About | BLOGS | Portfolio | Misc | Recommended | What's New | What's Hot

About | BLOGS | Portfolio | Misc | Recommended | What's New | What's Hot


Bibliography Options Menu

05 Jun 2023 at 01:40
Hide Abstracts   |   Hide Additional Links
Long bibliographies are displayed in blocks of 100 citations at a time. At the end of each block there is an option to load the next block.

Bibliography on: Diverticular Disease


Robert J. Robbins is a biologist, an educator, a science administrator, a publisher, an information technologist, and an IT leader and manager who specializes in advancing biomedical knowledge and supporting education through the application of information technology. More About:  RJR | OUR TEAM | OUR SERVICES | THIS WEBSITE

RJR: Recommended Bibliography 05 Jun 2023 at 01:40 Created: 

Diverticular Disease

Diverticular disease is the general name for a common condition that involves small bulges or sacs called diverticula that form from the wall of the large intestine (colon). Although these sacs can form throughout the colon, they are most commonly found in the sigmoid colon, the portion of the large intestine closest to the rectum. Diverticulosis refers to the presence of diverticula without associated complications or problems. The condition can lead to more serious issues including diverticulitis, perforation (the formation of holes), stricture (a narrowing of the colon that does not easily let stool pass), fistulas (abnormal connection or tunneling between body parts), and bleeding. Diverticulitis refers to an inflammatory condition of the colon thought to be caused by perforation of one of the sacs. Several secondary complications can result from a diverticulitis attack, and when this occurs, it is called complicated diverticulitis.

Created with PubMed® Query: "Diverticular disease"[tiab] NOT pmcbook NOT ispreviousversion

Citations The Papers (from PubMed®)


RevDate: 2023-06-01

Narayanaswamy S, Goradia R, Bhujbal S, et al (2023)

Unique case of colovesical fistula in a renal allograft recipient.

BMJ case reports, 16(6): pii:16/6/e254534.

Colovesical fistula is commonly suspected in cases of diverticular disease, malignancy, trauma, iatrogenic injury or radiotherapy. In a case of allogenic live related transplant, this is rarely expected, especially after 20 years. The presence of gas in the bladder in the absence of history of instrumentation of urinary tract should prompt us to evaluate for colovesical fistula. Pneumaturia, faecaluria and recurrent urinary tract infection are tell-tale features of colovesical fistula, and when patients who are renal allograft recipient present with them, it should prompt a proper workup and swift surgical management, since the outcome is uniformly favourable. From our knowledge in this realm, we know that these are immunocompromised patients and have a high tendency to develop risk factors like malignancy and/or diverticular disease and eventually form colovesical fistula. An expected time period could be from 2 months to 6 years. But in our case, fistula formation occurred long after peak corticosteroid action, in the absence of conventional aetiologies.

RevDate: 2023-06-01

Lee Y, McKechnie T, Samarasinghe Y, et al (2023)

Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015-2019.

International journal of colorectal disease, 38(1):156.

BACKGROUND: Up to 50% of patients with acute complicated diverticulitis require operative management on their index admission. There is ongoing debate as to whether primary anastomosis with diverting ileostomy versus a Hartmann's procedure is the optimal surgical approach for these patients. This study aims to compare postoperative complications in patients undergoing either Hartmann's procedure or primary anastomosis and diverting ileostomy for perforated diverticulitis using recent National Inpatient Sample data.

METHODS: Patients who underwent either primary anastomosis with diverting ileostomy or Hartmann's procedure for acute complicated diverticulitis from the 2015 to 2019 NIS database sample were included. Primary outcomes were postoperative in-hospital mortality and morbidity. Secondary outcomes were postoperative cause-specific complications, total admission cost, and length of stay (LOS). Univariate and multivariate regression were utilized to compare the two operative approaches.

RESULTS: Overall, 642 patients underwent primary anastomosis with diverting ileostomy and 4,482 patients underwent Hartmann's procedure. There was no difference in in-hospital mortality (OR 0.93, 95%CI 0.45-1.92, p = 0.84) or in-hospital morbidity (OR 1.10, 95%CI 0.90-1.35, p = 0.33). Adjusted analysis suggested shorter postoperative LOS for patients undergoing Hartmann's procedure (MD 0.79 days, 95%CI 0.15-1.43 days, p = 0.013) and decreased total admission cost (MD $4,893.99, 95%CI $1,425.04-$8,362.94, p = 0.006).

CONCLUSIONS: The present study supports that primary anastomosis with diverting ileostomy is safe for properly selected patients presenting with complicated diverticulitis. Primary anastomosis with diverting ileostomy is associated with greater total hospitalization costs and LOS.

RevDate: 2023-06-01

Waser A, Balaphas A, Uhe I, et al (2023)

Incidence of diverticulitis recurrence after sigmoid colectomy: a retrospective cohort study from a tertiary center and systematic review.

International journal of colorectal disease, 38(1):157.

INTRODUCTION: Our aim was to determine the incidence of diverticulitis recurrence after sigmoid colectomy for diverticular disease.

METHODS: Consecutive patients who benefited from sigmoid colectomy for diverticular disease from January 2007 to June 2021 were identified based on operative codes. Recurrent episodes were identified based on hospitalization codes and reviewed. Survival analysis was performed and was reported using a Kaplan-Meier curve. Follow-up was censored for last hospital visit and diverticulitis recurrence. The systematic review of the literature was performed according to the PRISMA statement. Medline, Embase, CENTRAL, and Web of Science were searched for studies reporting on the incidence of diverticulitis after sigmoid colectomy. The review was registered into PROSPERO (CRD42021237003, 25/06/2021).

RESULTS: One thousand three-hundred and fifty-six patients benefited from sigmoid colectomy. Four hundred and three were excluded, leaving 953 patients for inclusion. The mean age at time of sigmoid colectomy was 64.0 + / - 14.7 years. Four hundred and fifty-eight patients (48.1%) were males. Six hundred and twenty-two sigmoid colectomies (65.3%) were performed in the elective setting and 331 (34.7%) as emergency surgery. The mean duration of follow-up was 4.8 + / - 4.1 years. During this period, 10 patients (1.1%) developed reccurent diverticulitis. Nine of these episodes were classified as Hinchey 1a, and one as Hinchey 1b. The incidence of diverticulitis recurrence (95% CI) was as follows: at 1 year: 0.37% (0.12-1.13%), at 5 years: 1.07% (0.50-2.28%), at 10 years: 2.14% (1.07-4.25%) and at 15 years: 2.14% (1.07-4.25%). Risk factors for recurrence could not be assessed by logistic regression due to the low number of incidental cases. The systematic review of the literature identified 15 observational studies reporting on the incidence of diverticulitis recurrence after sigmoid colectomy, which ranged from 0 to 15% for a follow-up period ranging between 2 months and over 10 years.

CONCLUSION: The incidence of diverticulitis recurrence after sigmoid colectomy is of 2.14% at 15 years, and is mostly composed of Hinchey 1a episodes. The incidences reported in the literature are heterogeneous.

RevDate: 2023-05-30

Horesh N, Emile SH, Khan SM, et al (2023)

Meta-Analysis of Randomized Clinical Trials on Long-Term Outcomes of Surgical Treatment of Perforated Diverticulitis.

Annals of surgery pii:00000658-990000000-00484 [Epub ahead of print].

OBJECTIVE: Assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL).

SUMMARY BACKGROUND DATA: Surgical treatment of perforated diverticulitis changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate for the optimal surgical strategy lingers.

METHODS: PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for treatment of perforated diverticulitis were selected. Main outcomes measures were long-term ostomy, long term complications, recurrence, and re-intervention rates.

RESULTS: After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, two compared PRA and Hartmann's procedure. LL had lower odds of long-term ostomy (OR= 0.133, 95%CI: 0.278- 0.579;P<0.001) and re-operation (OR= 0.585, 95%CI: 0.365- 0.937;P=0.02) compared to colonic resection but higher odds of diverticular disease recurrence (OR= 5.8, 95%CI: 2.33- 14.42;P<0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR= 0.02, 95%CI: 0.003-0.195;P<0.001), long-term complications (OR= 0.195, 95%CI: 0.113-0.335;P<0.001), reoperation (OR= 0.2, 95%CI: 0.108- 0.384;P<0.001) and incisional hernia (OR= 0.184, 95%CI: 0.102-0.333;P<0.001). There was no significant difference in odds of mortality among the procedures.

CONCLUSIONS: Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and re-operation, but more risk for disease recurrence when compared to resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than Hartmann's procedure for fecal peritonitis.

RevDate: 2023-05-29

Solaini L, Giuliani G, Cavaliere D, et al (2023)

Robotic versus laparoscopic left colectomy: a propensity score matched analysis from a bi-centric experience.

Journal of robotic surgery [Epub ahead of print].

The advantages of using the robotic platform may not be clearly evident in left colectomies, where the surgeon operates in an "open field" and does not routinely require intraoperative suturing. Current evidences are based on limited cohorts reporting conflicting outcomes regarding robotic left colectomies (RLC). The aim of this study is to report a bi-centric experience with robotic left colectomy in order to help in defining the role of the robotic approach for these procedures. This is a bi-centric propensity score matched study including patients who underwent RLC or laparoscopic left colectomy (LLC) between January 1, 2012 and May 1, 2022. RLC patients were matched to LLC patients in a 1:1 ratio. Main outcomes were conversion to open surgery and 30-day morbidity. In total, 300 patients were included. Of 143 (47.7%) RLC patients, 119 could be matched. After matching, conversion rate (4.2 vs. 7.6%, p = 0.265), 30-day morbidity (16.1 vs. 13.7%, p = 0.736), Clavien-Dindo grade ≥ 3 complications (2.4 vs 3.2%, p = 0.572), transfusions (0.8 vs. 4.0%, p = 0.219), and 30-day mortality (0.8 vs 0.8%, p = 1.000) were comparable for RLC and LLC, respectively. Median operative time was longer for RLC (296 min 260-340 vs. 245, 195-296, p < 0.0001). Early oral feeding, time to first flatus, and hospital stay were similar between groups. RLC has safety parameters as well as conversion to open surgery comparable with standard laparoscopy. Operative time is longer with the robotic approach.

RevDate: 2023-05-27

Marasco G, Buttitta F, Cremon C, et al (2023)

The role of microbiota and its modulation in colonic diverticular disease.

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society [Epub ahead of print].

BACKGROUND: Diverticular disease (DD) is a common condition in Western countries. The role of microbiota in the pathogenesis of DD and its related symptoms has been frequently postulated since most complications of this disease are bacteria-driven and most therapies rely on microbiota modulation. Preliminary data showed fecal microbial imbalance in patients with DD, particularly when symptomatic, with an increase of pro-inflammatory and potentially pathogenetic bacteria. In addition, bacterial metabolic markers can mirror specific pathways of the disease and may be even used for monitoring treatment effects. All treatments currently suggested for DD can affect microbiota structure and metabolome compositions.

PURPOSE: Sparse evidence is available linking gut microbiota perturbations, diverticular disease pathophysiology, and symptom development. We aimed to summarize the available knowledge on gut microbiota evaluation in diverticular disease, with a focus on symptomatic uncomplicated DD, and the relative treatment strategies.

RevDate: 2023-05-27

Mateescu T, Miutescu B, Nicola A, et al (2023)

Health-Related Quality of Life and Stress-Related Disorders in Patients with Complicated Diverticular Disease under Conservative Management.

Healthcare (Basel, Switzerland), 11(10): pii:healthcare11101383.

Diverticular disease is a common gastrointestinal disorder with increasing prevalence in advanced age. This study aimed to investigate the impact of age and complexity of diverticulitis on health-related quality of life (HRQoL) and stress-related disorders. A cross-sectional study was conducted on 180 patients, including adults (18-64 years) with complicated diverticular disease, the elderly (≥65 years) with complicated diverticular disease, and a control group with uncomplicated symptomatic diverticular disease. HRQoL and stress-related disorders were assessed using the SF-36, GIQLI, HADS, and PHQ-9 questionnaires at baseline and six months after the initial episode of diverticulitis. At diagnosis, the adult group had significantly lower mean physical and mental scores compared with the elderly and control groups (p < 0.001). At the 6-month follow-up, the mean physical score increased for all groups, but the difference between adults and the elderly remained significant (p = 0.028). The adult group had a significantly lower mean GIQLI score at diagnosis compared with the elderly and control groups (p < 0.001), although after 6 months it increased and the difference became insignificant. Anxiety scores at diagnosis were significantly higher in the adult group compared with the control group (p = 0.009). The complexity of diverticulitis and age significantly impacted HRQoL at diagnosis, with adults having lower physical and mental scores compared with elderly patients and controls. Although improvements were observed after 6 months, the difference between adults and the elderly remained significant for physical HRQoL scores. This highlights the need for tailored management strategies and psychosocial support to optimize patient outcomes across age groups and diverticulitis complexity.

RevDate: 2023-05-23

Molina GA, Ojeda RH, Jimenez G, et al (2023)

Small bowel volvulus due to jejunal diverticula: a rare case of acute abdomen.

Journal of surgical case reports, 2023(5):rjad249 pii:rjad249.

Jejunal diverticula are rare, and small bowel diverticular disease resulting in volvulus can lead to severe complications; as symptoms are non-specific, many patients are misdiagnosed and treated wrongly for other conditions. When a small bowel volvulus is detected, urgent surgical treatment is needed to avoid troublesome difficulties. We present the case of a 36-year-old woman who presented to the emergency room with an acute abdomen due to small bowel obstruction. After further testing, a volvulus was detected and promptly treated. Jejunal diverticula that caused a small bowel volvulus was the final diagnosis.

RevDate: 2023-05-22

Drnovšek J, Čebron Ž, Grosek J, et al (2023)

Endoscopic ultrasound-guided transrectal drainage of a pelvic abscess after Hinchey II sigmoid colon diverticulitis: A case report.

World journal of clinical cases, 11(12):2848-2854.

BACKGROUND: Acute diverticulitis is one of the most prevalent complications of diverticular disease and may result in abscess formation, perforation, fistula formation, obstruction, or bleeding. Diverticular abscesses may be initially treated with antibiotics and/or percutaneous drainage and/or surgery. Endoscopic ultrasound (EUS)-guided drainage techniques are increasingly used as a minimally invasive alternative to percutaneous or surgical approaches, as they are associated with better treatment outcomes, shorter recovery time and duration of hospitalization.

CASE SUMMARY: A 57-year-old female presented to the emergency department on account of abdominal pain and fever. Clinical examination revealed tenderness in the left lower abdominal quadrant, with elevated inflammatory markers in laboratory tests. Abdominal computed tomography (CT) revealed an 8 cm × 8 cm × 5 cm well-encapsulated abscess of the sigmoid colon, surrounded by numerous diverticula. A diagnosis of Hinchey II diverticular abscess was made, and the patient was admitted and commenced on appropriate antibiotic treatment. A transrectal EUS showed a fluid collection in direct contact with the sigmoid colon. Transluminal drainage was performed, and a lumen-apposing metal stent was inserted into the abscess collection. A follow-up CT scan showed a regression of the collection. The patient's general condition improved, and the stent was removed during a follow-up transrectal EUS that revealed no visible collection.

CONCLUSION: We report the first successful management of a pelvic abscess in patient with Hinchey II acute diverticulitis using EUS-guided transluminal drainage in Slovenia. The technique appears effective for well-encapsulated intra-abdominal abscesses larger than 4 cm in direct contact with the intestinal wall of left colon.

RevDate: 2023-05-22

Yapa AKDS, Humes DJ, Crooks CJ, et al (2023)

Venous thromboembolism following colectomy for diverticular disease: an English population-based cohort study.

Langenbeck's archives of surgery, 408(1):203.

AIM: This study reports venous thromboembolism (VTE) rates following colectomy for diverticular disease to explore the magnitude of postoperative VTE risk in this population and identify high risk subgroups of interest.

METHOD: English national cohort study of colectomy patients between 2000 and 2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type, absolute incidence rates (IR) per 1000 person-years and adjusted incidence rate ratios (aIRR) were calculated for 30- and 90-day post-colectomy VTE.

RESULTS: Of 24,394 patients who underwent colectomy for diverticular disease, over half (57.39%) were emergency procedures with the highest VTE rate seen in patients ≥70-years-old (IR 142.27 per 1000 person-years, 95%CI 118.32-171.08) at 30 days post colectomy. Emergency resections (IR 135.18 per 1000 person-years, 95%CI 115.72-157.91) had double the risk (aIRR 2.07, 95%CI 1.47-2.90) of developing a VTE at 30 days following colectomy compared to elective resections (IR 51.14 per 1000 person-years, 95%CI 38.30-68.27). Minimally invasive surgery (MIS) was shown to be associated with a 64% reduction in VTE risk (aIRR 0.36 95%CI 0.20-0.65) compared to open colectomies at 30 days post-op. At 90 days following emergency resections, VTE risks remained raised compared to elective colectomies.

