Methods: The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively.
Results: A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis.
Conclusion: Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.},
}
@article {pmid34508065,
year = {2021},
author = {Sawada, H and Toyota, K and Ikeda, M and Hakoda, K and Hotta, R and Inoue, M and Ohmori, I and Takahashi, T},
title = {Anal Atresia in a Patient Who Had Undergone Hartmann Procedure.},
journal = {The American journal of case reports},
volume = {22},
number = {},
pages = {e932764},
pmid = {34508065},
issn = {1941-5923},
mesh = {Aged, 80 and over ; Anal Canal ; *Anus, Imperforate ; Colon, Sigmoid ; Female ; Humans ; *Rectal Neoplasms ; Rectum/surgery ; },
abstract = {BACKGROUND Hartmann procedure can be necessary for the treatment of rectal cancer and colonic perforation. The distal diverted intestinal tract is usually disregarded, while the proximal colon is diverted with a stoma. Most of the reported complications related to a diverted intestinal tract following Hartmann procedure include inflammation and intestinal tumors; however, there are only a few reports about postoperative anal complications. Herein, we report a rare case of anal atresia following Hartmann procedure. Anal atresia is generally considered as a congenital malformation; therefore, this was an extremely rare case, as there are no previous reports about anal atresia following Hartmann procedure. CASE REPORT An 84-year-old woman presented to our hospital with a persistent feeling of incomplete evacuation. She had undergone Hartmann procedure for diverticular disease of the sigmoid colon, with perforation, 5 years ago and had no major complications after the surgery. She had no history of anal disorders such as hemorrhoids or anal fissures. On examination, her anus was found to be closed by a thin skin, and computed tomography revealed stool retention in the diverted rectum. The anus was surgically opened to remove the stool, after which the feeling of incomplete evacuation resolved with no subsequent recurrence. CONCLUSIONS This is the first report of anal atresia in a patient following Hartmann procedure. The surgical intervention was effective in resolving the blockage and relieving the patient's feeling of incomplete evacuation.},
}
@article {pmid34504402,
year = {2021},
author = {Ali, F and Raskin, E},
title = {Robotic Surgery for Complicated Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {5},
pages = {297-301},
pmid = {34504402},
issn = {1531-0043},
abstract = {Diverticular disease is common, and increasing in prevalence worldwide. The treatment for acute and chronic diverticular disease has a huge clinical and economic burden. Surgery is standard for complicated diverticulitis, and there are several benefits to using robotic surgery in these cases. Complicated diverticular disease can result in fistula, fibrosis, and deranged anatomy, which present technical challenges to the surgeon. Understanding and anticipating these anatomical challenges is key to successful surgery. While fears of conversion in complicated cases may stop surgeons from using traditional laparoscopic surgery, robotic surgery is especially promising for enhancing dexterity, visualization, and facilitating completely minimally invasive surgery in these complicated cases. In this chapter, we review end-to-end technical strategies of robotic colorectal surgery for complicated diverticular disease, including cases with colovesicular, colovaginal, and colocutaneous fistulae.},
}
@article {pmid34492052,
year = {2021},
author = {van Rossen, TM and Ooijevaar, RE and Kuyvenhoven, JP and Eck, A and Bril, H and Buijsman, R and Boermeester, MA and Stockmann, HBAC and de Korte, N and Budding, AE},
title = {Microbiota composition and mucosal immunity in patients with asymptomatic diverticulosis and controls.},
journal = {PloS one},
volume = {16},
number = {9},
pages = {e0256657},
pmid = {34492052},
issn = {1932-6203},
mesh = {Aged ; Asymptomatic Diseases/*epidemiology ; Colon, Sigmoid/microbiology/pathology ; Colonoscopy ; Diverticulum/epidemiology/genetics/*immunology/*microbiology ; Female ; Gastrointestinal Microbiome/genetics ; Humans ; Immunity, Mucosal/genetics/immunology ; Inflammation/epidemiology/*microbiology/pathology ; Male ; Middle Aged ; RNA, Ribosomal, 16S/genetics/immunology ; },
abstract = {INTRODUCTION: The etiology of diverticulosis is still poorly understood. However, in patients with diverticulitis, markers of mucosal inflammation and microbiota alterations have been found. The aim of this study was to evaluate potential differences of the gut microbiota composition and mucosal immunity between patients with asymptomatic diverticulosis and controls.
METHODS: We performed a prospective study on patients who underwent routine colonoscopy for causes not related to diverticular disease or inflammatory bowel disease. Participants were grouped based on the presence or absence of diverticula. Mucosal biopsies were obtained from the sigmoid and transverse colon. Microbiota composition was analyzed with IS-pro, a 16S-23S based bacterial profiling technique. To predict if patients belonged to the asymptomatic diverticulosis or control group a partial least squares discriminant analysis (PLS-DA) regression model was used. Inflammation was assessed by neutrophil and lymphocyte counts within the taken biopsies.
RESULTS: Forty-three patients were enrolled. Intestinal microbiota profiles were highly similar within individuals for all phyla. Between individuals, microbiota profiles differed substantially but regardless of the presence (n = 19) of absence (n = 24) of diverticula. Microbiota diversity in both sigmoid and transverse colon was similar in all participants. We were not able to differentiate between diverticulosis patients and controls with a PLS-DA model. Mucosal lymphocyte counts were comparable among both groups; no neutrophils were detected in any of the studied biopsies.
CONCLUSIONS: Microbiota composition and inflammatory markers were comparable among asymptomatic diverticulosis patients and controls. This suggests that the gut microbiota and mucosal inflammation do not play a major role in the pathogenesis of diverticula formation.},
}
@article {pmid34447822,
year = {2021},
author = {Gallo, G and Ortenzi, M and Grossi, U and Di Tanna, GL and Pata, F and Guerrieri, M and Sammarco, G and Di Saverio, S},
title = {What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review.},
journal = {World journal of clinical cases},
volume = {9},
number = {23},
pages = {6759-6767},
pmid = {34447822},
issn = {2307-8960},
abstract = {BACKGROUND: Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients' visits have been cancelled or postponed worldwide.
AIM: To systematically explore the impact of the pandemic in the management of ACD.
METHODS: MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown).
RESULTS: A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.
CONCLUSION: During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.},
}
@article {pmid34447274,
year = {2021},
author = {Thomsen, L and Troelsen, FS and Nagy, D and Skajaa, N and Körmendiné Farkas, D and Erichsen, R},
title = {Venous Thromboembolism and Risk of Cancer in Patients with Diverticular Disease: A Danish Population-Based Cohort Study.},
journal = {Clinical epidemiology},
volume = {13},
number = {},
pages = {735-744},
pmid = {34447274},
issn = {1179-1349},
abstract = {Purpose: Venous thromboembolism may be a harbinger of cancer. Patients with diverticular disease are suggested to have an increased risk of developing venous thromboembolism compared with the general population, but it remains unclear whether venous thromboembolism is also a marker of occult cancer in these patients. We investigated the risk of cancer after venous thromboembolism among patients with diverticular disease.
Patients and Methods: We used Danish health registries to conduct a nationwide, population-based cohort study during 1996-2017. We identified all venous thromboembolism patients with a diagnosis of diverticular disease and calculated absolute risks of cancer and standardized incidence ratios (SIRs) by comparing observed and expected cancer incidence based on national cancer incidence in the Danish population.
