence of bacteremia due to this commensal agent.},
}

@article {pmid40037806,
year = {2025},
author = {Dalby, HR and Erichsen, R and Gotschalck, KA and Emmertsen, KJ},
title = {Colonic resection and stoma formation due to chronic diverticular disease: nationwide population-based cohort study.},
journal = {BJS open},
volume = {9},
number = {2},
pages = {},
pmid = {40037806},
issn = {2474-9842},
support = {NNF21OC0071125//The Novo Nordisk Foundation/ ; },
mesh = {Humans ; Female ; Male ; Denmark/epidemiology ; Aged ; Middle Aged ; *Elective Surgical Procedures/statistics & numerical data ; Chronic Disease ; *Colectomy/statistics & numerical data ; *Diverticular Diseases/surgery ; Incidence ; Registries ; Aged, 80 and over ; Cohort Studies ; *Surgical Stomas/statistics & numerical data ; Adult ; },
abstract = {BACKGROUND: Consensus on patient selection for elective colonic resection in patients with chronic diverticular disease is lacking. Early identification of patients who require surgery eventually enables timely elective resection, which could decrease the chronic diverticular disease burden. This register-based nationwide cohort study aimed to investigate the incidence of emergency and elective colonic resections or stoma formation in patients with chronic diverticular disease and explore predictors for surgery.

METHODS: The study included all patients with chronic diverticular disease in Denmark from 1996 to 2020, defined as patients with two or more hospital contacts due to diverticular disease. The incidence of surgery due to chronic diverticular disease was calculated as cumulative incidence proportions. Predictors for surgery were explored in a Cox proportional hazard model.

RESULTS: A total of 33 951 patients with chronic diverticular disease were included. The overall 5-year cumulative incidence proportion of surgery was 13.9% (elective surgery 9.8%, emergency surgery 4.2%). Patients with complicated chronic diverticular disease, including fistula, stenosis or perforation, had a three- to six-fold higher incidence of surgery overall than patients with uncomplicated chronic diverticular disease. The incidence of elective surgery decreased with age and co-morbidity and increased with the number of emergency admissions, even more pronounced if the emergency admissions accumulated within a shorter interval.

CONCLUSION: Patients with chronic diverticular disease should be considered for elective colonic resection if they have complicated disease or several hospital contacts as they are likely to undergo surgery eventually.},
}

Humans
Female
Male
Denmark/epidemiology
Aged
Middle Aged
*Elective Surgical Procedures/statistics & numerical data
Chronic Disease
*Colectomy/statistics & numerical data
*Diverticular Diseases/surgery
Incidence
Registries
Aged, 80 and over
Cohort Studies
*Surgical Stomas/statistics & numerical data
Adult

@article {pmid40021082,
year = {2025},
author = {McKechnie, T and Heimann, L and Sharma, S and Staibano, P and Nanji, K and Garfinkle, R and Garoufalia, Z and Doumouras, A and Parpia, S and Bhandari, M and Eskicioglu, C},
title = {Patients with class III obesity are at elevated risk of postoperative morbidity after surgery for left-sided diverticular disease: a retrospective population-level study.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {29},
number = {5},
pages = {102004},
doi = {10.1016/j.gassur.2025.102004},
pmid = {40021082},
issn = {1873-4626},
mesh = {Retrospective Studies ; *Postoperative Complications/epidemiology/etiology ; Risk Factors ; Body Mass Index ; *Obesity, Morbid/complications/diagnosis/epidemiology ; *Diverticulosis, Colonic/etiology/surgery ; *Colectomy/adverse effects/methods ; Humans ; Male ; Female ; Adult ; Middle Aged ; Aged ; Severity of Illness Index ; },
abstract = {BACKGROUND: Although obesity is a well-established risk factor for the development of diverticular disease, studies focusing on the effect of body mass index (BMI) on postoperative outcomes require updating. This population-level retrospective cohort study was designed to evaluate the effect of BMI on postoperative outcomes after operative intervention for left-sided diverticular disease.