CONCLUSION: Following emergency colectomy for diverticular disease, the VTE risk is approximately double compared to elective resections at 30 days while MIS was found to be associated with a reduced risk of VTE. This suggests advancements in postoperative VTE prevention in diverticular disease patients should focus on those undergoing emergency colectomies.

RevDate: 2023-05-20

Augustin G, Bruketa T, Kunjko K, et al (2023)

Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm.

Updates in surgery [Epub ahead of print].

Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45-95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.

RevDate: 2023-05-19

Bartel M, Burnett C, D Barnes (2021)

Sigmoid Diverticulitis in an Obese Pediatric Patient Without Genetic Predisposition.

JPGN reports, 2(2):e078.

Sigmoid diverticulitis has historically been a rare cause of abdominal pain in pediatrics, with minimal cases documented in the literature. The patient studied is one of the first reported cases of acquired pediatric uncomplicated sigmoid diverticulitis in whom lifestyle was the main contributing factor, as all associated known genetic risk factors were absent. Given the rarity of the diagnosis, many pediatricians may not consider the diagnosis; however, with the increasing incidence in younger patients, consideration of diverticulitis on the differential diagnosis with lower abdominal pain, especially in patients predisposed to diverticular disease, is increasingly important to avoid misdiagnosis and potential delays in appropriate treatment.

RevDate: 2023-05-17

Kumaresan M, Arun RS, Damle A, et al (2023)

Crystal-Induced Lower GI Necrosis in a Posttransplant Recipient with Diverticular Disease.

Indian journal of nephrology, 33(1):54-56.

We report the case of a 67-year-old male kidney transplant recipient for 12 years with sodium polystyrene sulfonate crystal-induced ileocecal colitis. He had adult polycystic kidney disease with associated colonic diverticular disease. Here, we describe how a potentially fatal complication of colonic perforation was averted with appropriate investigations and management.

RevDate: 2023-05-17

Joo YY, Pacheco JA, Thompson WK, et al (2023)

Multi-ancestry genome- and phenome-wide association studies of diverticular disease in electronic health records with natural language processing enriched phenotyping algorithm.

PloS one, 18(5):e0283553 pii:PONE-D-22-11388.

OBJECTIVE: Diverticular disease (DD) is one of the most prevalent conditions encountered by gastroenterologists, affecting ~50% of Americans before the age of 60. Our aim was to identify genetic risk variants and clinical phenotypes associated with DD, leveraging multiple electronic health record (EHR) data sources of 91,166 multi-ancestry participants with a Natural Language Processing (NLP) technique.

MATERIALS AND METHODS: We developed a NLP-enriched phenotyping algorithm that incorporated colonoscopy or abdominal imaging reports to identify patients with diverticulosis and diverticulitis from multicenter EHRs. We performed genome-wide association studies (GWAS) of DD in European, African and multi-ancestry participants, followed by phenome-wide association studies (PheWAS) of the risk variants to identify their potential comorbid/pleiotropic effects in clinical phenotypes.

RESULTS: Our developed algorithm showed a significant improvement in patient classification performance for DD analysis (algorithm PPVs ≥ 0.94), with up to a 3.5 fold increase in terms of the number of identified patients than the traditional method. Ancestry-stratified analyses of diverticulosis and diverticulitis of the identified subjects replicated the well-established associations between ARHGAP15 loci with DD, showing overall intensified GWAS signals in diverticulitis patients compared to diverticulosis patients. Our PheWAS analyses identified significant associations between the DD GWAS variants and circulatory system, genitourinary, and neoplastic EHR phenotypes.

DISCUSSION: As the first multi-ancestry GWAS-PheWAS study, we showcased that heterogenous EHR data can be mapped through an integrative analytical pipeline and reveal significant genotype-phenotype associations with clinical interpretation.

CONCLUSION: A systematic framework to process unstructured EHR data with NLP could advance a deep and scalable phenotyping for better patient identification and facilitate etiological investigation of a disease with multilayered data.

RevDate: 2023-05-11

Pshenichcnaya NY, Ponezheva ZB, Marzhokhova AR, et al (2022)

[Clinical cases of complicated diverticulitis against the background of severe course COVID-19. Case report].

Terapevticheskii arkhiv, 94(11):1315-1319.

Two clinical cases of perforation of a previously undiagnosed colon diverticulum in patients with coronavirus infection caused by the SARS-CoV-2 virus treated at the Hospital №1 of Nalchik. Both patients were elderly, overweight, had a lot of chronic concomitant diseases. Patients received hormone therapy and were targeted: the first patient twice (tocilizumab on the first day of hospitalization and olokizumab on the 7th day of inpatient treatment). The second patient received levilimab on the 3rd day of his stay in the hospital. A short time after targeting, both patients developed acute diffuse abdominal pain, the patients were transferred to the surgical department and operated on. During the operation, both patients were found to have previously undiagnosed diverticular disease, complicated by diverticular perforation and peritonitis on the background of immunosuppression. Both patients died. Thus, when using targeted therapy for patients with COVID-19, it is necessary to take into account that they may have previously undiagnosed chronic diseases that can cause fatal complications against the background of immunosuppression.

RevDate: 2023-05-10

Pansuriya S, Ekkel E, Pearl L, et al (2023)

Complicated Diverticulitis and Pelvic Radiation Leading to Colonic Stricture, Colorectal Fistula, and Anal Stenosis.

The American surgeon [Epub ahead of print].

The purpose of this case is to highlight a rare case of sigmoid colon-to-rectum fistula. A 66-year-old man with a history of pelvic radiation and diverticulosis presented to the emergency department with a 3-week history of abdominal pain and watery diarrhea. Computed tomography (CT) imaging was significant for a sigmoid-to-rectum fistula with sigmoid stricture. The patient underwent a laparoscopic colectomy with end colostomy. Pathology revealed perforated diverticulitis. To date, there have been no cases reported in literature describing sigmoid-to-rectum fistula. In conclusion, it is important to consider the development of complex diverticular disease in patients with history of pelvic radiation.

RevDate: 2023-05-08

Papatriantafyllou A, Dedopoulou P, Soukouli K, et al (2023)

Right-Sided Diverticulitis: A Rare Cause of Right-Sided Abdominal Pain.

Cureus, 15(4):e37123.

Acute diverticulitis is a particularly common medical entity, and its frequency increases with age. The most commonly affected part of the large intestine is the sigmoid colon, while right-sided diverticulitis is very rare. Here, we report the case of a 59-year-old man who presented to the emergency department due to acute right lower quadrant abdominal pain. The patient was diagnosed with a computed tomography scan of the abdomen with intravenous contrast with right-sided diverticulitis. The patient's treatment included hydration and intravenous antibiotics (ciprofloxacin and metronidazole). After three days of hospitalization, the patient was discharged from the hospital in stable condition and without signs of inflammation. This case report demonstrates the importance of including right-sided diverticulitis in the differential diagnosis of acute right lower quadrant abdominal pain, as in most cases patients are treated conservatively without the need for surgical intervention.

RevDate: 2023-05-06

Campobasso D, Zizzo M, Biolchini F, et al (2023)

Laparoscopic management of colovesical fistula in different clinical scenarios.

Journal of minimal access surgery pii:374479 [Epub ahead of print].

INTRODUCTION: Colovesical fistula (CVF) is a condition with various aetiologies and presentations. Surgical treatment is necessary in most cases. Due to its complexity, open approach is preferred. However, laparoscopic approach is reported in the management of CVF due to diverticular disease. The aim of this study was to analyse the management and outcome of patients with CVF of different aetiologies treated with laparoscopic approach.

PATIENTS AND METHODS: This was a retrospective study. We retrospectively reviewed all patients undergoing elective laparoscopic management of CVF from March 2015 to December 2019.


RESULTS: Nine patients underwent laparoscopic management of CVF. There were no intraoperative complications or conversions to open surgery. A sigmoidectomy was performed in eight cases. In one patient, a fistulectomy with sigmoid and bladder defect closure was performed. In two cases of locally advanced colorectal cancer with bladder invasion, a multi-stage procedure with temporary colostomy was chosen. In three cases, with no intraoperative leakage, we did not perform bladder suture. Four Clavien I-II complications were recorded. Two fragile patients died in the post-operative period. No patients required re-operation. At a median follow-up of 21 months (interquartile range: 6-47), none of the patients had recurrence of fistula.

CONCLUSIONS: CVF can be managed with laparoscopic approach by skilled laparoscopic surgeons in different clinical scenarios. Bladder suture is not necessary if leakage is absent. Informed counselling to the patient must be guaranteed concerning the risk of major complications and mortality in case of CVF due to malignant disease.

RevDate: 2023-05-05

Naseem Z, Kaneko Y, T Pham (2023)

Colo-rectal fistula: a rare complication of diverticular disease.

RevDate: 2023-05-04

Ruan X, Chen J, Sun Y, et al (2023)

Depression and 24 gastrointestinal diseases: a Mendelian randomization study.

Translational psychiatry, 13(1):146.

The causality of the association between depression and gastrointestinal diseases is undetermined. We conducted Mendelian randomization (MR) analyses to systematically explore the associations of depression with 24 gastrointestinal diseases. Independent genetic variants associated with depression at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank study, the FinnGen study, and large consortia. Multivariable MR analysis was conducted to explore the mediation effects of body mass index, cigarette smoking, and type 2 diabetes. After multiple-testing corrections, genetic liability to depression was associated with an increased risk of irritable bowel syndrome, non-alcohol fatty liver disease, alcoholic liver disease, gastroesophageal reflux, chronic pancreatitis, duodenal ulcer, chronic gastritis, gastric ulcer, diverticular disease, cholelithiasis, acute pancreatitis, and ulcerative colitis. For the causal effect of genetic liability to depression on non-alcoholic fatty liver disease, a substantial proportion was mediated by body mass index. Genetic predisposition to smoking initiation mediated half of effect of depression on acute pancreatitis. This MR study suggests that depression may play a causal role in many gastrointestinal diseases.

RevDate: 2023-05-04

Walayat S, Johannes AJ, Benson M, et al (2023)

Outcomes of colon self-expandable metal stents for malignant vs benign indications at a tertiary care center and review of literature.

World journal of gastrointestinal endoscopy, 15(4):309-318.

BACKGROUND: Endoscopic placement of a self-expandable metal stent (SEMS) is a minimally invasive treatment for use in malignant and benign colonic obstruction. However, their widespread use is still limited with a nationwide analysis showing only 5.4% of patients with colon obstruction undergoing stent placement. This underutilization could be due to perceived increase risk of complications with stent placement.

AIM: To review long- and short-term clinical success of SEMS use for colonic obstruction at our center.

METHODS: We retrospectively reviewed all the patients who underwent colonic SEMS placement over a eighteen year period (August 2004 through August 2022) at our academic center. Demographics including age, gender, indication (malignant and benign), technical success, clinical success, complications (perforation, stent migration), mortality, and outcomes were recorded.

RESULTS: Sixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were for malignant indications, 8 were for benign conditions. The benign strictures included diverticular disease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemic stricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primary or recurrent colon cancer; 12 were from extrinsic compression. Fifty-four strictures occurred on the left side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55) procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication rate was significantly higher for benign group: Four complications were observed in the malignant group (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stent migration) (P = 0.02). When stratifying complications of perforation and stent migration there was no significant difference between the two groups (P = 0.14, NS).

CONCLUSION: Colon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has a high procedural and clinical success rate. Benign indications for SEMS placement appear to have similar success to malignant. While there appears to be a higher overall complication rate in benign cases, our study is limited by sample size. When evaluating for perforation alone there does not appear to be any significant difference between the two groups. SEMS placement may be a practical option for indications other that malignant obstruction. Interventional endoscopists should be aware and discuss the risk for complications in setting of benign conditions. Indications in these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.

RevDate: 2023-05-02

Freeman HJ (2023)

Segmental Colitis Associated with Diverticulosis (SCAD).

Current gastroenterology reports [Epub ahead of print].

PURPOSE OF REVIEW: A distinctive, possibly "novel" form of a segmental inflammatory colonic disease process associated with diverticular disease (so-called SCAD or segmental-colitis-associated-diverticulosis) is reviewed.

RECENT FINDINGS: Although this phenotype of inflammatory colonic disease was initially recognized decades ago, mainly in the elderly, recent evidence from long term natural history studies along with meta-analyses confirms that its clinical course is usually benign and drug-responsive. Interestingly, its appearance in some treated with monoclonal agents (eg., ipilimumab associated colitis) or infected with coronavirus-19 may have critical implications for its pathogenesis. This review further explores the implications of recognition of this pattern of colonic inflammatory disease, with relevance for physicians involved in both clinical practice and clinical trials of newer therapeutic agents.

RevDate: 2023-05-01

Ojemolon PE, Shaka H, Kwei-Nsoro R, et al (2023)

Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis.

Cureus, 15(3):e36843.

Objective We aimed to describe epidemiologic trends in outcomes of colonic diverticular disease (CDD) hospitalizations in morbidly obese patients. Methods We searched the United States National Inpatient Sample databases from 2010 through 2019, obtained the incidence rate of morbid obesity (MO) among CDD hospitalizations, and used Joinpoint analysis to obtain trends in these rates adjusted for age and sex. Hospitalizations involving patients less than 18 years of age were excluded. Trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge were analyzed. Multivariate regression analysis was used to obtain trends in adjusted mortality, mean LOS, and mean total hospital charge. Results We found an average annual percent change of 7.5% (CI = 5.5-9.4%, p < 0.01) in the adjusted incidence of MO among hospitalizations for CDD over the study period. We noted a 7.2% decline in mortality (p = 0.011) and a 0.1 days reduction in adjusted LOS (p < 0.001) over the study period. Hospitalizations among the middle-aged and elderly had adjusted odds ratios of 7.18 (95% CI = 2.2-23.3, p = 0.001) and 24.8 (95% CI = 7.9-77.9, p < 0.001), respectively, for mortality compared to those in young adults. The mean LOS was 0.29 days higher in females compared to males (p < 0.001). Conclusion The incidence of MO increased among CDD hospitalizations while mortality and mean LOS reduced over the study period. Outcomes were worse in older patients, with an increased mean LOS in females compared to males.

RevDate: 2023-04-28

Ebrahimian S, Verma A, Sakowitz S, et al (2023)

Association of hospital volume with conversion to open from minimally invasive colectomy in patients with diverticulitis: A national analysis.

PloS one, 18(4):e0284729 pii:PONE-D-23-01247.

BACKGROUND: Despite the known advantages of minimally invasive surgery (MIS) for diverticular disease, the impact of conversions to open (CtO) colectomy remains understudied. The present study used a nationally representative database to characterize risk factors and outcomes associated with CtO in patients with diverticular disease.

METHODS: All elective adult hospitalizations entailing colectomy for diverticulitis were identified in the 2017-2019 Nationwide Readmissions Database. Annual institutional caseloads of MIS and open colectomy were independently tabulated. Restricted cubic splines were utilized to non-linearly estimate the risk-adjusted association between hospital volumes and CtO. Additional regression models were developed to evaluate the association of CtO with outcomes of interest.

RESULTS: Of an estimated 110,281 patients with diverticulitis who met study criteria, 39.3% underwent planned open colectomy, 53.3% completed MIS, and 7.4% had a CtO. Following adjustment, an inverse relationship between hospital MIS volume and risk of CtO was observed. In contrast, increasing hospital open volume was positively associated with greater risk of CtO. On multivariable analysis, CtO was associated with lower odds of mortality (AOR 0.3, p = 0.001) when compared to open approach, and similar risk of mortality when compared to completed MIS (AOR 0.7, p = 0.436).

CONCLUSION: In the present study, institutional MIS volume exhibited inverse correlation with adjusted rates of CtO, independent of open colectomy volume. CtO was associated with decreased rates of mortality compared to planned open approach but equivalence risk relative to completed MIS. Our findings highlight the importance of MIS experience and suggest that MIS may be safely pursued as the initial surgical approach among diverticulitis patients.

RevDate: 2023-04-20

Di Tommaso GR, de Castro GL, Júnior ECC, et al (2023)

Large epiphrenic esophageal diverticulum in symptomatic patient managed laparoscopically: Case report and review of literature.

INTRODUCTION: Diverticular disease most common site in digestive tract is large intestine, but can also appears in small intestine and esophagus. Esophageal diverticula are divided according to injured portion (pharyngeal, middle or epiphrenic).

CASE PRESENTATION: We present a case of large epiphrenic diverticulum in a 71-year-old woman with mild gastrointestinal symptoms managed laparoscopically with diverticulectomy and fundoplication.