Results: We followed 3406 patients with venous thromboembolism and diverticular disease for a median of 3.0 years (interquartile range: 1.0-6.0). During the first year of follow-up, we observed 212 cancer cases. The corresponding one-year risk of cancer was 6.2% (95% confidence interval [CI]: 5.5-7.1) with a SIR of 2.9 (95% CI: 2.5-3.3). The SIRs were particularly elevated for cancers of the stomach, pancreas, ovary, and kidney. During the second and subsequent years of follow-up, 337 cancers were diagnosed with a SIR of 1.1 (95% CI: 1.0-1.3).
Conclusion: Venous thromboembolism is a harbinger of occult cancer in patients with diverticular disease.},
}
@article {pmid34446657,
year = {2022},
author = {Ingraham, A and Schumacher, J and Fernandes-Taylor, S and Yang, DY and Godat, L and Smith, A and Barbosa, R and Cribari, C and Salim, A and Schroeppel, T and Staudenmayer, K and Crandall, M and Utter, G and , },
title = {General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin.},
journal = {The journal of trauma and acute care surgery},
volume = {92},
number = {1},
pages = {117-125},
doi = {10.1097/TA.0000000000003387},
pmid = {34446657},
issn = {2163-0763},
support = {K08 HS025224/HS/AHRQ HHS/United States ; },
abstract = {BACKGROUND: The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions.
METHODS: We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician.
RESULTS: Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes.
CONCLUSION: Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients.
LEVEL OF EVIDENCE: Prognostic/epidemiological, Level III.},
}
@article {pmid34441008,
year = {2021},
author = {Piccioni, A and Franza, L and Vaccaro, V and Saviano, A and Zanza, C and Candelli, M and Covino, M and Franceschi, F and Ojetti, V},
title = {Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {8},
pages = {},
pmid = {34441008},
issn = {1648-9144},
mesh = {Animals ; *Diverticulitis/therapy ; Dysbiosis ; Female ; Humans ; *Lactobacillus reuteri ; *Microbiota ; *Probiotics/therapeutic use ; },
abstract = {The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as "diverticulitis", "Limosilactobacillus reuteri", "human health and disease", "probiotics". We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.},
}
@article {pmid34422552,
year = {2021},
author = {Lee, ZW and Albright, EA and Brown, BP and Markel, TA},
title = {Congenital cecal diverticulitis in a pediatric patient.},
journal = {Journal of pediatric surgery case reports},
volume = {72},
number = {},
pages = {},
pmid = {34422552},
issn = {2213-5766},
support = {K08 DK113226/DK/NIDDK NIH HHS/United States ; },
abstract = {Diverticulitis in the pediatric population is a very rare cause of abdominal pain. When present in the cecum or ascending colon, it is often incorrectly diagnosed preoperatively as acute appendicitis. This is especially true in Western countries where right-sided diverticulitis is less common. Here we detail a case of a pediatric patient with complicated congenital cecal diverticulitis and review the literature on pertinent management. An extensive work up with imaging and endoscopy was completed and definitive surgical treatment with diverticulectomy an appendectomy was performed. As the incidence of diverticular disease in younger individuals increases, right sided diverticulitis is worthy of consideration on the differential diagnosis.},
}
@article {pmid34401167,
year = {2021},
author = {Ben Ismail, I and Ben Chaabene, H and Rebii, S and Zoghlami, A},
title = {Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain.},
journal = {Clinical case reports},
volume = {9},
number = {8},
pages = {e04594},
pmid = {34401167},
issn = {2050-0904},
abstract = {It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients.},
}
@article {pmid34388891,
year = {2021},
author = {Chung, D},
title = {Jejunal diverticulitis secondary to a gastrointestinal stromal tumor: A case report.},
journal = {International journal of surgery case reports},
volume = {85},
number = {},
pages = {106291},
doi = {10.1016/j.ijscr.2021.106291},
pmid = {34388891},
issn = {2210-2612},
abstract = {INTRODUCTION: The common manifestations of gastrointestinal stromal tumors (GIST) are well established. However, jejunal diverticulosis is an uncommon phenomenon to be associated with this lesion, with its rarity compounded by the relative difficulty associated with its diagnosis. Limited literature is available on this topic. This article examines one such case of jejunal diverticulitis as a result of a GIST, and the intervention of said disease.
CASE PRESENTATION: A 69 year old lady presented with abdominal pain, vomiting, and low grade fevers, on a background of ulcerative colitis. She was peritonitic, raising concerns of an acute abdomen. Her imaging identified an intra-abdominal contained perforation, prompting a transfer to theatres overnight for a laparotomy, which identified a jejunal diverticulum, which resembled a contained perforation. This was resected, and sent for histopathological analysis, identifying the lesion as a GIST.
DISCUSSION: Unlike other forms of jejunal diverticular disease, those arising from GISTs tend to present perforated, necessitating resection. This disease displays a tendency towards formation on the anti-mesenteric border of the small bowel. Additionally, this particular form of GIST shows macroscopic and histopathological uniformity across reported cases to date despite significant geographical disparity.
CONCLUSION: A scant number of case reports worldwide have identified jejunal diverticulitis from GISTs. We suggest diverticula be excised if perforation is suspected, while incidental findings of such be left untouched. However, overall management should be undertaken at the discretion of the operating surgeon.},
}
@article {pmid34386552,
year = {2021},
author = {Chia, ML and Chan, SWY and Shelat, VG},
title = {Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis.},
journal = {GE Portuguese journal of gastroenterology},
volume = {28},
number = {4},
pages = {236-242},
pmid = {34386552},
issn = {2341-4545},
abstract = {Introduction: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores.
Methods: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated.
Results: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality.
Conclusion: DDA is a distinct clinical pathology associated with complicated appendicitis.},
}
@article {pmid34366615,
year = {2021},
author = {Isohata, N and Nagata, K and Utano, K and Nozaki, R and Nozu, S and Kato, T and Kijima, S and Matsumoto, H and Majima, K and Ryu, Y and Hirayama, M and Endo, S},
title = {Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography.},
journal = {World journal of gastroenterology},
volume = {27},
number = {27},
pages = {4441-4452},
pmid = {34366615},
issn = {2219-2840},
mesh = {Aged ; *Colonography, Computed Tomographic ; Colonoscopy ; *Diverticulosis, Colonic/diagnostic imaging/epidemiology ; *Diverticulum, Colon/diagnostic imaging/epidemiology ; Humans ; Japan/epidemiology ; Prevalence ; Tomography ; },
abstract = {BACKGROUND: Computed tomography colonography (CTC) may be superior to colonoscopy and barium enema for detecting diverticula. However, few studies have used CTC to diagnose diverticula.
AIM: To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC.
METHODS: This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial, which included 1181 participants from 14 hospitals in Japan. We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex. The relationship between the diverticula and the length of the large intestine was also analyzed.
RESULTS: Diverticulosis was present in 48.1% of the participants. The prevalence of diverticulosis was higher in the older participants (P < 0.001 for trend). The diverticula seen in younger participants were predominantly located in the right-sided colon. Older participants had a higher frequency of bilateral type (located in the right- and left-sided colon) diverticulosis (P < 0.001 for trend). The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula (P < 0.001).