METHODS: This was a population-based retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) (September 1, 2015 to December 31, 2019). The International Classification of Diseases, 10th Revision, Clinical Modification codes were used to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. Patients were stratified according to obesity status (ie, not obese: BMI of <30.0 kg/m[2]; class I obesity: BMI of 30.0-34.9 kg/m[2]; class II obesity: BMI of 35.0-39.9 kg/m[2]; class III obesity: BMI of >40.0 kg/m[2]). The primary outcome was overall in-hospital postoperative morbidity. The multivariate regression models were fit.

RESULTS: There were 33,029 patients identified in the NIS who underwent left-sided colonic resection for diverticular disease. There were 27,212 patients who were not obese, 2209 patients with class I obesity, 1710 patients with class II obesity, and 1898 patients with class III obesity. Patients with class III obesity (ie, a BMI of >40.0 kg/m[2]) had 72.7% higher odds (95% CI, 1.54-1.94) of experiencing in-hospital postoperative morbidity than patients with a BMI of <30.0 kg/m[2]. Patients with class III obesity had 26.9% higher odds (95% CI, 0.98-1.65) of experiencing in-hospital postoperative infection, 54.6% higher odds (95% CI, 1.35-1.77) of experiencing in-hospital postoperative gastrointestinal complications, and 70.9% higher odds (95% CI, 1.48-1.97) of experiencing in-hospital postoperative genitourinary complications than those with a BMI of <30.0 kg/m[2].

CONCLUSION: Patients with class III obesity undergoing operative intervention for colonic diverticular disease are at increased risk of short-term postoperative morbidity compared with those with a BMI of <30.0 kg/m[2].},
}

Retrospective Studies
*Postoperative Complications/epidemiology/etiology
Risk Factors
Body Mass Index
*Obesity, Morbid/complications/diagnosis/epidemiology
*Diverticulosis, Colonic/etiology/surgery
*Colectomy/adverse effects/methods
Humans
Male
Female
Adult
Middle Aged
Aged
Severity of Illness Index

@article {pmid40012838,
year = {2025},
author = {Carabotti, M and Marasco, G and Radaelli, F and Barbara, G and Cuomo, R and Annibale, B},
title = {Look inside the management of colonic diverticular rebleeding: a systematic review.},
journal = {Therapeutic advances in gastroenterology},
volume = {18},
number = {},
pages = {17562848251321695},
pmid = {40012838},
issn = {1756-283X},
abstract = {BACKGROUND: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding in adults and carries a significant risk of recurrence. However, there are many uncertainties regarding the management of the prevention of diverticular rebleeding.

OBJECTIVES: To review the current evidence on the potential role of lifestyle, pharmacological and endoscopic treatments and to discuss the unmet needs in the prevention of colonic diverticular rebleeding.

DESIGN: A systematic review.

DATA SOURCES AND METHODS: Based on the identified Patients-Interventions-Comparators-Outcomes questions, a detailed and comprehensive literature search was conducted, from inception to 12 January 2024, without language restriction, according to the modified Preferred Reporting Items for Systematic review and Meta-Analyses reporting guidelines.

RESULTS: We did not find any dietary or lifestyle interventions (fibre intake, smoking, physical activity, alcohol consumption, BMI) to prevent colonic diverticular rebleeding. We also did not find any interventional studies of specific pharmacological treatments (such as rifaximin, mesalazine or probiotics) to prevent diverticular rebleeding. Data comparing endoscopic and conservative approaches used during the index episode come from observational studies and show conflicting results. Finally, there is a paucity of data regarding the timing of resumption of antiplatelet and anticoagulant therapy after an episode of colonic diverticular bleeding, and this remains to be determined.