DISCUSSION: Epiphrenic esophageal diverticulum is rare, originated from unknown increase of intraesophageal pressure. Diagnosis usually occurs with imaging and endoscopic investigation and surgical treatment is indicated for symptomatic patients.

CONCLUSION: High suspicion and proper analysis are fundamental for diagnosis and treatment definition, which may include outpatient follow-up or surgery.

RevDate: 2023-04-20

Ahmadi N, Ahmadi N, Ravindran P, et al (2023)

Acute diverticulitis in immunosuppressed patients: a 12-year management experience.

ANZ journal of surgery [Epub ahead of print].

BACKGROUND: Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis.

METHOD: A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018.

RESULT: A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001).

CONCLUSION: Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.

RevDate: 2023-04-19

Hill SS, JS Davids (2023)

The Benefits of Surgery for Diverticular Disease-Have We Met the Burden of Proof?.

JAMA surgery pii:2803639 [Epub ahead of print].

RevDate: 2023-04-04

Calini G, Abd El Aziz MA, Paolini L, et al (2023)

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management.

Clinical and experimental gastroenterology, 16:29-43.

Symptomatic Uncomplicated Diverticular Disease (SUDD) is a syndrome within the diverticular disease spectrum, characterized by local abdominal pain with bowel movement changes but without systemic inflammation. This narrative review reports current knowledge, delivers practical guidance, and reveals challenges for the clinical management of SUDD. A broad and common consensus on the definition of SUDD is still needed. However, it is mainly considered a chronic condition that impairs quality of life (QoL) and is characterized by persistent left lower quadrant abdominal pain with bowel movement changes (eg, diarrhea) and low-grade inflammation (eg, elevated calprotectin) but without systemic inflammation. Age, genetic predisposition, obesity, physical inactivity, low-fiber diet, and smoking are considered risk factors. The pathogenesis of SUDD is not entirely clarified. It seems to result from an interaction between fecal microbiota alterations, neuro-immune enteric interactions, and muscular system dysfunction associated with a low-grade and local inflammatory state. At diagnosis, it is essential to assess baseline clinical and Quality of Life (QoL) scores to evaluate treatment efficacy and, ideally, to enroll patients in cohort studies, clinical trials, or registries. SUDD treatments aim to improve symptoms and QoL, prevent recurrence, and avoid disease progression and complications. An overall healthy lifestyle - physical activity and a high-fiber diet, with a focus on whole grains, fruits, and vegetables - is encouraged. Probiotics could effectively reduce symptoms in patients with SUDD, but their utility is missing adequate evidence. Using Rifaximin plus fiber and Mesalazine offers potential in controlling symptoms in patients with SUDD and might prevent acute diverticulitis. Surgery could be considered in patients with medical treatment failure and persistently impaired QoL. Still, studies with well-defined diagnostic criteria for SUDD that evaluate the safety, QoL, effectiveness, and cost-effectiveness of these interventions using standard scores and comparable outcomes are needed.

RevDate: 2023-04-02

Dumitrascu DL, Bakulin I, Berzigotti A, et al (2023)

Update on the Role of Rifaximin in Digestive Diseases.

Journal of gastrointestinal and liver diseases : JGLD, 32(1):92-109.

Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.

RevDate: 2023-03-30

Kaye AJ, Patel SJ, Meyers SR, et al (2023)

Outcomes of Patients Hospitalized for Acute Diverticulitis With Comorbid Generalized Anxiety Disorder.

Cureus, 15(2):e35461.

Introduction Diverticular disease and anxiety disorders are common in the general population. Prior research on diverticular disease showed that these patients have an increased frequency of anxiety and depression. The objective of this study was to explore the impact of generalized anxiety disorder (GAD) on the outcomes of adult patients admitted with acute diverticulitis. Methods Using the National Inpatient Sample database from the year 2014 and International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes, acute diverticulitis patients were selected. The outcomes of diverticulitis patients with and without GAD were explored. The outcomes of interest included inpatient mortality, hypotension/shock, acute respiratory failure, acute hepatic failure, sepsis, intestinal abscess, intestinal obstruction, myocardial infarction, acute renal failure, and colectomy. A multivariate logistic regression analysis was performed to determine if GAD is an independent predictor for the outcomes. Results Among 77,520 diverticulitis patients in the study, 8,484 had comorbid GAD. GAD was identified as a risk factor for intestinal obstruction (adjusted odds ratio (aOR) 1.22, 95% CI: 1.05-1.43, p<0.05), and intestinal abscess (aOR 1.19, 95% CI: 1.10-1.29, p<0.05). GAD was found to be a protective factor for hypotension/shock (aOR 0.83, 95% CI: 0.76-0.91, p<0.05) and acute respiratory failure (aOR 0.76, 95% CI: 0.62-0.93, p<0.05). The aORs of sepsis, inpatient mortality, myocardial infarction, acute renal failure, and colectomy were not statistically significant. Conclusions Patients with acute diverticulitis who are also diagnosed with GAD are at increased risk for intestinal obstruction and intestinal abscess, which may be due to the influence GAD has on the gut microbiota as well as the impact of GAD pharmacotherapy on gut motility. There was also a decreased risk for acute respiratory failure and hypotension/shock appreciated in the GAD cohort which may be attributable to the elevated healthcare resource utilization seen generally in GAD patients, which may allow for presentation to the emergency department, hospitalization, and treatment earlier in the diverticulitis disease course.

RevDate: 2023-03-29

Alexandersson BT, Hugerth LW, Hedin C, et al (2023)

Diverticulosis is not associated with altered gut microbiota nor is it predictive of future diverticulitis: a population-based colonoscopy study.

Scandinavian journal of gastroenterology [Epub ahead of print].

BACKGROUND: The etiopathogenesis of diverticular disease is unknown.

OBJECTIVE: To compare the fecal and mucosa-associated microbiota between participants with and without diverticulosis and participants who later developed diverticulitis versus those that did not from a population-based study.

METHODS: The PopCol study, conducted in Stockholm, Sweden, invited a random sample of 3556 adults to participate, of which 745 underwent colonoscopy. Overall, 130 participants (17.5%) had diverticulosis. 16S rRNA gene sequencing was conducted on available sigmoid biopsy samples from 529 and fecal samples from 251 individuals. We identified individuals who subsequently developed acute diverticulitis up to 13 years after sample collection. In a case-control design matching for gender, age (+/-5 years), smoking and antibiotic exposure, we compared taxonomic composition, richness and diversity of the microbiota between participants with or without diverticulosis, and between participants who later developed acute diverticulitis versus those who did not.

RESULTS: No differences in microbiota richness or diversity were observed between participants with or without diverticulosis, nor for those who developed diverticulitis compared with those who did not. No bacterial taxa were significantly different between participants with diverticulosis compared with those without diverticulosis. Individuals who later developed acute diverticulitis (2.8%) had a higher abundance of genus Comamonas than those who did not (p = .027).

CONCLUSIONS: In a population-based cohort study the only significant difference was that those who later develop diverticulitis had more abundance of genus Comamonas. The significance of Comamonas is unclear, suggesting a limited role for the gut microbiota in the etiopathogenesis of diverticular disease.

RevDate: 2023-03-29

Piccin A, Gulotta M, di Bella S, et al (2023)

Diverticular Disease and Rifaximin: An Evidence-Based Review.

Antibiotics (Basel, Switzerland), 12(3): pii:antibiotics12030443.

There have been considerable advances in the treatment of diverticular disease in recent years. Antibiotics are frequently used to treat symptoms and prevent complications. Rifaximin, a non-absorbable antibiotic, is a common therapeutic choice for symptomatic diverticular disease in various countries, including Italy. Because of its low systemic absorption and high concentration in stools, it is an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties. Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. Unfortunately, there is no available evidence on the efficacy of rifaximin treatment for acute uncomplicated diverticulitis.

RevDate: 2023-03-24

Ivashkin V, Shifrin O, Maslennikov R, et al (2023)

Eubiotic effect of rifaximin is associated with decreasing abdominal pain in symptomatic uncomplicated diverticular disease: results from an observational cohort study.

BMC gastroenterology, 23(1):82.

BACKGROUND: Rifaximin effectively treats symptomatic uncomplicated diverticular disease (SUDD) and has shown eubiotic potential (i.e., an increase in resident microbial elements with potential beneficial effects) in other diseases. This study investigated changes in the fecal microbiome of patients with SUDD after repeated monthly treatment with rifaximin and the association of these changes with the severity of abdominal pain.

METHODS: This was a single-center, prospective, observational, uncontrolled cohort study. Patients received rifaximin 400 mg twice a day for 7 days per month for 6 months. Abdominal pain (assessed on a 4-point scale from 0 [no pain] to 3 [severe pain]) and fecal microbiome (assessed using 16 S rRNA gene sequencing) were assessed at inclusion (baseline) and 3 and 6 months. The Spearman's rank test analyzed the relationship between changes in the gut microbiome and the severity of abdominal pain. A p-value ≤ 0.05 was considered statistically significant.

RESULTS: Of the 23 patients enrolled, 12 patients completed the study and were included in the analysis. Baseline abdominal pain levels decreased significantly after 3 (p = 0.036) and 6 (p = 0.008) months of treatment with rifaximin. The abundance of Akkermansia in the fecal microbiome was significantly higher at 3 (p = 0.017) and 6 (p = 0.015) months versus baseline. The abundance of Ruminococcaceae (p = 0.034), Veillonellaceae (p = 0.028), and Dialister (p = 0.036) were significantly increased at 6 months versus baseline, whereas Anaerostipes (p = 0.049) was significantly decreased. The severity of abdominal pain was negatively correlated with the abundance of Akkermansia (r=-0.482; p = 0.003) and Ruminococcaceae (r=-0.371; p = 0.026) but not with Veillonellaceae, Dialister, or Anaerostipes. After 3 months of rifaximin, abdominal pain was significantly less in patients with Akkermansia in their fecal microbiome than in patients without Akkermansia (p = 0.022).

CONCLUSION: The eubiotic effect of rifaximin was associated with decreased abdominal pain in patients with SUDD.

RevDate: 2023-03-22

Lee GC, Kanters AE, Gunter RL, et al (2023)

Operative management of anastomotic leak after sigmoid colectomy for left-sided diverticular disease: Ileostomy creation may be as safe as colostomy creation.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Epub ahead of print].

AIM: The management of anastomotic leak after sigmoid colectomy for diverticular disease has not been well defined. Specifically, there is a lack of literature on optimal types of reoperations for leaks. The aim of this study was to describe and compare reoperative approaches and their postoperative outcomes.

METHODS: We performed a retrospective cohort study using the NSQIP Colectomy Module (2012-2019) and single-institution chart review. Patients with diverticular disease who underwent elective sigmoid colectomy were included. Primary outcomes were anastomotic leak requiring reoperation and management of anastomotic leak.

RESULTS: Of 37,471 patients who underwent sigmoid colectomy for diverticular disease, 1003 (2.7%) suffered an anastomotic leak, of whom 583 underwent reoperation. Of the 572 patients who were not initially diverted and underwent reoperation for leak, 302 (52.8%) were managed with stoma creation - 200 (35.0%) with colostomy and 102 (17.8%) with ileostomy. The remaining 47.2% underwent colectomy with reanastomosis, suturing of large bowel, and drainage. There were no differences in length of stay, readmission, or mortality between patients who underwent ileostomy or colostomy at reoperation (p > 0.05). Single-institution analysis demonstrated that 100% of patients with ileostomies underwent subsequent ileostomy closure, compared to 60% of patients with colostomies.

CONCLUSIONS: In patients who suffer anastomotic leaks after sigmoid colectomy for diverticular disease and undergo reoperations, ileostomy at the time of reoperation appears to be safe, with comparable results to colostomy. Ileostomies were more frequently closed than colostomies. When faced with a colorectal anastomotic leak, ileostomy creation may be considered.

RevDate: 2023-03-13

Constantin A, Constantinoiu S, Achim F, et al (2023)

Esophageal diverticula: from diagnosis to therapeutic management-narrative review.

Journal of thoracic disease, 15(2):759-779.

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.

RevDate: 2023-03-11

Nardone OM, Marasco G, Lopetuso LR, et al (2023)

Insights into Mesalazine Use in Clinical Practice of Young Gastroenterologists.

Journal of clinical medicine, 12(5): pii:jcm12052005.

BACKGROUND: Mesalazine is among the medications most prescribed by gastroenterologists, with variable and controversial use in different settings. We aimed to explore the use of mesalazine in the clinical practice of young gastroenterologists.

METHODS: A web-based electronic survey was distributed to all participants of the National Meeting of the Italian Young Gastroenterologist and Endoscopist Association.

RESULTS: A total of 101 participants took part in the survey, with a majority (54.4%) being aged >30 years, 63.4% of whom were trainees in academic hospitals, and 69.3% of whom were involved in the clinical management of inflammatory bowel disease (IBD). While both non-dedicated and IBD physicians generally agreed on the appropriate dose of mesalazine for mild ulcerative colitis (UC), significant differences were observed between the two groups for moderate-severe ulcerative colitis (UC). Additionally, in IBD patients who were starting immuno-modulators and/or biologics, 80% of IBD-dedicated physicians continued to prescribe mesalazine, compared to 45.2% of non-dedicated physicians (p = 0.002). Indeed, 48.4% of non-dedicated IBD physicians did not acknowledge mesalazine for colorectal cancer chemoprevention. With regards to Crohn's disease, it is mainly used by 30.1% of IBD physicians for preventing postoperative recurrence of Crohn's disease. Finally, 57.4% used mesalazine for symptomatic uncomplicated diverticular disease, and 84.2% did not recommend its use for irritable bowel syndrome.

CONCLUSIONS: This survey showed heterogeneous behaviors in the daily use of mesalazine, mainly in the management of IBD. Educational programs and novel studies are needed to clarify its use.

RevDate: 2023-03-09

Maconi G, Dell'Era A, Flor N, et al (2023)


Clinical and translational gastroenterology pii:01720094-990000000-00140 [Epub ahead of print].

AIM: To evaluate the ability of intestinal ultrasound in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms including irritable bowel syndrome (IBS).

DESIGN: This observational, prospective study included consecutive patients classified into the following categories: a) SUDD; b) IBS; c) unclassifiable abdominal symptoms; and d) controls, including asymptomatic healthy subjects and diverticulosis. The Intestinal ultrasound (IUS) evaluation of the sigmoid assessed the presence of diverticula, thickness of the muscularis propria and IUS-evoked pain, namely the intensity of pain evoked by compression with the ultrasound probe on sigmoid colon compared with an area of the left lower abdominal quadrant without underlying sigmoid colon.

RESULTS: We enrolled 40 patients with SUDD, 20 IBS, and 28 patients with unclassifiable abdominal symptoms, 10 healthy controls and 20 diverticulosis. SUDD patients displayed significantly (p<0.001) greater muscle thickness (2.25 ± 0.73 mm) compared to IBS patients (1.66±0.32 mm), patients with unclassifiable abdominal pain, and healthy subjects, but comparable to that of patients with diverticulosis (2.35 ± 0.71 mm). SUDD patients showed a greater (not significant) differential pain score than other patients. There was a significant correlation between the thickness of the muscularis propria and the differential pain score only for SUDD patients (r = 0.460; p: 0.01). Sigmoid diverticula were detected by colonoscopy in 40 patients (42.4%) and by IUS with a sensitivity of 96.0% and a specificity of 98.5%.

CONCLUSION: IUS could represent a useful diagnostic tool for SUDD, potentially useful in characterizing the disease and appropriately address the therapeutic approach.

RevDate: 2023-03-09

Shaikh A, Khrais A, Le A, et al (2023)

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis.

Cureus, 15(2):e34624.

Background and objective Diverticulitis occurs in 10-25% of patients with diverticulosis. Although opioids can decrease bowel motility, there is scarce data on the effect of chronic opioid use on the outcomes of diverticulitis. In this study, we aimed to explore the outcomes of diverticulitis in patients with pre-existing opioid use. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted using the International Classification of Diseases, 9th Revision (ICD-9) codes. Univariate and multivariate analyses were used to generate odds ratios (OR). Elixhauser Comorbidity Index (ECI) scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. Inclusion criteria included patients with a primary diagnosis of diverticulitis. Exclusion criteria included patients less than 18 years of age, and a diagnosis of opioid use disorder in remission. Studied outcomes included inpatient mortality, complications (including perforation, bleeding, sepsis event, ileus, abscess, obstruction, and fistula), length of hospital stay, and total costs. Results A total of 151,708 patients with diverticulitis and no active opioid use and 2,980 patients with diverticulitis and active opioid use were hospitalized in the United States from 2008 to 2014. Opioid users had a higher OR for bleeding, sepsis, obstruction, and fistula formation. Opioid users had a lower risk of developing abscesses. They had longer lengths of stay, higher total hospital charges, and higher Elixhauser readmission scores. Conclusion Hospitalized diverticulitis patients with comorbid opioid use are at an elevated risk of in-hospital mortality and sepsis. This could be attributed to complications from injection drug use predisposing opioid users to these risk factors. Outpatient providers caring for patients with diverticulosis should consider screening their patients for opioid use and try offering them medication-assisted treatment to reduce their risk of poor outcomes.