CONCLUSION: The prevalence of colonic diverticulosis in Japan is higher than that previously reported. The prevalence was higher, and the distribution tended to be bilateral in older participants.},
}
@article {pmid34354893,
year = {2021},
author = {Rim, D and Kaye, A and Ranpura, A and Verma, S},
title = {Cannabis Use Is Associated With an Increased Risk of Intestinal Obstruction in Patients Hospitalized With Diverticulitis.},
journal = {Cureus},
volume = {13},
number = {7},
pages = {e16768},
pmid = {34354893},
issn = {2168-8184},
abstract = {Objectives Diverticulitis is a common cause of hospitalization. The use of substances such as tobacco and alcohol can predispose patients to diverticulitis, and smoking is also associated with an increased risk of diverticulitis complications. Cannabis availability is growing in the United States, but there is a lack of data on the effects of cannabis use on the outcomes of diverticulitis. Thus, we investigated the effects of cannabis use on diverticulitis outcomes. Methods A retrospective analysis was conducted using 2014 data from the National Inpatient Sample. Patient demographics and outcomes of diverticulitis were compared between the groups with and without a history of cannabis use. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, intestinal obstruction, shock/hypotension, colectomy, intestinal abscess, intestinal fistula, and intestinal perforation. Results Among 48,214 patients with diverticulitis, 447 patients had a history of cannabis use. Patients with a history of cannabis use were younger, more likely to be male, less likely to be White, had a lower Charlson Comorbidity Index, and had shorter hospital stays. There were no significant differences in inpatient mortality and total hospital charge. After adjusting for age, sex, race, and the Charlson Comorbidity Index, cannabis use was an independent risk factor for intestinal obstruction in patients hospitalized with diverticulitis. There were no statistically significant differences in other outcomes. Conclusions This study indicates that patients hospitalized with diverticulitis with a history of cannabis use are more likely to have an intestinal obstruction. Inhibition of gastrointestinal motility by cannabis in the setting of diverticular inflammation may explain this finding.},
}
@article {pmid34350192,
year = {2021},
author = {De Vincentis, A and Santonico, M and Del Chierico, F and Altomare, A and Marigliano, B and Laudisio, A and Reddel, S and Grasso, S and Zompanti, A and Pennazza, G and Putignani, L and Guarino, MPL and Cicala, M and Antonelli Incalzi, R},
title = {Gut Microbiota and Related Electronic Multisensorial System Changes in Subjects With Symptomatic Uncomplicated Diverticular Disease Undergoing Rifaximin Therapy.},
journal = {Frontiers in medicine},
volume = {8},
number = {},
pages = {655474},
pmid = {34350192},
issn = {2296-858X},
abstract = {Background: Intestinal dysbiosis might play a pathogenetic role in subjects with symptomatic uncomplicated diverticular disease (SUDD), but the effect of rifaximin therapy has been scantly explored with regard to gut microbiota variations in patients with SUDD. Aims: To verify to which extent rifaximin treatment affects the gut microbiota and whether an electronic multisensorial assessment of stools and breath has the potential for detecting these changes. Methods: Breath and stool samples were collected from consecutive patients with SUDD before and after a 7 days' therapy with rifaximin. Stool microbiota was assessed, and the electronic multisensorial assessment was carried out by means of the BIONOTE electronic (e-)tongue in stools and (e-)nose in breath. Results: Forty-three subjects (female 60%, median age 66 years) were included, and 20 (47%) reported clinical improvement after rifaximin therapy. Alpha and beta diversity of stool microbiota did not significantly change after treatment, while a significant variation of selected taxa was shown (i.e., Citrobacter, Coprococcus, Anaerotruncus, Blautia, Eggerthella lenta, Dehalobacterium, SMB53, and Haemophilus parainfluenzae). Overall, the electronic multisensorial system suboptimally mirrored microbiota changes, but it was able to efficiently predict patients' clinical improvement after rifaximin with accuracies ranging from 0.81 to 0.98. Conclusions: In patients with SUDD, rifaximin administration is associated with significant variation of selected taxa. While inaccurate in predicting gut microbiota change, an electronic multisensorial system, made up of e-tongue and e-nose, was able to predict clinical improvement, thus potentially qualifying as an easy and cheap tool to forecast subjects taking most likely benefit from rifaximin therapy.},
}
@article {pmid34346712,
year = {2021},
author = {Napolitano, MA and Holleran, TJ and Sparks, AD and Zimmermann, J and Brody, FJ and Duncan, JE},
title = {Outcome and Timing of Ostomy Reversal Surgery for Diverticular Disease in Veterans Administration Hospitals.},
journal = {The American surgeon},
volume = {},
number = {},
pages = {31348211034764},
doi = {10.1177/00031348211034764},
pmid = {34346712},
issn = {1555-9823},
abstract = {BACKGROUND: Veterans undergoing elective surgery for diverticular disease have an ostomy creation rate of 18%. The purpose of this study was to analyze the outcomes and timing of ostomy reversal surgery, perioperative complications, and differences between colostomy and ileostomy reversal outcomes.
METHODS: A retrospective review of the Veterans Affairs Surgical Quality Improvement Project (VASQIP) database was performed. Patients undergoing elective colectomy for diverticular disease between 2004 and 2018 were identified. Demographics, comorbidities, ostomy type, time to reversal, and postoperative complications were analyzed.
RESULTS: 4,198 patients underwent elective colectomy for diverticular disease, with 751 patients (17.9%) receiving an ostomy. Of patients who received an ostomy, 407 had ostomy reversal surgery within the Veterans Health Administration system (54.2%), with 243 colostomies, 149 ileostomies, and 15 unspecified. Median time to ostomy reversal was 5.0 months (interquartile range 3.2, 7.8). Complication rate after reversal was 23.1%; surgical site infection was most common (9.1%). Patients with American Society of Anesthesiologists classification >3 (adjusted odds ratio (aOR) = .40[.22-.72]), increasing age (aOR = .98[.97-.99]), laparoscopic index procedure (aOR = .42[.27-.63]), and hypertension (aOR = .63[.46-.87]) were less likely to have their ostomy reversed. There were no differences in postoperative complication rates after ostomy vs ileostomy reversals. Reversals after 4.6 months were associated with 3.4-times higher odds of complications.
CONCLUSION: Ostomy creation and reversal rates are similar between the veteran and non-veteran populations in the United States. Delays in reversal surgery were associated with worse postoperative outcomes, which underscore the importance of close follow-up for patients with an ostomy after elective colectomy for diverticular disease.},
}
@article {pmid34346490,
year = {2021},
author = {Feakins, R and Torres, J and Borralho-Nunes, P and Burisch, J and Cúrdia Gonçalves, T and De Ridder, L and Driessen, A and Lobatón, T and Menchén, L and Mookhoek, A and Noor, N and Svrcek, M and Villanacci, V and Zidar, N and Tripathi, M},
title = {ECCO Topical Review on Clinicopathological Spectrum & Differential Diagnosis of IBD.},
journal = {Journal of Crohn's & colitis},
volume = {},
number = {},
pages = {},
doi = {10.1093/ecco-jcc/jjab141},
pmid = {34346490},
issn = {1876-4479},
abstract = {INTRODUCTION: Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics.
METHODS: European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search.
RESULTS: Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements.