CONCLUSION: This review highlights the paucity of data on the possible role of lifestyle, pharmacological and endoscopic treatments in the prevention of colonic diverticular rebleeding and advocates future studies aimed at finding effective therapeutic strategies.},
}

@article {pmid40007587,
year = {2025},
author = {Papagrigoriadis, S and Charalampopoulos, A},
title = {Surgery for diverticular peritonitis.},
journal = {Frontiers in medicine},
volume = {12},
number = {},
pages = {1501734},
pmid = {40007587},
issn = {2296-858X},
abstract = {Some patients with acute diverticulitis will present with colonic perforation and peritonitis. This paper is a review of the surgical management of diverticular peritonitis Hinchey III and Hinchey IV. The significance of prompt management of sepsis is discussed. The surgical options for Hinchey III and Hinchey IV peritonitis are discussed with presentation of the supporting literature. In Hinchey III peritonitis Laparoscopic Peritoneal Lavage has emerged as an alternative to laparotomy-colectomy. The classic Hartmann's operation has no advantage of survival and results frequently in permanent stoma. Recent published evidence supports on table colonic lavage and the performance of primary anastomosis unless the patient is critically ill.},
}

@article {pmid39997529,
year = {2025},
author = {Hashi, R and Thamer, R and Hassan, A and Canna, K and Ahmed, M and Hassan, MT and Badi, S and Ahmed, MH},
title = {A Contemporary Multifaceted Insight into the Association Between Diabetes Mellitus and Diverticular Disease: An Update About Geriatric Syndrome.},
journal = {Geriatrics (Basel, Switzerland)},
volume = {10},
number = {1},
pages = {},
pmid = {39997529},
issn = {2308-3417},
abstract = {Introduction: Diverticular disease, once considered a rare geriatric gastrointestinal condition, has now become a prevalent disorder associated with increased morbidity and healthcare costs. The spectrum of complications from diverticular disease ranges from incidental findings to more serious issues such as bleeding and diverticulitis. Symptomatic diverticular disease represents a significant economic burden in the western world. Diabetes mellitus is a major global health issue. As global aging accelerates, geriatric syndromes such as diabetes mellitus (DM) and diverticular disease (DD) are becoming increasingly prevalent. Understanding their interplay is critical, particularly within the geriatric population. Both conditions are linked to lifestyle, dietary habits, and changes in gut physiology. Additionally, age-related alterations in the gut microbiome and immune system make this association more complex, contributing to morbidity and healthcare burdens in older adults. The primary aim of this review is to provide an update on the association between diabetes mellitus and diverticular disease. Methods: This narrative review explores the association between diabetes mellitus and diverticular disease. Relevant articles were identified by searching major databases. Results: Risk factors for diverticular disease include insulin resistance, diabetes mellitus, smoking, non-alcoholic fatty liver disease, lack of physical activity, a low-fibre diet, and a high-carbohydrate diet. These risk factors are also associated with the development of diabetes mellitus. Major population studies indicate that diabetes can either increase the risk of diverticular disease or have a neutral impact. A complication of diabetes mellitus includes impaired intestinal peristalsis and enteric nervous system dysfunction, which can ultimately lead to the formation of intestinal diverticula. High-calorie foods low in fibre are a staple in the diets of many type 2 diabetes mellitus patients, contributing to gut dysbiosis. A detrimental consequence of dysbiosis is a breach in the protective intestinal barrier, which promotes the development of diverticulosis. Conclusions: Diabetes mellitus may be associated with diverticular disease, and the risk factors that contribute to diabetes mellitus can also be linked to diverticular disease. Further studies are needed to explore the complex relationship between diabetes mellitus and diverticular disease.},
}

@article {pmid39996222,
year = {2025},
author = {Miranda Thais, R and Sarofim, M and Gilmore, A},
title = {Complicated Sigmoid Diverticulitis Mimicking Pelvic Pain in a Patient With Giant Uterine Fibroids: A Case Report.},
journal = {Cureus},
volume = {17},
number = {1},
pages = {e77979},
pmid = {39996222},
issn = {2168-8184},
abstract = {This report describes the case of a woman in her late forties with a history of large uterine fibroids who presented to the Emergency Department with colicky suprapubic pain and urinary symptoms. Initial computed tomography (CT) showed uncomplicated acute diverticulitis but despite antibiotic treatment, her condition worsened, and a follow-up CT revealed sigmoid perforation, requiring high anterior resection and subtotal hysterectomy. The case highlights how large fibroids exert external pressure on the colon, impairing motility and increasing the risk of diverticula formation. Alterations in the gut microbiome may contribute to colonic mucosal inflammation, commonly seen in diverticular disease. Patients with uterine fibroids have altered microbiome composition, which could further increase the risk of diverticular disease. These findings provide a pathway for future research into the influence of uterine fibroids on the pathophysiology of diverticular disease.},
}