RevDate: 2023-03-07

Boot M, Chew K, Archer J, et al (2023)

Iatrogenic duodenal diverticulum perforation: a systematic review.

ANZ journal of surgery [Epub ahead of print].

BACKGROUND: Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum.

METHODS: A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes.

RESULTS: Forty-six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre-intervention, nine were identified peri-intervention, and the remainder were identified post-intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality.

CONCLUSION: Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication.

RevDate: 2023-03-01

Xu R, Vaughan A, Fagan M, et al (2023)

Colovesical fistula in men with chronic urinary tract infection: A diagnostic challenge.

Cleveland Clinic journal of medicine, 90(3):165-171 pii:90/3/165.

Although uncommon, colovesical fistula creates significant morbidity, and many patients wait months to receive a correct diagnosis and treatment. Most cases are in older men who have diverticular disease, Crohn disease, cancer, or iatrogenic injury, and some of these associations may have occurred in the patient's distant past and may not be immediately apparent. Since the incidence of diverticulitis in elderly patients is increasing and, in a separate trend, more patients are undergoing bladder instrumentation, we need to suspect this diagnosis when evaluating any patient with urinary tract infection, especially a man with prolonged symptoms refractory to conventional treatments.

RevDate: 2023-03-01

Portolese AC, McMullen BN, Baker SK, et al (2023)

The Microbiome of Complicated Diverticulitis: An Imbalance of Sulfur-Metabolizing Bacteria.

Diseases of the colon and rectum pii:00003453-990000000-00274 [Epub ahead of print].

BACKGROUND: The progression to acute diverticulitis from the relatively benign condition of colonic diverticulosis is not well characterized. A smaller subset may even develop complicated (perforated) diverticulitis resulting in sepsis and/or death. Characterizing the differences between recurrent, uncomplicated diverticulitis and the more virulent, complicated diverticulitis is necessary to guide clinical decision making. Alterations to the microbiome offer a possible explanation for local inflammation and the pathophysiology of diverticular disease.

OBJECTIVE: To characterize the mucosal-associated microbiome in patients with recurrent uncomplicated diverticulitis and complicated (perforated) diverticulitis.

DESIGN: Microbial DNA was extracted from full-thickness surgical specimens for 16S rRNA gene sequencing, targeting the V4 hypervariable region. Sequences were analyzed and a quantitative characterization based on taxonomic classification was performed.

SETTING: A tertiary care academic medical center.

PATIENTS: This study compared 48 patients with recurrent, uncomplicated diverticulitis and 35 patients with radiographically-confirmed perforated (complicated) diverticulitis. Tissues were harvested from surgical resection specimens to include both diseased regions as well as non-diseased (adjacent normal) regions.

MAIN OUTCOME MEASURES: We assessed differences in relative abundance and taxonomic classification of mucosal-associated microbes in surgical resection specimens from diverticular disease.

RESULTS: When analyzing the tissue of diverticular resection specimens, the complicated diseased segments demonstrated an increased abundance of sulfur-reducing and sulfur-oxidizing bacteria when compared to non-diseased, adjacent normal regions. When comparing diseased segments, tissues of complicated patients had a marked increase in sulfur-reducing microbes.

LIMITATIONS: We characterized the mucosal-associated microbiome present at the time of surgical resection, limiting conclusions on its role in pathophysiology. Furthermore, antibiotic usage and bowel preparation prior to surgery may result in perturbations to microbial flora.

CONCLUSIONS: The microbiome of complicated diverticulitis is marked by a localized imbalance of sulfur-metabolizing microbes. The abundance of sulfur-reducing microbes may lead to an excess of hydrogen sulfide and subsequent inflammation.

RevDate: 2023-02-27

Roberson JL, LM Maguire (2023)

Does Alteration of the Microbiome Cause Diverticular Disease?.

Clinics in colon and rectal surgery, 36(2):146-150.

The role of the microbiome in influencing the development and course of human disease is increasingly understood and appreciated. In diverticular disease, the microbiome presents an intriguing potential link between the disease and its long-established risk factors, dietary fiber and industrialization. However, current data have yet to demonstrate a clear link between specific alterations in the microbiome and diverticular disease. The largest study of diverticulosis is negative and studies of diverticulitis are small and heterogeneous. Although multiple disease-specific hurdles exist, the early state of the current research and the many un- or underexplored clinical phenotypes present a significant opportunity for investigators to improve our knowledge of this common and incompletely understood disease.

RevDate: 2023-02-24

Bradshaw E (2023)

Diverticular disease, diverticulitis and the impact on continence.

British journal of nursing (Mark Allen Publishing), 32(4):168-172.

Diverticulosis and the subsequent progression to diverticular disease and diverticulitis is becoming more prevalent in western countries. The cause for this progression is not known. Diverticulitis is a significant health burden - both financially to healthcare systems, and to the patients it affects in terms of morbidity. There is a dearth of research pertaining to diverticulitis and its impact on continence. This article examines the parallels between irritable bowel syndrome and diverticular disease, which have many symptom similarities, the overlap between the conditions, and the impact on continence. Current studies regarding the role of fibre in managing diverticular disease are also discussed.

RevDate: 2023-02-24

Ibrahim AHM, Amer N, Alatooq HH, et al (2023)

Jejunal diverticulosis: A case report.

INTRODUCTION: Jejunal diverticulosis is a rare entity that presents a challenging diagnosis due to its vague and non-specific clinical presentations. 40 % of the patients remain asymptomatic until the development of complications.

CASE PRESENTATION: We report a case of 84 years old female who presented to the hospital with vomiting and abdominal pain, found to have jejunal diverticulosis complicated by perforation in a CT scan. The patient underwent emergency expletory laparotomy with segmental intestinal resection and anastomosis.

DISCUSSION: The incidence of jejunal diverticulosis ranges between 3 and 5 %, with most patients discovered incidentally. Therefore, medical or surgical treatment management depends on clinical presentation and complications that necessitate surgical intervention.

CONCLUSION: Jejunal diverticulosis is a rare entity that commonly affects the elderly with significant morbidity and mortality; it is an important clinical entity to consider when approaching patients with acute abdomen.

RevDate: 2023-02-23

Dufera RR, Tolu-Akinnawo O, BJ Maliakkal (2023)

Colovesical Fistula Complicating the First Symptomatic Episode of Acute Diverticulitis in a Young Adult.

Cureus, 15(2):e35082.

Colovesical fistula is one of the known complications of acute diverticulitis. However, it is uncommon for a patient to present with a colovesical fistula without prior episodes of diverticulitis. In this case, we report a patient with acute diverticulitis presenting with a colovesical fistula with no antecedent history of any medical condition. The patient was treated with intravenous antibiotics and subsequently had a temporary laparoscopic colostomy. Although colovesical fistula caused by diverticular disease was once considered a relative contraindication to laparoscopic resection, this method is now being increasingly employed by experienced surgeons. Compared with laparoscopic colon resection surgery for uncomplicated diverticulitis, the minimally invasive treatment of colovesical fistula requires a longer operative time and advanced surgical skills.

RevDate: 2023-02-17

Chen J, Yuan S, Fu T, et al (2023)

Gastrointestinal Consequences of Type 2 Diabetes Mellitus and Impaired Glycemic Homeostasis: A Mendelian Randomization Study.

Diabetes care pii:148458 [Epub ahead of print].

OBJECTIVE: We conducted a Mendelian randomization (MR) study to examine the associations of type 2 diabetes and glycemic traits with gastrointestinal diseases (GDs).

RESEARCH DESIGN AND METHODS: Uncorrelated genetic variants associated with type 2 diabetes (n = 231), fasting insulin (n = 38), fasting glucose (n = 71), and hemoglobin A1c (n = 75) at the genome-wide significance were selected as instrument variables. Genetic associations with 23 common GDs were obtained from the FinnGen and UK Biobank studies and other large consortia.

RESULTS: Genetic liability to type 2 diabetes was associated with the risk of 12 GDs. Per 1-unit increase in the log-transformed odds ratio (OR) of type 2 diabetes, the OR was 1.06 (95% CI, 1.03-1.09) for gastroesophageal reflux disease, 1.12 (95% CI, 1.07-1.17) for gastric ulcer, 1.11 (95% CI, 1.03-1.20) for acute gastritis, 1.07 (95% CI, 1.01-1.13) for chronic gastritis, 1.08 (95% CI, 1.03-1.12) for irritable bowel syndrome, 1.04 (95% CI, 1.01-1.07) for diverticular disease, 1.08 (95% CI, 1.02-1.14) for acute pancreatitis, 1.09 (95% CI, 1.05-1.12) for cholelithiasis, 1.09 (95% CI, 1.05-1.13) for cholelithiasis with cholecystitis, 1.29 (95% CI, 1.17-1.43) for nonalcoholic fatty liver disease, 1.12 (95% CI, 1.03-1.21) for liver cirrhosis, and 0.93 (95% CI, 0.89-0.97) for ulcerative colitis. Genetically predicted higher levels of fasting insulin and glucose were associated with six and one GDs, respectively.

CONCLUSIONS: Associations were found between genetic liability to type 2 diabetes and an increased risk of a broad range of GDs, highlighting the importance of GD prevention in patients with type 2 diabetes.

RevDate: 2023-02-16

Watts EL, Saint-Maurice PF, Doherty A, et al (2023)

Association of Accelerometer-Measured Physical Activity Level With Risks of Hospitalization for 25 Common Health Conditions in UK Adults.

JAMA network open, 6(2):e2256186 pii:2801494.

IMPORTANCE: Higher physical activity levels are associated with lower risks of cancer, cardiovascular disease, and diabetes, but associations with many common and less severe health conditions are not known. These conditions impose large health care burdens and reduce quality of life.

OBJECTIVES: To investigate the association between accelerometer-measured physical activity and the subsequent risk of hospitalization for 25 common reasons for hospitalization and to estimate the proportion of these hospitalizations that might have been prevented if participants had higher levels of physical activity.

This prospective cohort study used data from a subset of 81 717 UK Biobank participants aged 42 to 78 years. Participants wore an accelerometer for 1 week (between June 1, 2013, and December 23, 2015) and were followed up over a median (IQR) of 6.8 (6.2-7.3) years; follow-up for the current study ended in 2021 (exact date varied by location).

EXPOSURES: Mean total and intensity-specific accelerometer-measured physical activity.

MAIN OUTCOMES AND MEASURES: Hospitalization for the most common health conditions. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95% CIs for mean accelerometer-measured physical activity (per 1-SD increment) and risks of hospitalization for 25 conditions. Population-attributable risks were used to estimate the proportion of hospitalizations for each condition that might be prevented if participants increased their moderate to vigorous physical activity (MVPA) by 20 minutes per day.

RESULTS: Among 81 717 participants, the mean (SD) age at accelerometer assessment was 61.5 (7.9) years; 56.4% were female, and 97.0% self-identified as White. Higher levels of accelerometer-measured physical activity were associated with lower risks of hospitalization for 9 conditions: gallbladder disease (HR per 1 SD, 0.74; 95% CI, 0.69-0.79), urinary tract infections (HR per 1 SD, 0.76; 95% CI, 0.69-0.84), diabetes (HR per 1 SD, 0.79; 95% CI, 0.74-0.84), venous thromboembolism (HR per 1 SD, 0.82; 95% CI, 0.75-0.90), pneumonia (HR per 1 SD, 0.83; 95% CI, 0.77-0.89), ischemic stroke (HR per 1 SD, 0.85; 95% CI, 0.76-0.95), iron deficiency anemia (HR per 1 SD, 0.91; 95% CI, 0.84-0.98), diverticular disease (HR per 1 SD, 0.94; 95% CI, 0.90-0.99), and colon polyps (HR per 1 SD, 0.96; 95% CI, 0.94-0.99). Positive associations were observed between overall physical activity and carpal tunnel syndrome (HR per 1 SD, 1.28; 95% CI, 1.18-1.40), osteoarthritis (HR per 1 SD, 1.15; 95% CI, 1.10-1.19), and inguinal hernia (HR per 1 SD, 1.13; 95% CI, 1.07-1.19), which were primarily induced by light physical activity. Increasing MVPA by 20 minutes per day was associated with reductions in hospitalization ranging from 3.8% (95% CI, 1.8%-5.7%) for colon polyps to 23.0% (95% CI, 17.1%-28.9%) for diabetes.

CONCLUSIONS AND RELEVANCE: In this cohort study of UK Biobank participants, those with higher physical activity levels had lower risks of hospitalization across a broad range of health conditions. These findings suggest that aiming to increase MVPA by 20 minutes per day may be a useful nonpharmaceutical intervention to reduce health care burdens and improve quality of life.

RevDate: 2023-02-16

Varghese C, Wu Z, Bissett IP, et al (2023)

Seasonal variations in acute diverticular disease hospitalisations in New Zealand.

International journal of colorectal disease, 38(1):46.

PURPOSE: Seasonal variation of acute diverticular disease is variably reported in observational studies. This study aimed to describe seasonal variation of acute diverticular disease hospital admissions in New Zealand.

METHODS: A time series analysis of national diverticular disease hospitalisations from 2000 to 2015 was conducted among adults aged 30 years or over. Monthly counts of acute hospitalisations' primary diagnosis of diverticular disease were decomposed using Census X-11 times series methods. A combined test for the presence of identifiable seasonality was used to determine if overall seasonality was present; thereafter, annual seasonal amplitude was calculated. The mean seasonal amplitude of demographic groups was compared by analysis of variance.

RESULTS: Over the 16-year period, 35,582 hospital admissions with acute diverticular disease were included. Seasonality in monthly acute diverticular disease admissions was identified. The mean monthly seasonal component of acute diverticular disease admissions peaked in early-autumn (March) and troughed in early-spring (September). The mean annual seasonal amplitude was 23%, suggesting on average 23% higher acute diverticular disease hospitalisations during early-autumn (March) than in early-spring (September). The results were similar in sensitivity analyses that employed different definitions of diverticular disease. Seasonal variation was less pronounced in patients aged over 80 (p = 0.002). Seasonal variation was significantly greater among Māori than Europeans (p < 0.001) and in more southern regions (p < 0.001). However, seasonal variations were not significantly different by gender.

CONCLUSIONS: Acute diverticular disease admissions in New Zealand exhibit seasonal variation with a peak in Autumn (March) and a trough in Spring (September). Significant seasonal variations are associated with ethnicity, age, and region, but not with gender.

RevDate: 2023-02-12

Cameron R, Duncanson K, Hoedt EC, et al (2023)

Does the microbiome play a role in the pathogenesis of colonic diverticular disease? A systematic review.

Journal of gastroenterology and hepatology [Epub ahead of print].

BACKGROUND AND AIMS: The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology.

METHODS: Seven databases were searched for relevant studies published up to September 28[th] , 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies.

RESULTS: Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared to controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome.

CONCLUSION: Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.

RevDate: 2023-02-11

Zhang Y, Zhang H, Zhu J, et al (2023)

Association between diverticular disease and colorectal cancer: a bidirectional mendelian randomization study.

BMC cancer, 23(1):137.

BACKGROUND: Diverticular disease has been inconsistently associated with colorectal cancer risk. We conducted a bidirectional Mendelian randomization study to assess this association.

METHODS: Forty-three and seventy single-nucleotide polymorphisms associated with diverticular disease and colorectal cancer at the genome-wide significance level (p < 5 × 10[- 8]) were selected as instrumental variables from large-scale genome-wide association studies of European descent, respectively. Summary-level data for colon cancer, rectum cancer, and colorectal cancer were obtained from genome-wide association analyses of the FinnGen consortium and the UK Biobank study. Summary-level data for diverticular disease was derived from a genome-wide association study conducted in the UK Biobank population. The random effect inverse-variance weighted Mendelian randomization approach was used as the primary method and MR-Egger, weighted-median, and MR-PRESSO approaches were conducted as sensitivity analyses.