CONCLUSION: Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.},
}
@article {pmid34336432,
year = {2021},
author = {Vayzband, V and Ashraf, H and Esparragoza, P},
title = {Surgically Managed Perforated Jejunal Diverticulitis.},
journal = {Cureus},
volume = {13},
number = {6},
pages = {e15930},
pmid = {34336432},
issn = {2168-8184},
abstract = {A 71-year-old male with a past medical history significant for chronic constipation presented to the emergency department for acute onset of severe abdominal pain. On presentation, the patient appeared to be in distress, exemplifying signs of peritonitis despite vital signs being grossly benign. CT scan established the diagnosis of a perforated jejunal diverticulitis. Initially, the patient was managed conservatively with IV fluids, antibiotics, and pain control medications. Diagnostic imaging in tandem with the patient's failure to improve incited surgical intervention with a jejunal resection and establishment of a primary anastomosis. This case illustrates additional differential diagnoses necessary for consideration in an elderly patient presenting with an acute abdomen.},
}
@article {pmid34336351,
year = {2021},
author = {Krischak, MK and Ord, JR and Connor, AA and Barbas, AS},
title = {Spontaneous Ureterocolic Fistula between Nonfunctioning Kidney Transplant Ureter and Colon in Setting of Diverticulitis.},
journal = {Case reports in transplantation},
volume = {2021},
number = {},
pages = {5572067},
pmid = {34336351},
issn = {2090-6943},
abstract = {Ureterocolic fistula is a rare condition that most commonly occurs in the setting of diverticular disease. The development of a ureterocolic fistula following kidney transplantation is even rarer, with no prior cases in the literature to our knowledge. We describe the case of a patient with three prior failed kidney transplants who developed a fistula between the sigmoid colon and nonfunctioning renal transplant ureter in the setting of diverticulitis.},
}
@article {pmid34312817,
year = {2021},
author = {Gallo, G and Picciariello, A and Di Tanna, GL and Santoro, GA and Perinotti, R and , and Grossi, U},
title = {E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study.},
journal = {Updates in surgery},
volume = {},
number = {},
pages = {},
pmid = {34312817},
issn = {2038-3312},
abstract = {Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders' median age was 44.5 (IQR 36-60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated.},
}
@article {pmid34297280,
year = {2021},
author = {Valletta, R and Faccioli, N and Bonatti, M and Foti, G and Lombardo, F and Santi, E and Tagliamonte, M and Ferro, F},
title = {Role of CT colonography in differentiating sigmoid cancer from chronic diverticular disease.},
journal = {Japanese journal of radiology},
volume = {},
number = {},
pages = {},
pmid = {34297280},
issn = {1867-108X},
abstract = {PURPOSE: To evaluate the accuracy of computed tomography colonography (CTC) in differentiating chronic diverticular disease from colorectal cancer (CRC), using morphological and textural parameters.
MATERIALS AND METHODS: We included 95 consecutive patients with histologically proven chronic diverticular disease (n = 53) or CRC (n = 42) who underwent CTC. One radiologist, unaware of histological findings, evaluated CTC studies for the presence of potential discriminators including: maximum thickness, involved segment length, shouldering phenomenon, growth pattern, diverticula, fascia thickening, fat tissue edema, loco-regional lymph nodes, mucosal pattern. Another radiologist performed volumetric texture analysis on the involved segment.
RESULTS: Several qualitative imaging parameters resulted to significantly correlated with colorectal cancer, including absence of diverticula in the affected segment, straightened growth pattern and shouldering phenomenon. A maximum wall thickness/involved segment length ratio < 0.1 had 98% specificity and 47% sensitivity in identifying diverticular disease. Regarding first-order texture analysis parameters, kurtosis resulted to be significantly different between the two groups.
CONCLUSIONS: Absence of diverticula, straightened growth pattern and shouldering phenomenon are significantly associated with CRC (71-91% sensitivity; 82-91%).},
}
@article {pmid34277166,
year = {2021},
author = {Pierre, K and Gomez, NF and Bing, S and Garcia, CE and Dalton, BG},
title = {Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass.},
journal = {Cureus},
volume = {13},
number = {6},
pages = {e15540},
pmid = {34277166},
issn = {2168-8184},
abstract = {Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months post-operatively.},
}
@article {pmid34271946,
year = {2021},
author = {Askani, E and Rospleszcz, S and Rothenbacher, T and Wawro, N and Messmann, H and De Cecco, CN and von Krüchten, R and Kulka, C and Kiefer, LS and Rathmann, W and Peters, A and Schlett, CL and Bamberg, F and Linseisen, J and Storz, C},
title = {Dietary habits and the presence and degree of asymptomatic diverticular disease by magnetic resonance imaging in a Western population: a population-based cohort study.},
journal = {Nutrition & metabolism},
volume = {18},
number = {1},
pages = {73},
pmid = {34271946},
issn = {1743-7075},
abstract = {BACKGROUND: Despite the worldwide burden of diverticular disease, the connections between diverticular disease and dietary habits remain poorly understood, particularly in an asymptomatic representative sample. We investigated the association between asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) and dietary habits in a Western study cohort.
METHODS: Participants from a cross-sectional sample of a population-based cohort study underwent whole-body 3T-MRI including an isotropic VIBE-Dixon sequence. The presence and extent of diverticular disease was assessed in blinded fashion. Habitual dietary intake was recorded using a blended approach, applying 24-h food lists and a food-frequency questionnaire. Traditional cardiometabolic risk factors were obtained by interviews and medical examination. Univariate and multivariate associations were calculated.
RESULTS: A total of 308 subjects were included in this analysis (56% male, 56.4 ± 9.1 years). 39.9% had any form of diverticular disease and 15.3% had advanced asymptomatic diverticular disease. After adjustment for age, sex and total energy intake a higher intake of fiber and vegetables was associated with a lower odds for asymptomatic diverticular disease (fiber: OR 0.68 95% CI [0.48, 0.95]; vegetables: OR 0.72 95% CI [0.53, 0.97]) and an increased intake of meat was associated with an approximately two-fold higher odds for advanced asymptomatic diverticular disease (OR 1.84 95% CI [1.13, 2.99]). However, after additional adjustment for body-mass-index (BMI), alcohol consumption, smoking behavior and physical activity only a high fiber and vegetables intake remained significantly associated with lower odds of asymptomatic diverticular disease.
CONCLUSION: Our results indicate that a high-fiber diet and increased intake of vegetables is associated with lower odds of having asymptomatic diverticular disease, independent of age, sex, total energy intake, BMI and other life-style factors.},
}
@article {pmid34225052,
year = {2021},
author = {Kline, BP and Yochum, GS and Brinton, DL and Schieffer, KM and Weaver, T and Harris, L and Deiling, S and Berg, AS and Koltun, WA},
title = {COLQ and ARHGAP15 are Associated with Diverticular Disease and are Expressed in the Colon.},
journal = {The Journal of surgical research},
volume = {267},
number = {},
pages = {397-403},
doi = {10.1016/j.jss.2021.05.043},
pmid = {34225052},
issn = {1095-8673},
abstract = {BACKGROUND: Diverticular disease is a common but poorly understood disease of the gastrointestinal tract. Recent studies have identified several single nucleotide polymorphisms (SNPs) that are associated with diverticular disease.
MATERIALS AND METHODS: The genotypes of three SNPs (rs4662344 in ARHGAP15, rs7609897 in COLQ, and rs67153654 in FAM155A) were identified by Taqman assay in 204 patients with diverticular disease. Clinical characteristics were obtained from the medical record to study association with genotype. To evaluate gene expression in colon tissue, qPCR was performed on 24 patients with diverticulitis, and COLQ was localized using immunohistochemistry.