@article {pmid39976023,
year = {2025},
author = {Zhou, J and Xu, Y and Wang, H and Wang, K and Chen, C},
title = {Exploring the Diet-diverticular Disease Link: Insights from a Comprehensive Mendelian Randomization Study.},
journal = {Current medicinal chemistry},
volume = {},
number = {},
pages = {},
doi = {10.2174/0109298673342480250203111209},
pmid = {39976023},
issn = {1875-533X},
abstract = {BACKGROUND: The interplay between dietary habits and the development of Diverticular Disease (DD) has long been a subject of vibrant debate.

OBJECTIVE: Utilizing Mendelian Randomization (MR), this study aims to meticulously examine the causal dynamics at play.

METHODS: The foundation for the Genome-Wide Association Studies (GWAS) on DD was established using a dataset from the FinnGen consortium, encompassing 33,619 patients and 329,381 control participants. Data on 18 dietary habits and DD for the validation cohort were procured from the UK Biobank. An MR analysis was executed to delve into the causal relationship between dietary habits and DD, adhering to a rigorous Bonferroni correction threshold of 3.00E-03. Our main analysis method was the Inverse Variance Weighted (IVW) approach. To improve the accuracy and reliability of our study, we also conducted heterogeneity analysis, tests for horizontal pleiotropy, outlier identification, and "leave-one-out" sensitivity analysis.

RESULTS: Our analysis unearthed a potential causal association between the consumption of dried fruits and a lower risk of developing DD (IVW: odds ratio (OR) 0.372, 95% confidence interval (CI) 0.272 - 0.509, p = 5.79E-10), a finding that was corroborated in the validation cohort (IVW: OR 0.975, 95% CI 0.961 - 0.990, p = 1.04E-03). Conversely, our results do not substantiate a causal link between the consumption of alcohol, dietary fiber, and red meat and the risk of DD.

CONCLUSION: Our detailed MR analyses show that eating dried fruit lowers the risk of DD, providing strong support for prevention and treatment approaches for DD.},
}

@article {pmid39974228,
year = {2025},
author = {Mithany, RH and Shaikh, A and Murali, S and Rafique, A and Bebawy, PS and Nair, PG and Ramadan, W and Abdelglil, M and Gupta, A and Sayed, MA and Ismaiel, M},
title = {A Review of the Current Trends and Future Perspectives of Robots in Colorectal Surgery: What Have We Got Ourselves Into?.},
journal = {Cureus},
volume = {17},
number = {1},
pages = {e77690},
pmid = {39974228},
issn = {2168-8184},
abstract = {Robotic colorectal surgery represents a significant advancement in the management of complex colorectal conditions, offering enhanced precision, safety, and improved patient outcomes. It is widely utilised for colorectal cancer, inflammatory bowel disease, diverticular disease, and rectal prolapse, with key benefits such as 3D visualisation, superior dexterity, and precise navigation in confined spaces. These advantages contribute to lower conversion rates to open surgery, faster recovery, reduced pain, and shorter hospital stays. This narrative review analysed recent peer-reviewed literature, focusing on technological advancements, clinical outcomes, and emerging challenges in robotic colorectal surgery. Findings highlight improved oncological precision, faster recovery, and fewer complications, driven by innovations like AI-guided decision-making and advanced robotic platforms. However, issues such as prolonged operative times, high costs, and steep learning curves remain. Future efforts should prioritise integrating AI, enhancing surgeon training, and addressing cost barriers to maximise the potential of robotic colorectal surgery in improving patient care.},
}