RESULTS: Genetically determined diverticular disease was associated with a higher risk of colorectal cancer (beta = 0.441, 95%CI: 0.081-0.801, P = 0.016) in the FinnGen population, but the association was not found in the UK Biobank (beta = 0.208, 95%CI: -0.291,0.532, P = 0.207). The positive association remained consistent direction in the three sensitivity analyses. In the stratified analysis in the FinnGen consortium, an association was found to exist between genetically predicted diverticular disease and colon cancer (beta = 0.489, 95%CI: 0.020-0.959, P = 0.041), rather than rectum cancer (beta = 0.328, 95%CI: -0.119-0.775, P = 0.151). Besides, we found a slight association between colorectal cancer and diverticular disease (beta = 0.007, 95%CI: 0.004-0.010, P < 0.001) when using colorectal cancer as exposome and diverticular disease as outcome. However, there is a large sample overlap in this step of analysis.

CONCLUSION: This Mendelian randomization study suggests that diverticular disease may be a possible risk factor for colorectal cancer and colon cancer rather than rectum cancer in the FinnGen population.

RevDate: 2023-02-06

Fialho A, Fialho A, A Shuja (2023)

Analysis of the Epidemiological Trends on Inpatient Diverticulosis Admissions in the US: A Longitudinal Analysis From 1997-2018.

Cureus, 15(2):e34493.

Background Diverticulosis of the colon is characterized by outpouchings of mucosa and serosa through the muscular layer of the large intestinal wall. It is classically associated with increasing age with older individuals having a higher prevalence and greater density of diverticula secondary to its progressive disease nature. Also, diverticular disease is associated with dietary habits, low fiber intake in western society as well as obesity. The aim of this study was to investigate the epidemiological trends associated with diverticular disease in the United States in a 21-year interval from 1997 to 2018. Methods Using the Nationwide Inpatient Sample, all hospitalizations between 1997 and 2018 were analyzed. We examined annual data for hospitalization rate, the average length of stay (LOS), mean age and interval age groups, and hospital charges for inpatient admissions for diverticular disease (diverticulitis and diverticulosis). Results Between 1997 and 2018, the number of hospitalizations for patients with a primary discharge diagnosis of diverticular disease (diverticulosis and diverticulitis) increased 32% from 220,896 to 293,530 with 89.7 discharges per 100,000 persons in 2018 versus 81.0 discharges per 100,000 persons in 1997. Overall, the average age of patients decreased from 67.55 ± 0.15 years in 1997 to 64.59 ±0.08 in 2018, [t-value (t) 12.56, degrees of freedom (df) 514424, 95% confidence interval (CI) 2.497-3.423, P<0.0001]. On further evaluation, the mean average age in males decreased from 63.16±0.21 years in 1997 to 61.31±0.12 years in 2018, (t 8.16, df 217981, 95% CI 1.404-2.295 P<0.0001), while in females it decreased from 70.53±0.14 years to 67.15±0.10 years, (t 20.13, df 296422, 95% CI 3.050-3.709 P<0.0001), in the same interval time. While evaluating different subgroups of age in this time interval, the prevalence rate of diverticular disease diagnosis per 100,000 persons increased in the interval age between 18-44 years from 20.1 to 29.8, [relative risk (RR) 0.848, CI 95% 0.834-0.863, P< 0.0001) and 45-64 years from 107.1 to 125.3, (RR 0.761, CI 95% 0.754-0.769 P<0.0001) while it decreased in the interval age between 65-84 years from 357.6 to 259.7, (RR 1.211, CI 95% 1.206-1.226, P<0.0001) as well as > 85 years from 746.2 to 523.6, (RR 1.130, CI 95% 1.112-1.147, P<0.0001) The length of stay (LOS) mean average in days decreased from 5.8 ± 0.04 days in 1997 to 4.4±0.021 days in 2018, (t 33.08 df 514424, 95%CI 1.316-1.483, P< 0.0001). Hospital Inpatient National Statistics data over hospital mean charges, available from the period between 1997 to 2015, shows that the mean hospital charges in US dollars increased over 100%, from $19,735.17 in 1997 to $39,575 in 2015 (P<0.001) even after adjusting values to 2015 inflation. Conclusion There is an overall trend of decreased mean age of patients admitted with diverticular disease in the US over the past 21 years with a respective significant increased rate of disease in younger age groups. We postulate that these changes may be associated with poor dietary habits and obesity epidemics worsened in the last two decades in the US. In addition, despite the decreased length of stay over the same time period, the mean hospital charges more than double likely reflecting the increased access to expensive diagnostic methods such as computed tomography and colonoscopies.

RevDate: 2023-02-02

Yuan S, Chen J, Ruan X, et al (2023)

Smoking, Alcohol consumption, and 24 Gastrointestinal Diseases: Mendelian Randomization Analysis.

eLife, 12: pii:84051 [Epub ahead of print].

Background: Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization (MR) to comprehensively examine associations of smoking and alcohol consumption with common gastrointestinal diseases. Methods: Genetic variants associated with smoking initiation and alcohol consumption at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank, FinnGen study, and other large consortia. Univariable and multivariable MR analyses were conducted to estimate the overall and independent MR associations after mutual adjustment for genetic liability to smoking and alcohol consumption. Results: Genetic predisposition to smoking initiation was associated with increased risk of 20 of 24 gastrointestinal diseases, including 7 upper gastrointestinal diseases (gastroesophageal reflux, esophageal cancer, gastric ulcer, duodenal ulcer, acute gastritis, chronic gastritis and gastric cancer), 4 lower gastrointestinal diseases (irritable bowel syndrome, diverticular disease, Crohn's disease and ulcerative colitis), 8 hepatobiliary and pancreatic diseases (non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis, liver cancer, cholecystitis, cholelithiasis, acute and chronic pancreatitis), and acute appendicitis. Fifteen out of 21 associations persisted after adjusting for genetically-predicted alcohol consumption. Genetically-predicted higher alcohol consumption was associated with increased risk of duodenal cancer, alcoholic liver disease, cirrhosis, and chronic pancreatitis; however, the association for duodenal ulcer did not remain after adjustment for genetic predisposition to smoking initiation. Conclusion: This study provides MR evidence supporting causal associations of smoking with a broad range of gastrointestinal diseases, whereas alcohol consumption was associated with only a few gastrointestinal diseases. Funding: The Natural Science Fund for Distinguished Young Scholars of Zhejiang Province; National Natural Science Foundation of China; Key Project of Research and Development Plan of Hunan Province; the Swedish Heart Lung Foundation; the Swedish Research Council; the Swedish Cancer Society.

RevDate: 2023-01-25

Laursen ASD, Jensen BW, Strate LL, et al (2023)

Birth weight, childhood body mass index, and risk of diverticular disease in adulthood.

International journal of obesity (2005) [Epub ahead of print].

OBJECTIVE: Adult overweight is associated with increased risk of diverticular disease (DD). We investigated associations between birthweight and childhood body mass index (BMI) and DD.

METHODS: Cohort study of 346,586 persons born during 1930-1996 with records in the Copenhagen School Health Records Register. Data included birthweight, and height and weight from ages 7 through 13. We used Cox proportional hazard regression to examine associations between birthweight and BMI z-scores and DD registered in the Danish National Patient Registry. Due to non-proportionality, we followed participants from age 18-49 and from age 50.

RESULTS: During follow-up, 5459 (3.2%) women and 4429 (2.5%) men had DD. For low and high BMI in childhood, we observed a higher risk of DD before age 50. Among women with z-scores <0 at age 13, the hazard ratio (HR) was 1.16 [95% confidence interval (CI): 0.98-1.39] per one-point lower z-score. For z-scores ≥0 at age 13, the HR was 1.30 (95% CI: 1.11-1.51) per one-point higher z-score. Among men with z-scores <0 at age 13, the HR was 1.02 (95% CI: 0.85-1.22). For z-scores ≥0 at age 13, the HR was 1.54 (95% CI: 1.34-1.78). Z-scores ≥0 were not associated with DD after age 50. Among women only, birthweight was inversely associated with DD before age 50 [HR = 0.90 (95% CI: 0.83-0.99) per 500 g higher birthweight].

CONCLUSION: BMI z-scores below and above zero in childhood were associated with higher risk of DD before age 50. In addition, we observed lower risk of DD among women, the higher their birthweight.

RevDate: 2023-01-24

Zhu Z, Chen X, Wang C, et al (2023)

Haemorrhoidal disease reduces the risk of diverticular disease and irritable bowel syndrome: a Mendelian randomisation study.

RevDate: 2023-01-20

Tursi A, Mastromarino P, Capobianco D, et al (2023)

Faecalibacterium prausnitzii is not decreased in symptomatic uncomplicated diverticular disease of the colon.

Bioscience of microbiota, food and health, 42(1):1-2.

In this letter, assessment of the amount of fecal Faecalibacterium prausnitzii in symptomatic uncomplicated diverticular disease (SUDD) is described. Among 44 consecutive patients, comprising 15 SUDD patients, 13 patients with asymptomatic diverticulosis (AD), and 16 healthy controls (HC), the fecal amount of Faecalibacterium prausnitzii was not found to be significantly different between HC, AD and SUDD subjects (p=0.871). Moreover, its count in the HC microbiota (-4.57 ± 2.15) was lower compared with those in the AD (-4.11 ± 1.03) and SUDD subjects (-4.03 ± 1.299). This behavior seems to be different from that occurring in inflammatory bowel disease (IBD) and similar to that of other mucin-degrading species in a SUDD setting.

RevDate: 2023-01-20

Teke E, Ciyiltepe H, Bulut NE, et al (2022)

Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient.

Sisli Etfal Hastanesi tip bulteni, 56(4):503-508.

OBJECTIVES: Diverticular disease is a highly frequent condition and affects 50% of the population in the 9th decade in Western society. Acute diverticulitis is the most prevalent complication. The patients who are clinically stable and tolerate fluid should be hospitalized if fluid intake tolerance worsens, fever occurs, or pain increases. Bowel rest, intravenous fluid therapy, and empiric antibiotic therapy are the traditional treatments for patients admitted to the hospital. This retrospective study aimed to determine the parameters that will affect the outpatient or inpatient treatment of patients diagnosed with uncomplicated acute diverticulitis.

METHODS: Patients who presented to the emergency department with abdominal pain between January 2018 and December 2020 and were diagnosed with uncomplicated diverticulitis (modified Hinchey 1a) on computed tomography (CT) taken after intravenous contrast material shoot up were included in the study. Patient records were recorded retrospectively in the Excel file. After being seen in the emergency department, a comparison was performed between the inpatient group (Group 1) and the outpatient follow-up group (Group 2).

RESULTS: The study comprised 172 patients with acute uncomplicated diverticulitis (modified Hinchey 1a). While 110 (64.0%) patients were followed up and treated as inpatients (Group 1), 62 (36.0%) patients were followed up as outpatients (Group 2). There was no statistically significant difference between the two groups in terms of patients readmitted to the hospital in the first 30 days after discharge (both for outpatient follow-up in the emergency department and after treatment in the inpatient group).

CONCLUSION: In this retrospective study, in which we evaluated the hospitalization criteria in uncomplicated Modified Hinchey 1a patients, it was found that patients can be safely treated as an outpatient if they have poor physical examination findings. Although there was no difference between the two groups in terms of hospital readmission after discharge and it was thought that follow-up of patients with Modified Hinchey 1a diverticulitis with outpatient oral antibiotic therapy might be reliable, prospective studies with larger numbers of patients are needed.

RevDate: 2023-01-19

Omar H, Fulaij AA, Felemban J, et al (2023)


Ureteral injury is one of the major complications related to colorectal and gynaecologic procedures. Injuries are sometimes identified intraoperatively, but the diagnosis of ureteral injury is often delayed. Ureterocolic fistula is a relatively rare condition and mostly due to obstructing calculi, diverticular disease of the colon, radiotherapy, cancer, or trauma. Here in, we present a boy with an iatrogenic left ureterocolic fistula following multiple colonic surgeries that were complicated by an un-noticed left ureteric injury. This injury was not diagnosed early and the patient presented later with recurrent UTIs and decreased left differential renal function which necessitated open left nephroureterectomy.

RevDate: 2023-01-19

Kwan B, Gillespie C, A Warwick (2023)

Colonoscopic findings in patients with pelvic floor dysfunction.

ANZ journal of surgery [Epub ahead of print].

BACKGROUNDY: Colonoscopy is often performed in the initial workup of pelvic floor dysfunction, even in the absence of red flag symptoms. Current guidelines suggest colonoscopy is only required in the presence of rectal bleeding, diarrhoea or change in bowel habit. The aim of this study was to evaluate the prevalence of significant pathology found at colonoscopy in patients with pelvic floor dysfunction.

METHODS: Retrospective chart review was performed on all patients presenting to a functional colorectal outpatient clinic between May 2018 and August 2019. Information was collected on presenting symptoms, whether colonoscopy had been performed within 5 years, quality of bowel preparation, withdrawal time, number of polyps detected, histology, presence of diverticular disease, colorectal malignancy, inflammatory bowel disease, solitary rectal ulcer or rectal prolapse.

RESULTS: There were 260 patients seen within the study period, of which 67% had undergone recent colonoscopy within the last 5 years. The mean age was 53 and 219 (84%) patients were female. Average withdrawal time was 13 min. Polyps were found in 48.7% and adenomas in 32.4% of all colonoscopies. The adenoma detection rate was 32.7%. None of the colonoscopies found evidence of malignancy. A new diagnosis of inflammatory bowel disease was discovered in two patients.

CONCLUSION: There was low rates of serious pathology such as malignancy or inflammatory bowel disease in patients referred to a functional clinic. However, colonoscopy is still useful in workup of pelvic floor dysfunction, as many patients have erratic bowel habits or vague symptoms, and will have adenomas found.

RevDate: 2023-01-16

Abdalla TSA, Zimmermann M, Weisheit L, et al (2023)

Long-term functional outcome after tubular laparoscopic sigmoid resection for diverticular disease.

International journal of colorectal disease, 38(1):14.

PURPOSE: Sigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease.

METHODS: We retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome.

RESULTS: Two hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21-29) and 35 (15.1%) major LARS (LARS ≥ 30-42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up.

CONCLUSION: Sigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as "sigmoidectomy syndrome."

RevDate: 2023-01-11

Bromley L, Huang D, Mohan H, et al (2023)

Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short-term outcomes.

ANZ journal of surgery [Epub ahead of print].

BACKGROUNDS: Robotic colorectal surgery is a method of performing complex surgery in a minimally invasive manner. In diverticular disease, chronic inflammation obscures tissues planes and increases difficulty of resection. This study aims to assess feasibility and safety of application of a robotic approach to diverticular disease, by reviewing short-term outcomes from a series of diverticular resections.

METHODS: Forty-one patients underwent robotic colorectal surgery for diverticular disease across three centres within Melbourne from June 2016 to June 2022. Demographic, operative, and clinicopathological data were collected. Descriptive statistics were used to evaluate primary and secondary outcomes. Comparative analysis between simple and complex diverticular disease was performed to identify differences in groups regarding short term outcomes. The primary outcome in this study is to determine conversion rate from minimally invasive to open surgery. Secondary outcomes include major complication rates and length of stay.

RESULTS: Of the 41 patients, 24 (58.5%) had simple disease, and 17 (41.5%) had complex disease. One patient (2.4%) required conversion to open resection. The median length of stay for complex disease was 7 days, for simple disease 5 days (P = 0.05). Four surgical Clavien-Dindo III or above complications occurred (9.8%), one patient required return to theatre. There were no anastomotic leaks or collections requiring radiological drainage. Thirteen patients (31.7%) underwent ureteric stenting and intraoperative indocyanine green dye ureteric identification.

CONCLUSION: Robotic diverticular resections in this series are safe and associated with a low conversion rate of 2.4%. Robotic resection of complex disease was feasible with an acceptable safety profile.

RevDate: 2023-01-09

McChesney SL, AT Hawkins (2023)

Anastomotic Considerations in Diverticulitis.

Clinics in colon and rectal surgery, 36(1):57-62.

Diverticulitis is a common indication for colorectal surgery, both in the acute and the elective setting. The anastomosis between the colon and rectum is a critical component of colectomy for diverticular disease and should be approached thoughtfully. This article reviews important surgical considerations when creating a colorectal anastomosis in the setting of diverticular disease, whether following the reversal of an end colostomy, during an acute episode of diverticulitis, or electively for chronic or complicated disease. Timing of surgery and preoperative assessment, minimally invasive approaches, and intraoperative maneuvers and considerations are discussed.

RevDate: 2023-01-02

Hantouli MN, Khor S, Strate LL, et al (2022)

What's in a Number? Assessing the Burden of Diverticular Disease.

Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 3(4):e202.

In this prospective observational cohort of patients with a history of diverticulitis, we assessed the correlation between the diverticulitis quality of life survey (DVQOL) and other patient-reported expressions of disease measures including work and activity impairment, and contentment with gastrointestinal-related health. Then, we assessed whether the DVQOL is better correlated with these measures than diverticulitis episode count. Our study results showed that the DVQOL has a stronger correlation with other disease measures than diverticulitis episode count, and our findings support the broader use of the DVQOL in assessing the burden of diverticulitis and monitoring response to management.