RESULTS: The ARHGAP15 and COLQ SNPs were significantly associated with both diverticular disease and specifically diverticulitis, while the FAM155A was not associated with either. No association was found with clinical disease characteristics. Heterozygous genotypes at the ARHGAP15 SNP was associated with lower ARHGAP15 expression in colon tissues. COLQ protein localized to the myenteric plexus in the colon.
CONCLUSIONS: This study confirmed association of the ARHGAP15 and COLQ SNPs with diverticular disease in our patients but could not confirm FAM155A SNP association. Neither of these SNPs appeared to associate with more severe disease, but genotype at the ARHGAP15 SNP did impact expression of ARHGAP15 in the colon. Additionally, this study is the first to localize COLQ in the colon. Its presence in the myenteric nervous system suggests COLQ SNP variants may contribute to diverticular disease by altering motility.},
}
@article {pmid34191049,
year = {2021},
author = {Germer, CT},
title = {[Diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {681-682},
pmid = {34191049},
issn = {1433-0385},
mesh = {*Diverticular Diseases ; *Diverticulitis, Colonic/diagnosis/surgery ; Humans ; },
}
@article {pmid34139333,
year = {2021},
author = {Yuan, S and Larsson, SC},
title = {Genetically Predicted Adiposity, Diabetes, and Lifestyle Factors in Relation to Diverticular Disease.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.cgh.2021.06.013},
pmid = {34139333},
issn = {1542-7714},
abstract = {BACKGROUND & AIMS: Adiposity, type 2 diabetes, alcohol and coffee consumption, and smoking have been examined in relation to diverticular disease in observational studies. We conducted a Mendelian randomization study to assess the causality of these associations.
METHODS: Independent genetic instruments associated with the studied exposures at genome-wide significance were obtained from published genome-wide association studies. Summary-level data for the exposure-associated single nucleotide polymorphisms with diverticular disease were available in the FinnGen consortium (10,978 cases and 149,001 noncases) and the UK Biobank study (12,662 cases and 348,532 noncases).
RESULTS: Higher genetically predicted body mass index and genetic liability to type 2 diabetes and smoking initiation were associated with an increased risk of diverticular disease in meta-analyses of results from the two studies. The combined odds ratio of diverticular disease was 1.23 (95% confidence interval [CI], 1.14-1.33; P < .001) for a 1-standard deviation (~4.8 kg/m2) increase in body mass index, 1.04 (95% CI, 1.01-1.07; P = .007) for a 1-unit increase in log-transformed odds ratio of type 2 diabetes, and 1.21 (95% CI, 1.12-1.30; P < .001) for a 1-standard deviation increase in prevalence of smoking initiation. Coffee consumption was not associated with diverticular disease, whereas the association for alcohol consumption largely differed between the 2 studies.
CONCLUSIONS: This study strengthens the causal associations of higher body mass index, type 2 diabetes, and smoking with an increased risk of diverticular disease. Coffee consumption is not associated with diverticular disease. Whether alcohol consumption affects the risk of diverticular disease needs further investigation.},
}
@article {pmid34137686,
year = {2021},
author = {Aiyegbeni, B and Jonnalagadda, S and Creedon, L and Teibe, A},
title = {Rare Cause of Left Upper Abdominal Pain.},
journal = {Prague medical report},
volume = {122},
number = {2},
pages = {106-111},
doi = {10.14712/23362936.2021.11},
pmid = {34137686},
issn = {1214-6994},
mesh = {Abdominal Pain/diagnosis/etiology ; Aged ; *Diabetes Mellitus, Type 2 ; *Diverticulitis/complications/diagnosis ; *Diverticulum/complications/diagnosis ; Humans ; *Jejunal Diseases ; Male ; },
abstract = {Inflamed diverticular disease of the small bowel is an uncommon cause of acute abdominal pain. Despite its low prevalence rate (0.3-2%), it is associated with a high mortality rate between 20-25% (Fisher and Fortin, 1977; Ferreira-Aparicio et al., 2012). This is due to complications including perforation, bleeding, and obstruction. This case report presents the diagnosis and management of Mr. X, a 70-year-old male with jejunal diverticulitis and a duodenal diverticulum. Mr. X has a background of type 2 diabetes mellitus and sigmoid diverticulosis, he presented with a three-day history of left upper quadrant pain radiating to the left iliac fossa. He was haemodynamically stable despite his elevated inflammatory markers (C-reactive protein 161 mg/l and neutrophils 13.3×109/l) and computerised tomography (CT) of the abdomen and pelvis showing jejunal diverticulitis and a duodenal diverticulum. Mr. X was successfully treated with intravenous antibiotics and analgesia and a follow up CT scan showed that the jejunal diverticulitis had resolved. Previous operative management of the discussed pathology has been reported, the current report is novel as the diagnosis was made early and the case managed conservatively.},
}
@article {pmid34124181,
year = {2021},
author = {Hovstadius, H and Lundgren, D and Karling, P},
title = {Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study.},
journal = {Inflammatory intestinal diseases},
volume = {6},
number = {2},
pages = {101-108},
pmid = {34124181},
issn = {2296-9365},
abstract = {Introduction: Faecal calprotectin (FC) is commonly used as a diagnostic tool for patients with gastrointestinal (GI) symptoms. However, there is uncertainty in daily clinical practice how to interpret an elevated FC in patients with a normal colonoscopy. We investigated if patients with a normal colonoscopy but with an elevated FC more often were diagnosed with a GI disease in a 3-year follow-up period.
Methods: Patients referred for colonoscopy (n = 1,263) to the Umeå University Hospital endoscopy unit between 2007 and 2013 performed a FC test (CALPRO®) on the day before bowel preparation. A medical chart review was performed on all patients who had normal findings on their colonoscopy (n = 585, median age 64 years).
Results: Thirty-four percent of the patients (n = 202) with normal colonoscopy had elevated FC (>50 μg/g), and these patients were more frequently diagnosed with upper GI disease during the follow-up period than patients with normal FC levels (9.9 vs. 4.7%; p = 0.015). The upper GI diseases were mainly benign (i.e., gastritis). In a binary logistic regression analysis controlling for age, gender, nonsteroid anti-inflammatory drug use, and proton-pump inhibitor use, there was no difference for a new diagnosis of upper GI disease in the follow-up period (multivariate OR 1.70; 95% CI: 0.77-3.74). There was no difference in a new diagnosis of lower GI disease (6.4 vs. 5.2%; p = 0.545) or cardiovascular disease/death (multivariate OR 1.68; 95% CI: 0.83-3.42) in the follow-up period between patients with elevated versus normal FC levels.
Conclusions: In patients with a normal colonoscopy, a simultaneously measured increased FC level was not associated with an increased risk for significant GI disease during a follow-up period of 3 years.},
}
@article {pmid34120857,
year = {2021},
author = {Facciorusso, A and Bertini, M and Bertoni, M and Tartaglia, N and Pacilli, M and Pavone, G and Ambrosi, A and Sacco, R},
title = {Efficacy of hemostatic powders in lower gastrointestinal bleeding: Clinical series and literature review.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {10},
pages = {1327-1333},
doi = {10.1016/j.dld.2021.05.026},
pmid = {34120857},
issn = {1878-3562},
abstract = {BACKGROUND: There is limited evidence on the efficacy of hemostatic powders in the management of lower gastrointestinal bleeding.
AIMS: to revise our series of patients with lower gastrointestinal bleeding treated with hemostatic powders and to provide a pooled estimate of their efficacy based on the current literature.