RevDate: 2023-01-02

Sigurdardottir J, Chabok A, Wagner P, et al (2022)

Increased accuracy in diagnosing diverticulitis using predictive clinical factors.

Upsala journal of medical sciences, 127:.

BACKGROUND: The aim of this study was to identify clinical factors leading to increased diagnostic accuracy for acute colonic diverticulitis.

METHODS: Patients with clinical suspicion of acute colonic diverticulitis verified with computed tomography (CT) from two hospitals in Sweden between 9 January 2017 and 31 October 2017 were prospectively included. Symptoms, comorbidities, and laboratory results were documented. Candidate variables were analyzed using logistic regression, and the final variable set that yielded the most accurate predictions was identified using least absolute shrinkage and selection operator regression and evaluated using the area under the receiver operating characteristic (ROC) curve.

RESULTS: In total, 146 patients were included (73% women; median age 68 years; age range, 50-94 years). The clinical diagnostic accuracy was 70.5%. In the multiple logistic regression analysis, gender (female vs male odds ratio [OR]: 4.82; confidence interval [CI], 1.56-14.91), age (OR, 0.92; 95% CI, 0.87-0.98), pain on the lower left side of the abdomen (OR, 15.14; 95% CI, 2.65-86.58), and absence of vomiting (OR, 14.02; 95% CI, 2.90-67.88) were statistically significant and associated with the diagnosis of CT-verified diverticulitis. With seven predictors (age, gender, urinary symptoms, nausea, temperature, C-reactive protein, and pain left lower side), the area under the ROC curve was 0.82, and a formula was developed for calculating a risk score.

CONCLUSION: We present a scoring system using common clinical variables that can be applied to patients with clinical suspicion of colonic diverticulitis to increase the diagnostic accuracy. The developed scoring system is available for free of charge at https://phille-wagner.shinyapps.io/Diverticulitis_risk_model/.

RevDate: 2022-12-23

Rodríguez-Zentner H, Cukier M, Montagne V, et al (2022)

Ureteral identification with indocyanine green in laparoscopic colorectal surgery.

Asian journal of endoscopic surgery [Epub ahead of print].

INTRODUCTION: Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery.

We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital.

RESULTS: We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4 minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration.

DISCUSSION: Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.

RevDate: 2022-12-23

Cardoso D, Rebanda J, C Góis (2022)

Mesh Migration and Bowel Perforation as a Late Complication of Transabdominal Preperitoneal Laparoscopic Hernia Repair.

Cureus, 14(12):e32683.

Minimally invasive surgery is increasingly used in the treatment of inguinal hernias, with two main techniques described: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). In both techniques, a prosthetic mesh is placed in a preperitoneal position. However, in TAPP, the peritoneum flap must be completely closed. The TAPP technique is associated with more intra-abdominal complications. This article describes a case of bowel occlusion due to migration and erosion of a mesh after a TAPP repair in a 57-year-old patient with a history of colonic diverticular disease. The patient complained of abdominal discomfort and constipation, having undergone a colonoscopy and CT scan that demonstrated the presence of a foreign body partially in the lumen of the sigmoid colon. The treatment was surgical, with bowel resection and partial removal of the mesh, complicated by a deep tissue collection. The patient maintained follow-up in a surgery consultation, with no evidence of hernia recurrence. This is a rare complication of the laparoscopic approach in the treatment of inguinal hernia, more frequent in the TAPP technique. It is intended to draw attention to the type of closure of the peritoneum.

RevDate: 2022-12-23

Yarullina D, Pankratova Y, Karaseva O, et al (2022)

Microbiota of the Colonic Diverticula in the Complicated Form of Diverticulitis: A Case Report.

Life (Basel, Switzerland), 12(12):.

Intestinal microbiota appears to be implicated in the pathogenesis of diverticular disease. We present the case of a patient with diverticular colon disease complicated by a pelvic abscess. During the successful surgical treatment, two specimens were taken from the resected colon segment for the microbiota analysis: an inflamed and perforated diverticulum and a diverticulum without signs of inflammation. Culturing and 16S rRNA gene sequencing revealed significant changes in the microbial community structure and composition associated with the acute inflammation and perforation of the colonic diverticulum. The characteristics that are usually associated with the inflammatory process in the gut, namely reduced microbial diversity and richness, decreased Firmicutes-to-Bacteroidetes (F/B) ratio, depletion of butyrate-producing bacteria, and Enterobacteriaceae blooming, were more pronounced in the non-inflamed diverticulum rather than in the adjacent inflamed and perforated one. This is the first study of the intraluminal microbiota of the diverticular pockets, which is more relevant to the etiology of diverticular disease than mucosa-associated microbiota via biopsies and luminal microbiota via fecal samples.

RevDate: 2022-12-22

Zehra S, MK Abbas (2022)

Hartmann's Reversal: A Single-Centre Experience.

Cureus, 14(11):e31654.

A proctosigmoidectomy, commonly called Hartmann's procedure (HP), is the surgical resection of the rectosigmoid colon with the closure of the anorectal stump and creation of an artificial stomal opening (ostomy) on the abdomen (colostomy). It is generally performed with the intention of reversal once the underlying cause is treated. The aim of this study is to assess the predictive factors and intra-operative difficulties that might influence the decision to indicate or contra-indicate stomal reversal after HP. Patients who underwent HP between January 2010 and December 2017 were retrospectively evaluated in a single institution. Preoperative, intraoperative, and postoperative data were analysed for patients who underwent HP for benign as well as malignant conditions. The reversal rate was comparable with the proportion of benign cases, consistent with published evidence that reversal rates for diverticular disease are higher as compared to colorectal cancer. Disease progression/metastasis, advanced age, multiple co-morbidities, and procedure abandonment (frozen pelvis /leak) were the most common contra-indications for reversal.

RevDate: 2022-12-21

Azizian JM, Trieu H, Kovacs TO, et al (2022)

Yield of Post-Acute Diverticulitis Colonoscopy for Ruling Out Colorectal Cancer.

Techniques and innovations in gastrointestinal endoscopy, 24(3):254-261.

BACKGROUND AND AIMS: Colonoscopy is recommended post-acute diverticulitis (AD) to exclude underlying adenocarcinoma (CRC). However, post-AD colonoscopy utility remains controversial. We aimed to examine yield of post-AD colonoscopy in our majority-Hispanic patient population.

METHODS: Patients undergoing post-AD colonoscopy between 11/1/2015-7/31/2021 were identified from a prospectively maintained endoscopic database. AD cases without computed tomography confirmation were excluded. Pertinent data, including complicated vs uncomplicated AD, fecal immunochemical test (FIT) result post-AD/pre-colonoscopy, and number/type/location of non-advanced adenomas, advanced adenomas, and CRC, were abstracted. Analyses were conducted using two-sample Wilcoxon rank-sum and Fisher's exact tests.

RESULTS: 208 patients were included, of whom 62.0% had uncomplicated AD. Median age was 53, 54.3% were female, and 77.4% were Hispanic. Ninety non-advanced adenomas were detected in 45 patients (21.6%), in addition to advanced adenoma in eight patients (3.8%). Two patients (1.0%) had CRC, both of whom had complicated AD in the same location seen on imaging, and one of whom was FIT+ (the other had not undergone FIT). Patients with uncomplicated versus complicated AD had similarly low rates of advanced adenomas (4.7% vs. 2.5%, p=0.713). FIT data were available in 51 patients and positive in three (5.9%); non-advanced adenomas were found in all three FIT+ patients. No FIT- patient had an advanced adenoma or CRC.

CONCLUSION: Colonoscopy post-AD is generally low yield, with CRC being rare and found only in those with complicated AD. Colonoscopy post-complicated AD appears advisable, whereas less invasive testing (e.g. FIT) may be considered post-uncomplicated AD to inform the need for colonoscopy.

RevDate: 2022-12-19

Gelu-Simeon M, Schnee M, Lafrance MJ, et al (2022)

The Characteristics of Diverticular Disease in Caribbean Population: A Control Group Study.

Canadian journal of gastroenterology & hepatology, 2022:8360837.

BACKGROUND: Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity.

METHODS: We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid.

RESULTS: AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC.

CONCLUSION: Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet.

RevDate: 2022-12-19

Wiangphoem N (2022)

Secondary Aorto-Colonic Fistula: A Case Report and Literature Review of a Rare Complication after EVAR.

Case reports in surgery, 2022:8412460.

Background: Aorto-enteric fistula (AEF) is a rare but fatal condition. The incidence of the overall AEF was approximately 0.36-2%, but the incidence of the aorto-colonic fistula was scarcely reported. A history of abdominal pain, fever, or gastrointestinal bleeding (GIB) in a patient with a history of aortic intervention should be highly suspected of this condition. This report describes a patient with lower GIB after an endovascular aneurysm repair (EVAR) for a symptomatic abdominal aortic aneurysm (AAA). Case Presentation: A 65-year-old man with a history of EVAR for symptomatic AAA presented with a massive lower GIB for two weeks. He also had a history of left lower quadrant pain and low-grade fever. Diverticular disease was suspected, and medical treatment was administered. After the initial conservative treatment, a colonoscopy was performed. The findings showed a fistula that exposed an aortic stent graft at the left-sided colon. An aorto-colonic fistula was diagnosed. After administering intravenous (IV) antibiotics, a staged axillo-bifemoral bypass graft with aortic stent graft explantation was performed. The patient recovered well and was discharged home after a month of hospitalization and IV antibiotics. Conclusion: In a patient with a history of aortic intervention, any abdominal pain, unknown fever, or even GIB should be suspected of complications of aortic intervention. Highly suspicious of this rare condition is the key to an early diagnosis and prompt treatment.

RevDate: 2022-12-15

Gross M, Beckenbauer UE, Bruder L, et al (2022)

[Diverticular disease: treatment and management by general practitioners in Germany - high importance of probiotics in primary care].

MMW Fortschritte der Medizin, 164(Suppl 8):16-26.

INTRODUCTION: The symptomatic uncomplicated diverticular disease (SUDD) is often difficult to treat and guidelines only provide few evidence-based treatment options.

METHOD: For the German-wide survey, a questionnaire was sent to 13790 physicians. It contained questions concerning the status of medical care for patients with diverticula and queried their individual option in regards to current treatment options and challenges for the daily medical routine.

RESULTS: In total, 526 questionnaires were sent back for analysis. The biggest challenge for doctors handling patients with chronic diverticular disease (SUDD) is to make the correct diagnosis (17%) and the distinction to the irritable bowel syndrome (22%). Despite the high abundance of SUDD pathology, only 6% of the medical practitioners feel themselves sufficiently informed about it. The support for general practitioners by medical specialists (gastroenterologists) is limited: In the case of a SUDD or a diverticulitis diagnosis, the physicians sometimes receive an acute therapy plan (27%), but rarely get recommendations for diverticulitis pre- and post-care (11% and 18%), or assisting information for patient education (4%). For primary prophylaxis for persons with asymptomatic diverticula, practitioners give nutrition (41%) and life style (37%) recommendations, as well as probiotics (18%). After an acute diverticulitis, 42% recommend life style and nutrition modifications and 26% the intake of probiotics. For the treatment of SUDD symptoms, they advise mostly life style and nutrition modifications (45%) and probiotics (30%). About 60% of the doctors are satisfied with the efficacy of probiotics. Another 15% stated that they have not yet used them to treat SUDD. The main reasons for it seem to be the lack of reimbursability for probiotics (31%), the poor adherence of patients to therapy (20%) due to the slow onset of positive effects, and the difficulty of finding an evidence-based probiotic (16%).

CONCLUSION: In the daily medical routine the correct diagnosing of SUDD is a major challenge and supporting information by medical specialist is scarce. Physicians frequently choose life style and nutrition recommendations and the use of probiotics as treatment options. The majority of the general practitioners is thereby satisfied with the efficacy of probiotics for patients with chronic diverticular disease, even though the choice of an evidence-based probiotic is an obstacle.

RevDate: 2022-12-11

Tursi A, Papa V, Lopetuso LR, et al (2022)

Microbiota Composition in Diverticular Disease: Implications for Therapy.

International journal of molecular sciences, 23(23): pii:ijms232314799.

Gut microbiota (GM) composition and its imbalance are crucial in the pathogenesis of several diseases, mainly those affecting the gastrointestinal tract. Colon diverticulosis and its clinical manifestations (diverticular disease, DD) are among the most common digestive disorders in developed countries. In recent literature, the role of GM imbalance in the onset of the different manifestations within the clinical spectrum of DD has been highlighted. This narrative review aims to summarize and critically analyze the current knowledge on GM dysbiosis in diverticulosis and DD by comparing the available data with those found in inflammatory bowel disease (IBD). The rationale for using probiotics to rebalance dysbiosis in DD is also discussed.

RevDate: 2022-12-06

Gussago S, Poroli Bastone C, Celio D, et al (2022)

Metronidazole and Peripheral Neuropathy: A Report of Two Cases of (Unusual) Side Effects.

Cureus, 14(10):e30889.

Metronidazole is an antibiotic commonly prescribed for anaerobic and protozoan infections. Despite its good safety profile, this drug frequently causes a series of well-known side effects (nausea and intestinal transit disorders, dysgeusia, headaches, and alcohol intolerance). However, there are few data in the literature, mainly case reports and case series, about the onset of peripheral neuropathy with a generally self-limiting course after drug withdrawal. Thus, we herein describe two cases of peripheral neuropathy due to treatment with metronidazole. A 69-year-old woman treated with a total of 55 g of metronidazole for diverticular disease and a 52-year-old male patient on a long course of antibiotic therapy for hepatic abscesses (a cumulative dose of 168 g) developed peripheral neuropathy. The suspicion of metronidazole side effects was raised after the exclusion of other causes. After the suspension of the drug, different degrees of improvement were observed. Metronidazole is an effective antibiotic for treating infections caused by anaerobic or protozoan pathogens, and it has a good pharmacological and economic safety profile. However, in the existing literature, prolonged therapy regimens (>4 weeks of treatment and/or 42 g cumulative dose) may increase the risk of developing neurological complications, in particular peripheral polyneuropathy.

RevDate: 2022-12-02

Kruis W, Germer CT, Böhm S, et al (2022)

German guideline diverticular disease/diverticulitis: Part II: Conservative, interventional and surgical management.

United European gastroenterology journal [Epub ahead of print].

Diverticulosis and diverticular disease are ranked among the most common gastroenterological diseases and conditions. While for many years diverticulitis was found to be mainly an event occurring in the elder population, more recent work in epidemiology demonstrates increasing frequency in younger subjects. In addition, there is a noticeable trend towards more complicated disease. This may explain the significant increase in hospitalisations observed in recent years. It is not a surprise that the number of scientific studies addressing the clinical and socioeconomic consequences in the field is increasing. As a result, diagnosis and conservative as well as surgical management have changed in recent years. Diverticulosis, diverticular disease and diverticulitis are a complex entity and apparently an interdisciplinary challenge. To meet theses considerations the German Societies for Gastroenterology and Visceral Surgery decided to create joint guidelines addressing all aspects in a truely interdisciplinary fashion. The aim of the guideline is to summarise and to evaluate the current state of knowledge on diverticulosis and diverticular disease and to develop statements as well as recommendations to all physicians involved in the management of patients with diverticular disease.

RevDate: 2022-11-30

Chinelli J, Ximenez V, Brandolino S, et al (2022)

Laparoscopic repair of a colovesical fistula secondary to diverticular disease (Video vignette).

RevDate: 2022-12-02

Brotherton T, Al-Taee AM, Carpenter D, et al (2022)

Metastatic Hepatocellular Carcinoma Masquerading as Acute Diverticulitis.

ACG case reports journal, 9(11):e00913.

Colorectal cancer may masquerade as acute diverticulitis. Our case is a 71-year-old man who presented to the emergency department with abdominal pain and was diagnosed with acute diverticulitis. He was ultimately found to have metastatic hepatocellular carcinoma to the colon without any evidence of diverticular disease on colonoscopy. Although the most common malignancy to masquerade as diverticulitis is colorectal cancer, metastatic deposits should also be considered, especially in patients with a history of extracolonic malignancy.

RevDate: 2022-12-02

Lesi OK, Probert S, Iqbal MR, et al (2022)

Diverticulitis and Diverticulosis of the Appendix: A Case Series.

Cureus, 14(10):e30786.

Introduction Diverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung's disease, cystic fibrosis and adult age, where some reports claim that they are also associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitis and one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methods A total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied. The demographic details and clinical data including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. Results The study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptoms were right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. Conclusion Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula - this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.

RevDate: 2022-11-29

Zuin M, Portale G, Mazzeo A, et al (2022)

Laparoscopic Welti's Maneuver: A Single-Center Experience.

Journal of laparoendoscopic & advanced surgical techniques. Part A [Epub ahead of print].

Purpose: Left hemicolectomy is the standard surgical operation for a variety of colonic diseases, both benign and malignant. When colonic resection is extended, relocation of the small bowel loops can be difficult. Several techniques have been described to reposition the small intestine. Welti's technique consists in the passage of the entire small bowel to the left side of the abdomen, below the descending colon that is positioned on the right side. Methods: We retrospectively evaluated 23 patients who underwent extended left hemicolectomy and reconstruction according to the Welti's technique at our hospital. We assessed the recovery of intestinal function and the length of hospital stay; in the mid-term follow-up we searched for episodes of acute or chronic intestinal obstruction. Results: Median operative time was 215 minutes; median resumption of gas and stool emission were, respectively, 3 days (interquartile range [IQR]: 2-6) and 4 days (IQR: 2-9) after surgery. Median hospital stay was 8 (IQR: 5-37) day. After a median follow-up of 15 months (IQR: 3-132) we did not observe any episode of acute or chronic bowel obstruction. Conclusions: Welti's technique is safe and does not cause a delay in resumption of bowel functions or a delayed hospital discharge; it is a useful technique that the colorectal surgeon can use when needed.

RevDate: 2022-11-29

Kechagias KS, Katsikas-Triantafyllidis K, Geropoulos G, et al (2022)

Diverticulitis during pregnancy: A review of the reported cases.

Frontiers in medicine, 9:942666.

BACKGROUND: Diverticular disease of the colon represents a common clinical condition in the western world. Its prevalence increases with age and only 5% of cases occur in adults younger than 40 years of age, making it a rare condition during pregnancy. The aim of this review was to provide an overview of the reported cases of diverticulitis during pregnancy.

METHODS: We conducted a systematic review of the literature based on preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. We searched three different electronic databases namely PubMed, Scopus and Web of Science from inception to December 2021. Literature search and data extraction were completed in duplicates.

RESULTS: The initial search yielded 564 articles from which 12 were finally included in our review. Ten articles were case reports and two were observational studies. The mean age of the cases was 34 years. The presenting complain was provided for 11 cases. The majority of the patients (10/11, 91%) presented with abdominal pain located mainly on the left (6/11, 55%) or right (4/11, 36%) iliac fossa. The most common diagnostic modality used for the diagnosis of the condition was ultrasonography in nine cases (9/12, 75%) followed by magnetic resonance imaging (MRI) in two cases (2/12, 17%). In spite of clinical and radiological evaluation, the initial diagnosis was inaccurate in seven cases (7/12, 58%). The therapeutic approach was available for 11 cases and it was based on the administration of intravenous antibiotics in six cases (6/11, 55%) and surgical management in five cases (5/11, 45%). Data for the type of delivery was provided in nine studies with five patients (5/9, 56%) delivering vaginally and four patients (4/9, 44%) delivering with cesarean section.

CONCLUSION: As advanced maternal age becomes more common, the frequency of diverticulitis in pregnancy may increase. Although available guidelines do not exist, the clinical awareness, early recognition of the disorder, using diagnostic modalities such as ultrasound and MRI, and rapid therapeutic approach with antibiotics, may improve maternal and neonatal outcomes.

RevDate: 2022-11-29
CmpDate: 2022-11-29

Hassan S, P Singh (2022)

Right-sided colopleural fistula secondary to diverticular disease: a case report.

Journal of medical case reports, 16(1):442.

BACKGROUND: Colopleural fistulas are mostly left-sided and related to trauma, Crohn's disease, or gastrointestinal malignancy. However, a diverticular fistula between the colon and right pleural space has not been reported and is rare considering the liver forms a natural anatomical barrier on this side. Colopleural fistulas often present with respiratory symptoms ranging from mild cough and dyspnea to sepsis from empyema caused by the leakage of gastrointestinal content into the pleural space. Although colopleural fistulas are rare, maintaining low suspicion is pivotal for timely investigation and appropriate surgical planning, particularly in the context of previous intra-abdominal infections or trauma.

CASE PRESENTATION: A 67-year-old Chinese male presenting with prolonged respiratory symptoms was found to have a right-sided colopleural fistula confirmed by computed tomography imaging and a colonoscopy. It was addressed surgically after multidisciplinary consensus was reached, with a right hemicolectomy and repair of the diaphragmatic defect. The patient recovered remarkably well with resolution of respiratory symptoms.

CONCLUSION: Appropriate work-up of a suspected colopleural fistula with radiological and endoscopic investigations to determine anatomy and etiology is crucial. Most cases will require surgical management, and involvement of the respiratory and cardiothoracic teams is important to optimize lung function preoperatively and plan for possible chest complications.

RevDate: 2022-11-22

Kruis W, Germer CT, Böhm S, et al (2022)

German guideline diverticular disease/diverticulitis: Part I: Methods, pathogenesis, epidemiology, clinical characteristics (definitions), natural course, diagnosis and classification.

United European gastroenterology journal [Epub ahead of print].

Diverticulosis and diverticular disease are ranked among the most common gastroenterological diseases and conditions. While for many years diverticulitis was found to be mainly an event occurring in the elder population, more recent work in epidemiology demonstrates increasing frequency in younger subjects. In addition, there is a noticeable trend towards more complicated disease. This may explain the significant increase in hospitalisations observed in recent years. It is not a surprise that the number of scientific studies addressing the clinical and socioeconomic consequences in the field is increasing. As a result, diagnosis and conservative as well as surgical management have changed in recent years. Diverticulosis, diverticular disease and diverticulitis are a complex entity and apparently an interdisciplinary challenge. To meet theses considerations the German Societies for Gastroenterology and Visceral Surgery decided to create joint guidelines addressing all aspects in a truely interdisciplinary fashion. The aim of the guideline is to summarise and to evaluate the current state of knowledge on diverticulosis and diverticular disease and to develop statements as well as recommendations to all physicians involved in the management of patients with diverticular disease.

RevDate: 2022-11-19

Than JK, GS Cohen (2022)

Colovesical Fistula: An Uncommon Cause of Hematuria and Rectal Bleeding.

Case reports in gastrointestinal medicine, 2022:1419250.

Colovesical fistula is an infrequent complication of diverticular disease that presents with pneumaturia, fecaluria, dysuria and, rarely, hematuria or hematochezia. Here we present a case of concurrent hematuria and rectal bleeding arising from a diverticular bleed traversing a previously undiagnosed colovesical fistula. Other causes of colovesical fistula include Crohn's disease, radiation, and malignancy, though it is most commonly caused by complicated diverticulitis as in this case. Computed tomography (CT) imaging, cystoscopy, and gastrograffin enema have been described as high-yield diagnostic tests. Interestingly, colonoscopy is only successful in diagnosing colovesical fistula in approximately 55% of cases. Management often requires surgical intervention, as in this case, given limited success with conservative management. Colovesical fistula should be considered in patients presenting with fecaluria, pneumaturia, and dysuria as well as in cases of hematuria.

RevDate: 2022-11-30
CmpDate: 2022-11-30

Boullier M, Fohlen A, Viennot S, et al (2022)

How to manage lower gastrointestinal bleeding in 2022?.

Journal of visceral surgery, 159(6):486-496.

Lower gastrointestinal bleeding (LGIB), originating mainly in the colon, rectum and anus, occurs most often in older patients (7th decade) with co-morbidity, half of whom have coagulation abnormalities due to anti-coagulant or anti-aggregant therapy. In three cases out of four, bleeding regresses spontaneously but can recur in up to one third of patients. The main causes are diverticular disease, vascular disorders (hemorrhoids, angiodysplasia) and colitis. Ten to 15% of patients present in hypovolemic shock. The main problem is to determine the precise location and etiology of bleeding. First-line steps include correction of hemodynamics, correction of coagulation disorders and transfusion, as necessary. Rectal digital examination allows differentiation between melena and hematochezia. In patients with severe LGIB, upper endoscopy can eliminate upper gastro-intestinal bleeding (UGIB). Computerized tomography (CT) angiography can pinpoint the source. If contrast material extravasates, the therapeutic strategy depends on the cause of bleeding and the general status of the patient: therapeutic colonoscopy, arterial embolization and/or surgery. In the absence of severity criteria (Oakland score≤10), ambulatory colonoscopy should be performed within 14 days. Discontinuation of anticoagulant and/or antiplatet therapy should be discussed case by case according to the original indications.

RevDate: 2022-11-16
CmpDate: 2022-11-16

Vergara-Fernandez O, Morales-Cruz M, Armillas-Canseco F, et al (2022)

Hartmann's procedure versus primary anastomosis for Hinchey stage III diverticulitis: a prospective case-control study.

Revista de gastroenterologia de Mexico (English), 87(4):509-512.

INTRODUCTION: Hartmann's procedure (HP) is the conventional treatment in patients with complicated diverticulitis. Segmental resection with primary anastomosis (PA) is a treatment alternative for those patients. Our aim was to compare the postoperative results of HP and PA in patients with complicated diverticulitis (Hinchey stage III).

METHODS: A case-control study was conducted on patients operated on for purulent Hinchey stage III diverticulitis, within the time frame of 2000 and 2019.

RESULTS: Twenty-seven patients that underwent PA were compared with 27 that underwent HP. The patients that underwent HP had a greater probability of morbidity at 30 days (OR 3.5; 95% CI 1.13-11.25), as well as a greater probability of major complications (OR 10.9; 95% CI 1.26-95.05).

CONCLUSION: The patients that underwent segmental resection and PA presented with lower morbidity rates and higher stoma reversal rates than the patients that underwent HP.

RevDate: 2022-11-09

Frieder JS, Montorfano L, De Stefano F, et al (2022)

A National Inpatient Sample Analysis of Racial Disparities After Segmental Colectomy for Inflammatory Colorectal Diseases.

The American surgeon [Epub ahead of print].

BACKGROUND: Racial disparities and poor access to care are common among African Americans (AA), potentially adversely affecting surgical outcomes in inflammatory bowel conditions. We aimed to analyze the effect of race on outcomes in patients undergoing segmental colectomy for inflammatory bowel conditions.

METHODS: Retrospective review of data from the National Inpatient Sample between 2010 and 2015 identified patients who underwent segmental colectomy without ostomy for Crohn's or diverticular disease. AA patients were compared with Caucasians using a multivariable analysis model. Primary outcomes of interest were overall complications, mortality, and extended hospital stay.

RESULTS: 38,143 admissions were analyzed; AA patients constituted 8% of the overall cohort. Diagnoses included Crohn's (11%) and diverticular disease (89%). After multivariable analysis, AA patients had significantly higher overall risk of complications (OR = 1.27; 95% CI, 1.15-1.40) and extended hospital stay (OR = 1.59; 95% CI, 1.45-1.75) than Caucasians. On bivariate analysis, there was no significant difference in mortality between AA and Caucasian patients. AA patients had significantly higher rates of Medicaid insurance (14% vs 6%, P < .001), lower rates of private insurance (35% vs 47%, P < .001), and were less likely to undergo surgery at a private hospital (31% vs 41%, P < .001).

CONCLUSIONS: AA patients requiring segmental colectomy for inflammatory colorectal conditions experience significantly higher rates of postoperative complications, longer hospital stays, and lower rates of private insurance. Direct correlation between insurance status and postoperative outcomes could not be established, but we speculate such great disparity in outcomes may stem from these socioeconomic differences.

RevDate: 2022-10-28

Dahlbäck C, Karlsson N, Samuelsson C, et al (2022)

Muscle mass and quality as predictors for complications, recurrence and length of hospital stay in acute uncomplicated diverticulitis: a retrospective cohort study.

Scandinavian journal of gastroenterology [Epub ahead of print].

OBJECTIVES: The aim of this study was to investigate the potential correlation between muscle mass/muscle quality and risk of complications or recurrence in patients presenting with acute uncomplicated diverticulitis. It was also to study if low muscle mass/quality correlated to prolonged hospital stay.

MATERIALS AND METHODS: The study population comprised 501 patients admitted to Helsingborg Hospital or Skåne University Hospital between 1 January 2015 and 31 December 2017, who had been diagnosed with acute uncomplicated diverticulitis and undergone computed tomography upon admission. The scans were used to estimate skeletal muscle mass and muscle radiation attenuation (an indicator for muscle quality). Skeletal muscle index was obtained by adjusting skeletal muscle mass to the patients' height. Values of below the fifth percentile of a normal population were considered low.

RESULTS: There were no differences between the patients with normal versus those with low skeletal muscle mass, skeletal muscle index or muscle radiation attenuation regarding risk of complications or recurrence of diverticular disease. However, as only 11 patients had complications, no conclusion as to a potential correlation can be made. Low muscle quality correlated to longer hospital stay, also when adjusting for other potential confounders.

CONCLUSIONS: Muscle mass/quality do not seem to serve as predictor of risk for recurrent disease in patients with acute uncomplicated diverticulitis. However, low muscle radiation attenuation was associated with prolonged hospital stay. This indicates that muscle quality, assessed by computed tomography scan, might be used in clinical practise to identify patients at risk of longer hospitalisation.

RevDate: 2022-10-30

Tursi A, Papa V, Lopetuso LR, et al (2022)

When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach.

Journal of personalized medicine, 12(10):.

Colonoscopy is a crucial diagnostic tool in managing diverticular disease (DD). Diverticulosis can often be an unexpected diagnosis when colonoscopy is performed in asymptomatic subjects, generally for colorectal cancer screening, or it could reveal an endoscopic picture compatible with DD, including acute diverticulitis, in patients suffering from abdominal pain or rectal bleeding. However, alongside its role in the differential diagnosis of colonic diseases, particularly with colon cancer after an episode of acute diverticulitis or segmental colitis associated with diverticulosis, the most promising use of colonoscopy in patients with DD is represented by its prognostic role when the DICA (Diverticular Inflammation and Complication Assessment) classification is applied. Finally, colonoscopy plays a crucial role in managing diverticular bleeding, and it could sometimes be used to resolve other complications, particularly as a bridge to surgery. This article aims to summarize "when" to safely perform a colonoscopy in the different DD settings and "why".

RevDate: 2022-11-28
CmpDate: 2022-11-28

Cameron R, Walker MM, Thuresson M, et al (2022)

Mortality risk increased in colonic diverticular disease: a nationwide cohort study.

Annals of epidemiology, 76:39-49.

INTRODUCTION: There are limited population cohort data on overall and cause-specific mortality in colonic diverticular disease.

OBJECTIVE: To measure overall and cause-specific mortality in colonic diverticular disease, compared to matched reference individuals and siblings.

METHODS: Population-based cohort study ("the ESPRESSO study") in Sweden. There were 97,850 cases with a medical diagnosis of diverticular disease (defined by international classification of disease codes) and colorectal histology identified in 1987-2017 from histopathology reports. The mortality risk between individuals with colonic diverticular disease and matched reference individuals (n = 453/634) from the general population was determined. Cox regression models adjusted for comorbidity estimated hazard ratios (HRs) for all-cause mortality.

RESULTS: During follow-up, there were 32,959 deaths in individuals with colonic diverticular disease (44/1000 person-years) compared with 127,153 in matched reference individuals (34/1000 person-years), resulting in an HR of 1.27 (95%CI 1.25-1.29). Also compared to siblings, colonic diverticular disease patients were at increased risk of death, HR 1.39 (95%CI 1.33-1.45). Mortality risks were further increased in colonic diverticular disease patients with a colorectal biopsy showing any mucosal inflammation HR 1.36; (95%CI 1.33-1.38), with the most significant increase during the first year after diagnosis HR 2.18; (95%CI 2.05-2.32).

CONCLUSIONS: Mortality in colonic diverticular disease is increased over reference individuals in the general population. The presence of mucosal inflammation on colorectal biopsies is a predictor of increased risk of mortality.

RevDate: 2022-10-19

Chou MY, Cheng CY, Long SJ, et al (2022)

Ileocolic Thrombophlebitis and Lymphadenitis Mimicking Acute Appendicitis as a Late Manifestation in a COVID-19 Patient: A Case Report.

Cureus, 14(9):e29019.