METHODS: Sixty-five patients underwent topical endoscopic application of hemostatic powder between 2016 and 2020. The primary endpoint was treatment success, with 7- and 30-day rebleeding rate, adverse events and mortality as secondary outcomes. Literature review was based on computerized bibliographic search on the main databases through December 2020. Pooled effects were calculated using a random-effects model.
RESULTS: Overall, the powder was applied as monotherapy in 37 patients (56.9%), as combination therapy in 15 patients (23.4%), and as rescue therapy in 13 cases (19.9%). Hemostasis was achieved in 100% of patients. Rebleeding rate at 7- and 30-day was 7.7% and 9.2%, respectively. A total of 10 studies with 259 patients were included in the meta-analysis. Immediate hemostasis was achieved in 96.3% (93.4%-99.2%) patients, whereas pooled 7- and 30-day rebleeding rates were 9.6% (4.5%-14.6%) and 12.9% (7.2%-18.5%), respectively.
CONCLUSION: Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.},
}
@article {pmid34116453,
year = {2021},
author = {Rausch, VH and Weinrich, JM and Schön, G and Sabour, L and Özden, C and Kaul, MG and Adam, G and Bannas, P and Henes, FO},
title = {Accuracy of preoperative CT staging of acute colonic diverticulitis using the classification of diverticular disease (CDD) - Is there a beneficial impact of water enema and visceral obesity?.},
journal = {European journal of radiology},
volume = {141},
number = {},
pages = {109813},
doi = {10.1016/j.ejrad.2021.109813},
pmid = {34116453},
issn = {1872-7727},
mesh = {Acute Disease ; Aged ; *Diverticulitis, Colonic/diagnostic imaging ; Enema ; Female ; Humans ; Middle Aged ; *Obesity, Abdominal ; Retrospective Studies ; Tomography, X-Ray Computed ; Water ; },
abstract = {PURPOSE: We evaluated the accuracy of preoperative CT in staging colonic diverticulitis (ACD) by using the classification of diverticular disease (CDD) and investigated the diagnostic impact of water enema (WE) and visceral obesity.
METHODS: In this retrospective study, the radiological and hospital information system was searched for patients who underwent CT for clinically suspected ACD prior to surgery between 2009 and 2019. From the initial population (n = 164), we included 155 patients (94.5 %) (85 women; mean age: 58 ± 13 years) matching the following inclusion criteria: i.) clinically suspected ACD, ii.) i.v. contrast-enhanced CT, iii.) surgery for ACD within 1 week after CT, iv.) histopathological report that proved ACD. The remaining 9 patients (5.5 %) were excluded because histopathological reports were lacking (n = 3) or CT was performed without intravenous contrast agent (n = 6). WE (+ butylscopolamine i.v.) was performed in 93 patients (group A, 60 %). 62 patients (group B, 40 %) had no WE. Visceral-to-subcutaneous fat ratio (V/S) was determined for each patient. Two radiologists blinded for final diagnosis independently staged ACD according to CDD and assessed prevalence and confidence ratings of ACD-related CT-findings: pericolonic fat stranding, covered- and free-perforation, local and generalized peritonitis, abscess. Interobserver-agreement of CT-findings were assessed and effects of WE and V/S ratio on the diagnostic accuracy of CT with surgical and histopathological findings as reference were determined by calculating a logistic regression model.
RESULTS: CT-staging showed high accuracy (94 %) and excellent interrater-correlation (ICC 0.96) for staging ACD. WE had no positive impact neither on diagnostic accuracy of staging, nor on confidence ratings of ACD-related CT-findings (all p > 0.5). Confidence ratings were significantly higher in examinations without WE for perforation, peritonitis as well as abscesses (all p < 0.5). Confidence ratings for the assessment of local peritonitis improved significantly with higher V/S (p = 0.049). The increase of V/S significantly correlated with the probability for correct CDD staging of ACD in CT (p = 0.023).
CONCLUSION: Increase of visceral obesity significantly improves accuracy of CT in preoperative staging acute colonic diverticulitis. However, independently of the degree of visceral obesity, water enema has no diagnostic benefit and may therefore be omitted. Overall, CT proves high accuracy in preoperative staging ACD using the classification of diverticular disease.
LEVEL OF EVIDENCE: Retrospective study, observational study.},
}
@article {pmid34100113,
year = {2021},
author = {Lock, J and Wiegering, A and Germer, CT},
title = {[Indications for surgical treatment of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {694-701},
pmid = {34100113},
issn = {1433-0385},
mesh = {Colon, Sigmoid ; *Diverticular Diseases/surgery ; *Diverticulitis ; *Diverticulitis, Colonic/surgery ; Humans ; Quality of Life ; Recurrence ; },
abstract = {BACKGROUND: The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality.
OBJECTIVE: Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence.
MATERIAL AND METHODS: The narrative review is based on current national and international guidelines and a selective literature search.
RESULTS: There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment.
CONCLUSION: The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.},
}
@article {pmid34059533,
year = {2021},
author = {Khan, ZU and Ghuman, N and Mak, K},
title = {Rare case of diabetic neuropathic cachexia along with diabetic amyotrophy.},
journal = {BMJ case reports},
volume = {14},
number = {5},
pages = {},
doi = {10.1136/bcr-2020-239869},
pmid = {34059533},
issn = {1757-790X},
mesh = {Aged ; Cachexia/etiology ; *Diabetes Mellitus, Type 2/complications ; *Diabetic Neuropathies/complications ; Glycated Hemoglobin A ; Humans ; Male ; *Wounds, Gunshot ; },
abstract = {A 65-year-old patient with background of alcohol excess and previous gunshot wounds was admitted with significant weight loss, leg cramps, dizziness and lethargy for the last 3 months. He was diagnosed with type 2 diabetes mellitus in July 2020 and was started on Metformin and Gliclazide by his in July; he was later commenced on alogliptin and empaglaflozin by diabetes specialist nurse in early August. He also had generalised muscle wasting, dorsal guttering in both hands and was cachectic when he presented to hospital. His haemoglobin A1c (HbA1c) was 124 mmol/mol in July 2020 and was 63 mmol/mol in September 2020. The patient had negative autoimmune and TB screen. CT abdomen/pelvis and CT lumbosacral spine that showed mild diverticular disease and bilateral L5 spondylolysis with L5-S1 spondylotic changes. Electrophysiological studies confirmed sensory motor peripheral neuropathy. Patient was diagnosed with diabetic neuropathic cachexia secondary to poorly controlled diabetes and was commenced on 30 units two times per day of NovoMix 30 insulin; this was adjusted to 24 units two times per day in endocrine clinic 3 months later, after gaining 10 kg in weight. Good glycaemic control is key to the management of such cases and, therefore, we recommend early referral to diabetes specialist input for consideration of insulin therapy.},
}
@article {pmid34056819,
year = {2021},
author = {Trejo-Avila, M and Vergara-Fernández, O},
title = {Open versus laparoscopic surgery for the treatment of diverticular colovesical fistulas: A systematic review and meta-analysis.},
journal = {ANZ journal of surgery},
volume = {91},
number = {9},
pages = {E570-E577},
doi = {10.1111/ans.16985},
pmid = {34056819},
issn = {1445-2197},
mesh = {Colectomy ; Humans ; *Intestinal Fistula/etiology/surgery ; *Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The aim of this study was to analyze the evidence regarding open versus laparoscopic surgery for the treatment of diverticular colovesical fistula (CVF) in terms of perioperative outcomes.
METHODS: A systematic review was performed using PubMed, Cochrane, Google Scholar, and Web of Science databases for studies comparing laparoscopic versus open surgery for CVF. We pooled odds ratios (OR) and mean differences (MD) using random or fixed effects models.
RESULTS: Five non-randomized studies with 227 patients met the inclusion criteria. All were retrospective studies, published between 2014 and 2020. For laparoscopic surgery, the pooled rate for conversion to laparotomy was 36%. Laparoscopic and open procedures required similar operative time (MD: -11.62; 95% confidence interval [CI]: -51.41 to 28.16). No difference was found in terms of stoma rates between laparoscopic and open surgery (OR: 1.12; 95% CI 0.44-2.86). Overall, the rate of total postoperative complications was lower in the laparoscopic group (OR: 0.55; 95% CI: 0.30-0.99). The pooled analysis showed equivalent rates of anastomotic leaks (OR: 0.61; 95% CI 0.15-2.45), surgical site infections (OR: 0.44; 95% CI 0.19-1.01), and mortality (OR: 0.18; 95% CI 0.03-1.15). The length of stay was significantly reduced with laparoscopic surgery (MD: -2.89; 95% CI -4.20 to -1.58).
CONCLUSION: Among patients with CVF, the laparoscopic approach appears to have shorter hospital length of stay, with no differences in anastomotic leaks, surgical site infections, stoma rates, and mortality, when compared with open surgery.},
}
@article {pmid34053611,
year = {2021},
author = {Hines, JJ and Mikhitarian, MA and Patel, R and Choy, A},
title = {Spectrum and Relevance of Incidental Bowel Findings on Computed Tomography.},
journal = {Radiologic clinics of North America},
volume = {59},
number = {4},
pages = {647-660},
doi = {10.1016/j.rcl.2021.03.012},
pmid = {34053611},
issn = {1557-8275},
mesh = {Humans ; *Incidental Findings ; Intestinal Diseases/*diagnostic imaging ; Intestines/diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. When suspicious incidental bowel wall thickening is detected, the radiologist can alert the clinical team to the finding prior to the patient becoming symptomatic, potentially leading to definitive management at an early, more curable stage.},
}
@article {pmid34046119,
year = {2021},
author = {Guediche, A and Amor, SB and Mnari, W and Abdelaali, M and Farhat, W and Ammar, H and Said, MA and Zakhama, M and Bouhlel, W and Sellem, OK and Chaabene, NB and Golli, M and Ali, AB and Safer, L},
title = {Diverticular disease of the small bowel: a rare cause of the duodenojejunal flexure obstruction (a case report).},
journal = {The Pan African medical journal},
volume = {38},
number = {},
pages = {213},
pmid = {34046119},
issn = {1937-8688},
mesh = {Diverticular Diseases/*complications ; Duodenal Obstruction/*diagnosis/etiology ; Female ; Humans ; Intestine, Small/pathology ; Jejunal Diseases/*diagnosis/etiology ; Middle Aged ; },
abstract = {The small bowel is the least common site for diverticula in the entire gastrointestinal tract. Chronic upper intestinal obstruction due to diverticula is very rare. We report a case of multiple small bowel diverticula causing mechanical obstruction of the duodenojejunal flexure.},
}
@article {pmid34031729,
year = {2021},
author = {Posabella, A and Steinemann, DC and Droeser, RA and Varathan, N and Ayçiçek, SG and Nocera, F and von Flüe, M and Rotigliano, N and Füglistaler, I},
title = {Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {406},
number = {5},
pages = {1571-1580},
pmid = {34031729},
issn = {1435-2451},
mesh = {Aged ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; },
abstract = {BACKGROUND: Growing consideration in quality of life (QoL) has changed the therapeutic strategy in patients suffering from diverticular disease. Patients' well-being plays a crucial role in the decision-making process. However, there is a paucity of studies investigating patients' or surgery-related factors influencing the postoperative gastrointestinal function. The aim of this study was to investigate in a predictive model patients or surgical variables that allow better estimation of the postoperative gastrointestinal QoL.
METHODS: This observational study retrospectively analyzed patients undergoing elective laparoscopic sigmoidectomy for diverticulitis between 2004 and 2017. The one-time postoperative QoL was assessed with the gastrointestinal quality of life index (GIQLI) in 2019. A linear regression model with stepwise selection has been applied to all patients and surgery-related variables.
RESULTS: Two hundred seventy-two patients with a mean age of 62.30 ± 9.74 years showed a mean GIQLI of 116.39±18.25 at a mean follow-up time of 90.4±33.65 months. Women (n=168) reported a lower GIQLI compared to male (n=104; 112.85±18.79 vs 122.11±15.81, p<0.001). Patients with pre-operative cardiovascular disease (n=17) had a worse GIQLI (106.65 ±22.58 vs 117.08±17.66, p=0.010). Finally, patients operated less than 5 years ago (n=63) showed a worse GIQLI compared to patients operated more than 5 years ago (n=209; 111.98±19.65 vs 117.71±17.63, p=0.014).
CONCLUSIONS: Female gender and the presence of pre-operative cardiovascular disease are predictive for a decreased postoperative gastrointestinal QoL. Furthermore, patients' estimation of gastrointestinal functioning seems to improve up to 5 years after surgery.},
}
@article {pmid34014356,
year = {2021},
author = {Muse, A and Wusterbarth, E and Thompson, S and Thompson, E and Saeed, S and Deeyor, S and Lee, J and Krall, E and Hamidi, M and Nfonsam, V},
title = {The role of preoperative anemia in patients undergoing colectomy for diverticular disease: does surgical urgency matter?.},
journal = {International journal of colorectal disease},
volume = {36},
number = {11},
pages = {2463-2470},
pmid = {34014356},
issn = {1432-1262},
mesh = {Adult ; Anastomotic Leak ; *Anemia/complications ; Colectomy/adverse effects ; *Diverticulitis ; Elective Surgical Procedures ; Humans ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {PURPOSE: Surgery especially in the emergent setting carries higher rates of morbidity and mortality. The aim of our study was to evaluate the impact of preoperative anemia on outcomes for patients undergoing colectomy for acute diverticulitis in both elective and emergent settings.
METHODS: We performed a 4-year analysis of the ACS-NSQIP and included adult patients with acute diverticulitis who underwent colectomy. Patients were stratified into two groups based on preoperative hemoglobin levels, preop anemia and no-preop Anemia. Outcome measures were 30-day complications, anastomotic leaks, readmissions, mortality, and intra-/postoperative blood transfusion. We also performed a sub-analysis for patients who underwent emergent colectomy.
RESULTS: Six thousand nine hundred sixty-three patients were included in the analysis, of which 37% (n = 2571) had preoperative anemia. Patients in the anemia group were more likely to have higher ASA class and receive blood 72-h preoperatively (5.4% vs. 0.2%, p < 0.01). Patients in the anemia group had higher rates of complications (35.4% vs. 24.7%, p < 0.01), unplanned readmission (9.2% vs 7.2%, p < 0.01), mortality (4.5% vs. 1.8%, p < 0.01), and intra/postoperative transfusion requirement (21% vs. 3.8%, p < 0.01) with no difference in rate of anastomotic leaks. On sub-analysis, 39% of the cases were completed in an emergent setting, 85% of which were due to perforation. Patients with preoperative anemia that underwent colectomy in an emergent setting had higher odds of intra/postoperative blood transfusion (OR 51.6, CI 3.87-6.87, p < 0.01) with no statistical significance in 30-day complications (p = 0.51).