Coronavirus disease 2019 (COVID-19) is an infectious viral disease, manifesting primarily as a lung infection with fever and respiratory symptoms. However, it also has a wide range of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and diarrhea. Right lower quadrant (RLQ) abdominal pain is a common complaint for patients seeking care at emergency departments. In addition to appendicitis, the other possible causes include diverticular disease, epiploic appendagitis, Crohn's disease, or mesenteric lymphadenitis, among others. Mesenteric ischemia is an uncommon, but crucial cause of abdominal pain, necessitating early diagnosis and treatment. Herein, we report a 47-year-old man who presented to our emergency department complaining of RLQ abdominal pain following recovery from COVID-19. CT was performed due to concern for acute appendicitis. However, mesenteric thrombophlebitis and lymphadenitis in the ileocolic branch were noted on CT. His abdominal pain improved after receiving anticoagulation therapy. This case describes an uncommon etiology of RLQ abdominal pain that should be considered as a late complication of COVID-19.

RevDate: 2022-10-17

Wang L, Xu R, Kaelber DC, et al (2022)

Time Trend and Association of Early-Onset Colorectal Cancer with Diverticular Disease in the United States: 2010-2021.

Cancers, 14(19):.

PURPOSE: To examine time trends of incidence rates of EOCRC from 2010 to 2021 among patients with and without diverticular disease and to examine whether diverticular disease is associated with increased risk of EOCRC.

METHODS: This is a retrospective cohort study of 46,179,351 young adults aged 20-49, including 298,117 with diverticular disease. We examined yearly incidence rate of first diagnosis of EOCRC from 2010 through 2021 among patients with and without diverticular disease. The 5-year risk of EOCRC among patients with pre-existing diverticular disease was compared to propensity-matched patients without diverticular disease and EOCRC and odds ratio (OR) and 95% confidence interval (CI) were calculated.

RESULTS: The yearly incidence rate of new diagnosis of EOCRC (measured as new cases per 100,000 people per year) in young adults with pre-existing diverticular disease increased from 100 in 2010 to 402 in 2021, 4-6 times higher than in those without diverticular disease (24 in 2010 to 77 in 2021) (p < 0.001). Patients with diverticular disease were at higher risk for EOCRC than those without (OR: 1.76, 95% CI: 1.40-2.32).

CONCLUSION: The incidence of EOCRC continuously increased from 2010 through 2021 in patients with and without diverticular disease and was 4-6 times higher among patients with diverticular disease. Patients with pre-existing diverticular disease were at a significantly increased risk for EOCRC.

RevDate: 2022-10-21

Katsura M, Fukuma S, Chida K, et al (2022)

Which factors influence the decision to perform Hartmann's reversal in various causative disease situations? A retrospective cohort study between 2006 and 2021.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Epub ahead of print].

AIM: Our aim was to investigate the predictive factors for Hartmann's reversal and to describe the differences in the rates and timings of Hartmann's reversal for various causative diseases.

METHOD: In this multicentre retrospective cohort study patients who underwent Hartmann's procedure (HP) between 2006 and 2018 were enrolled. To describe the demographic patterns of Hartmann's reversal through to 2021, we analysed the cumulative incidence rate of Hartmann's reversal over time based on the Kaplan-Meier failure estimate. Multivariable Cox proportional hazard analysis was performed with cluster-adjusted robust standard errors to calculate hazard ratios (HRs) for the assessment of variables associated with colostomy reversal.

RESULTS: Of 250 patients who underwent the index HP and survived to discharge, 112 (45%) underwent subsequent Hartmann's reversal (36% for malignant and 51% for benign disease). The causative diseases with the highest probability of colostomy reversal were trauma (85%) and diverticular disease (73%). Conversely, colostomy reversal was performed in only 16% for colonic volvulus and 17% for bowel ischaemia. Home discharge after index HP (HR 5.22, 95% CI 3.31-8.23) and a higher body mass index (HR 1.03, 95% CI 1.01-1.04) were associated with a higher probability of Hartmann's reversal, whereas older age, malignant disease and a history of cardiovascular and psychoneurological diseases were independently associated with a lower probability of colostomy reversal.

CONCLUSION: The probability and timing of Hartmann's reversal varied considerably with the surgical indications for colostomy creation. Our results could help surgeons counsel patients and their families regarding stoma closure surgery to set realistic expectations.

RevDate: 2022-12-07
CmpDate: 2022-12-07

Vaghiri S, Prassas D, Knoefel WT, et al (2022)

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis.

Langenbeck's archives of surgery, 407(8):3259-3274.

PURPOSE: The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease.

METHODS: A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated.

RESULTS: Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427-4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020-0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202-1.0233, p = 0.0131) were significant in favor of the delayed elective approach.

CONCLUSIONS: Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.

RevDate: 2022-10-06

Fedirko V, Kopetz S, CR Daniel (2022)

Diverticular disease and cancer risk: More than a gut feeling.

Journal of the National Cancer Institute pii:6749572 [Epub ahead of print].

RevDate: 2022-10-06

Ma W, Walker MM, Thuresson M, et al (2022)

Cancer risk in patients with diverticular disease: a nationwide cohort study.

Journal of the National Cancer Institute pii:6749573 [Epub ahead of print].

BACKGROUND: There are little data on diverticular disease and cancer development, other than colorectal cancer.

METHODS: We conducted a population-based, matched cohort study with linkage of nationwide registers to the ESPRESSO histopathology cohort. We included 75,704 patients with a diagnosis of diverticular disease and colorectal histopathology and 313,480 reference individuals from the general population matched on age, sex, calendar year, and county. Cox proportional hazards models estimated multivariable-adjusted hazard ratios (HRs) for associations between diverticular disease and overall cancer and specific cancers.

RESULTS: Over a median follow-up of 6 years, we documented 12,846 incident cancers among patients with diverticular disease and 43,354 incident cancers among reference individuals from the general population. Compared to reference individuals, patients with diverticular disease had significantly increased overall cancer incidence (24.5 vs. 18.1 per 1,000 person-years), equivalent to 1 extra cancer case in 16 individuals with diverticular disease followed for ten years. After adjusting for covariates, having a diagnosis of diverticular disease was associated with a 33% increased risk of overall cancer (95% confidence interval (CI)=1.31-1.36). The risk increases also persisted compared to siblings as secondary comparators (HR = 1.26; 95%CI = 1.21-1.32). Patients with diverticular disease also had increased risk of specific cancers, including colon cancer (HR = 1.71; 95%CI = 1.60-1.82), liver cancer (HR = 1.72; 95%CI = 1.41-2.10), pancreatic cancer (HR = 1.62; 95%CI = 1.42-1.84), and lung cancer (HR = 1.50; 95%CI = 1.39-1.61). The increase in colorectal cancer risk was primarily restricted to the first year of follow-up, and especially early cancer stages.

CONCLUSIONS: Patients with diverticular disease who have colorectal histopathology have an increased risk of overall incident cancer.

RevDate: 2022-11-30
CmpDate: 2022-11-30

Holland C, Vabi BW, Shenoy PP, et al (2022)

Removal of Indwelling Urinary Catheter Two Days After Colovesical Fistula Repair: a Single-Arm Prospective Trial.

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(12):2597-2599.

BACKGROUND: Colovesical fistulas are uncommon but associated with significant morbidity and reduced quality of life. In cases with diverticular etiology, surgical management involves single-stage colonic resection with anastomosis and simple or no bladder repair. No single approach to postoperative bladder management has been widely accepted. Although historically a Foley catheter remained in place for about 2 weeks, elevated risk of the attendant complications has motivated exploring shorter durations. This study examined the feasibility and safety of removing the Foley catheter on postoperative day two.

METHODS: Patients with colovesical fistula due to diverticular disease undergoing colectomy with simple or no bladder repair were enrolled in this single-arm prospective trial conducted at a large community health system. The primary outcome was removal of the Foley catheter on postoperative day two after negative cystogram without re-insertion prior to hospital discharge. Secondary outcomes were complications after Foley catheter removal and hospital length of stay. Ninety-five percent confidence intervals were calculated for the outcomes.

RESULTS: Twenty-four patients were enrolled. About half (54%) of procedures were open, with 33% requiring simple bladder repair. Ninety-six percent (95% confidence interval, 79-99%) of patients had their Foley catheter removed on postoperative day two after a negative cystogram. There were no complications. Mean (range) hospital length of stay was 4.3 (2-6) days.

DISCUSSION: Foley catheter removal after negative cystogram on postoperative day two appears to be feasible and safe in the setting of diverticulitis-related colovesical fistula repair. Further research on a larger number of patients should confirm these findings.

RevDate: 2022-09-14

Okusaki T, Araki Y, Narai S, et al (2022)

Pyometra and Pyogenic Spondylitis with Suspected Involvement of Diverticulitis of the Sigmoid Colon: A Case Report.

Internal medicine (Tokyo, Japan) [Epub ahead of print].

Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that diverticular disease causes pyometra. We herein report an 83-year-old woman presented to our hospital with a fever, loss of appetite, general fatigue and back pain. After some inspections, she was diagnosed with pyometra and lumbar pyogenic spondylitis secondary to diverticulitis of the sigmoid colon. We performed transvaginal drainage and continued antibiotic administration for about three months. The pyometra and pyogenic spondylitis successfully resolved, and she did not experience any recurrence.

RevDate: 2022-09-13

Medellin Abueta A, Senejoa NJ, Pedraza Ciro M, et al (2022)

Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Health science reports, 5(5):e788.

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.

RevDate: 2022-09-08

Hui JWQ, En JWQ, Lau J, et al (2022)

Adjunctive endoscopic clip marking enhances non-operative management of massive lower gastrointestinal bleeding.

ANZ journal of surgery [Epub ahead of print].

BACKGROUNDS: Massive lower gastrointestinal bleeding (LGB) is common especially in elderly patients. Controversy in the approach to management stems from location of bleeding and morbidity of surgery. Colonic diverticula disease (CD) is the leading cause of painless haematochezia and haemodynamic instability.

METHODS: The use of a novel technique of endoscopic pre-marking (EPM) with radiopaque metal clips to localize is described. EPM guided superselective active transarterial embolization (A-TAE) when active vascular blush was seen. When no active contrast extravasation was seen, EPM also guided prophylactic superselective transarterial embolization (P-TAE).

RESULTS: From May 2004 to December 2021, there were 36 patients with massive LGB from diverticular disease encompassing 44 separate bleeding episodes. Spontaneous haemostasis was observed in 18.2% (8/44). The overall success rate in non-operative management was 83.3% (30/36) patients. Three patients proceeded for emergency surgery. Of the 36 patients, six patients had documented EPM followed by TAE due to recurrent bleed in the same episode. A-TAE was performed in two patients. P-TAE was performed in the four patients without active contrast extravasation. Initial haemostasis was successful in five out of six patients. One patient failed embolization and proceeded to emergency surgery. Three months later, one patient encountered late rebleeding and was scheduled for elective colectomy. None of the six developed intestinal infarction from embolization. The 30-day mortality was 0%.

CONCLUSION: A consistent approach to LGB and defined protocol of endoscopic haemostasis, with routine EPM and embolization, has the potential to mitigate the morbidity and mortality in this group of vulnerable patients.

RevDate: 2022-09-07

Shimizu A, Yoshimitsu M, Yano T, et al (2022)

Single-incision laparoscopic ileocolectomy for solitary cecal colon diverticulitis with calcified fecalith: a case report.

Journal of surgical case reports, 2022(8):rjac323.

The prevalence of colonic diverticular disease has been on the increase in Japan due to an increase in westernized diet and a rapidly aging population. However, solitary cecal diverticulum is rare and considered congenital in etiology. Solitary cecal diverticulitis with calcified fecaliths is even rarer. Herein, we report a case of cecal colon diverticulitis caused by a calcified fecalith in a 38-year-old woman treated with single-incision laparoscopic surgery. To the best of our knowledge, this report describes the first case of cecal colon diverticulitis caused by a calcified fecalith that was successfully treated with single-incision laparoscopic ileocolectomy.

RevDate: 2022-10-17
CmpDate: 2022-10-17

Giulio M, Gaia S, Andrea C, et al (2022)

Recurrent diverticulitis after elective surgery.

International journal of colorectal disease, 37(10):2149-2155.

PURPOSE: Elective sigmoid resection is proposed as a treatment for symptomatic diverticular disease for the possible improvement in quality of life achievable. Albeit encouraging results have been reported, recurrent diverticulitis is still a concern deeply affecting quality of life. The aim of this study is to determine the rate of recurrent diverticulitis after elective sigmoid resection and to look for possible perioperative risk factors.

METHODS: Patients who underwent elective resection for DD with at least a 3-year follow-up were included. Postoperative recurrence was defined as left-sided or lower abdominal pain, with CT scan-confirmed findings of diverticulitis.

RESULTS: Twenty of 232 (8.6%) patients developed CT-proven recurrent diverticulitis after elective surgery. All the 20 recurrent diverticulitis were uncomplicated and did not need surgery. Eighty-five percent of the recurrences occurred in patients with a preoperative diagnosis of uncomplicated DD, 70% in patients who had at least 4 episodes of diverticulitis, and 70% in patients with a history of diverticulitis extended to the descending colon. Univariate analysis showed that recurrence was associated with diverticulitis of the sigmoid and of the descending colon (p = 0.04), with a preoperative diagnosis of IBS (p = 0.04) and with a longer than 5 years diverticular disease (p = 0.03). Multivariate analysis was not able to determine risks factors for recurrence.

CONCLUSION: Our study showed that patients with a preoperative diagnosis of IBS, diverticulitis involving the descending colon, and a long-lasting disease are more likely to have recurrent diverticulitis. However, these variables could not be assumed as risk factors.


RJR Experience and Expertise


Robbins holds BS, MS, and PhD degrees in the life sciences. He served as a tenured faculty member in the Zoology and Biological Science departments at Michigan State University. He is currently exploring the intersection between genomics, microbial ecology, and biodiversity — an area that promises to transform our understanding of the biosphere.


Robbins has extensive experience in college-level education: At MSU he taught introductory biology, genetics, and population genetics. At JHU, he was an instructor for a special course on biological database design. At FHCRC, he team-taught a graduate-level course on the history of genetics. At Bellevue College he taught medical informatics.


Robbins has been involved in science administration at both the federal and the institutional levels. At NSF he was a program officer for database activities in the life sciences, at DOE he was a program officer for information infrastructure in the human genome project. At the Fred Hutchinson Cancer Research Center, he served as a vice president for fifteen years.


Robbins has been involved with information technology since writing his first Fortran program as a college student. At NSF he was the first program officer for database activities in the life sciences. At JHU he held an appointment in the CS department and served as director of the informatics core for the Genome Data Base. At the FHCRC he was VP for Information Technology.


While still at Michigan State, Robbins started his first publishing venture, founding a small company that addressed the short-run publishing needs of instructors in very large undergraduate classes. For more than 20 years, Robbins has been operating The Electronic Scholarly Publishing Project, a web site dedicated to the digital publishing of critical works in science, especially classical genetics.


Robbins is well-known for his speaking abilities and is often called upon to provide keynote or plenary addresses at international meetings. For example, in July, 2012, he gave a well-received keynote address at the Global Biodiversity Informatics Congress, sponsored by GBIF and held in Copenhagen. The slides from that talk can be seen HERE.


Robbins is a skilled meeting facilitator. He prefers a participatory approach, with part of the meeting involving dynamic breakout groups, created by the participants in real time: (1) individuals propose breakout groups; (2) everyone signs up for one (or more) groups; (3) the groups with the most interested parties then meet, with reports from each group presented and discussed in a subsequent plenary session.


Robbins has been engaged with photography and design since the 1960s, when he worked for a professional photography laboratory. He now prefers digital photography and tools for their precision and reproducibility. He designed his first web site more than 20 years ago and he personally designed and implemented this web site. He engages in graphic design as a hobby.

Support this website:
Order from Amazon
We will earn a commission.

This book (written by experts in the field and scheduled for release in 2022) provides up-to-date information on all aspects of colonic diverticular disease, particularly common in Western countries. The first parts of the book will deal with the disease epidemiology and etiopathogenesis, focusing on the roles of inflammation and dysbiosis as part of the pathophysiology of diverticular disease. The clinical spectrum, the diagnostic approach and differential diagnosis, medical and surgical treatments are described in the following sections. The book is intended as a unique and valuable resource for all clinicians, residents, and physicians involved in the management of this disease. R. Robbins

963 Red Tail Lane
Bellingham, WA 98226


E-mail: RJR8222@gmail.com

Collection of publications by R J Robbins

Reprints and preprints of publications, slide presentations, instructional materials, and data compilations written or prepared by Robert Robbins. Most papers deal with computational biology, genome informatics, using information technology to support biomedical research, and related matters.

Research Gate page for R J Robbins

ResearchGate is a social networking site for scientists and researchers to share papers, ask and answer questions, and find collaborators. According to a study by Nature and an article in Times Higher Education , it is the largest academic social network in terms of active users.

Curriculum Vitae for R J Robbins

short personal version

Curriculum Vitae for R J Robbins

long standard version

RJR Picks from Around the Web (updated 11 MAY 2018 )