CONCLUSION: Preoperative anemia in patients undergoing colectomy for acute diverticular disease is associated with higher odds complications, readmissions, and intra/postoperative blood transfusions.},
}
@article {pmid33996526,
year = {2021},
author = {Ali Alzahrani, H},
title = {A Case of Self-Induced Hydrostatic Colonic Perforation.},
journal = {Qatar medical journal},
volume = {2021},
number = {1},
pages = {14},
pmid = {33996526},
issn = {0253-8253},
abstract = {INTRODUCTION: Constipation is a common complaint. The elderly are five times more prone to constipation than young people because of the effects of medication, immobility, and a blunted urge to defecate. Many of these patients are demented, have cognitive deficits, or suffer from a psychiatric disorder. Colonic perforation caused by hydrostatic pressure is rare, and this typically occurs during fluoroscopic studies resulting when there is excessive intraluminal colonic pressure. Self-induced colonic perforation is even rarer.
CASE REPORT: We report the case of a 95-year-old man who presented to the emergency department with an acute surgical abdomen and symptoms of sepsis. He had a history of longstanding constipation. He gave a history of frequent insertion of a rubber hose into his anal canal to relieve his constipation while rinsing his anus after defecation. After resuscitation, an emergency operation was performed, and sigmoid colon perforation was found in addition to pre-existing diverticular disease. Hartmann's procedure was performed after abdominal washout. Unfortunately, the patient died of multi-organ failure two days after surgery.
CONCLUSION: Self-induced hydrostatic colonic perforation is rare. The consequence is fatal, especially in the elderly or in cases of delayed presentation.},
}
@article {pmid33965198,
year = {2021},
author = {Jayaprakasam, VS and Paroder, V and Schöder, H},
title = {Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers.},
journal = {Seminars in nuclear medicine},
volume = {51},
number = {5},
pages = {485-501},
pmid = {33965198},
issn = {1558-4623},
support = {P30 CA008748/CA/NCI NIH HHS/United States ; },
mesh = {Fluorodeoxyglucose F18 ; *Gastrointestinal Neoplasms ; Humans ; Male ; *Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography ; Radiopharmaceuticals ; Tissue Distribution ; Tomography, X-Ray Computed ; },
abstract = {In the past two decades, PET/CT has become an essential modality in oncology increasingly used in the management of gastrointestinal (GI) cancers. Most PET/CT tracers used in clinical practice show some degree of GI uptake. This uptake is quite variable and knowledge of common patterns of biodistribution of various radiotracers is helpful in clinical practice. 18F-Fluoro-Deoxy-Glucose (FDG) is the most commonly used radiotracer and has quite a variable uptake within the bowel. 68Ga-Prostate specific membrane antigen (PSMA) shows intense uptake within the proximal small bowel loops. 11C-methyl-L-methionine (MET) shows high accumulation within the bowels, which makes it difficult to assess bowel or pelvic diseases. One must also be aware of technical artifacts causing difficulties in interpretations, such as high attenuation oral contrast material within the bowel lumen or misregistration artifact due to patient movements. It is imperative to know the common variants and benign diseases that can mimic malignant pathologies. Intense FDG uptake within the esophagus and stomach may be a normal variant or may be associated with benign conditions such as esophagitis, reflux disease, or gastritis. Metformin can cause diffuse intense uptake throughout the bowel loops. Intense physiologic uptake can also be seen within the anal canal. Segmental bowel uptake can be seen in inflammatory bowel disease, radiation, or medication induced enteritis/colitis or infection. Diagnosis of appendicitis or diverticular disease requires CT correlation, as normal appendix or diverticulum can show intense uptake. Certain malignant pathologies are known to have only low FDG uptake, such as early-stage esophageal adenocarcinoma, mucinous tumors, indolent lymphomas, and multicystic mesotheliomas. Response assessment, particularly in the neoadjuvant setting, can be limited by post-treatment inflammatory changes. Post-operative complications such as abscess or fistula formation can also show intense uptake and may obscure underlying malignant pathology. In the absence of clinical suspicion or rising tumor marker, the role of FDG PET/CT in routine surveillance of patients with GI malignancy is not clear.},
}
@article {pmid33960587,
year = {2021},
author = {Giang, J and Lan, X and Crichton, M and Marx, W and Marshall, S},
title = {Efficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysis.},
journal = {Nutrition & dietetics: the journal of the Dietitians Association of Australia},
volume = {},
number = {},
pages = {},
doi = {10.1111/1747-0080.12672},
pmid = {33960587},
issn = {1747-0080},
abstract = {AIM: Biophenol-rich nutraceuticals may be an adjuvant treatment for Crohn's disease (CD), ulcerative colitis (UC), symptomatic uncomplicated diverticular disease (SUDD), and irritable bowel syndrome (IBS). This systematic review and meta-analysis aimed to determine the efficacy and safety of biophenol-rich nutraceutical supplementation on CD, UC, SUDD, and IBS on gastrointestinal symptoms (GIS), quality of life (QoL), inflammatory and oxidative stress biomarkers, and adverse events compared to usual care or placebo.
METHODS: PubMed, Embase, CINAHL, and CENTRAL were searched for randomised controlled trials until 27 April 2020. Outcomes were GIS, inflammatory and oxidative stress markers, QoL, and adverse events. The Cochrane Risk of Bias tool and GRADE were used to appraise studies. Data were pooled using Revman.
RESULTS: Twenty-three trials in CD, UC, and IBS patients were included. Compared with placebo, biophenol-rich nutraceuticals improved GIS (SMD: 0.43 [95%CI: 0.22, 0.63]; GRADE: very low) in UC, CD, and IBS participants. In UC and CD participants, biophenol-rich nutraceuticals improved CRP by 1.6 mg/L [95%CI:0.08, 3.11; GRADE: low], malondialdehyde by 1 mmol/L [95%CI:0.55, 1.38; GRADE: low]; but only resveratrol improved QoL (SMD: -0.84 [95%CI: -1.24, -0.44; GRADE: high). Resveratrol (for UC and CD participants) and peppermint oil (for IBS participants) had greater certainty in the evidence for improving GIS and QoL (GRADE: moderate to high). There was no effect on adverse events (P > .05).
CONCLUSIONS: Biophenol-rich nutraceuticals may be an effective and safe adjuvant treatment for the management of CD, UC, and IBS; with higher certainty of evidence for resveratrol for UC and CD and peppermint oil for IBS.},
}
@article {pmid33944850,
year = {2021},
author = {Mascolo, AP and Marrama, F and Mercuri, NB and Placidi, F},
title = {Efficacy and safety of lacosamide in the treatment of status epilepticus in a patient with comorbidities.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {92},
number = {S1},
pages = {e2021090},
pmid = {33944850},
issn = {2531-6745},
mesh = {Aged ; Aged, 80 and over ; Anticonvulsants/adverse effects ; Comorbidity ; Female ; Humans ; Lacosamide/therapeutic use ; Levetiracetam/therapeutic use ; *Status Epilepticus/drug therapy ; },
abstract = {Efficacy, safety and tolerability of lacosamide in the treatment of status epilepticus are well described. However, other evidence of its pharmacologic profile in elderly patients with other comorbidities seems warranted. We describe the case of an 80 year-old woman with an history of arterial hypertension, ischemic cardiomyopathy, COPD, CKD, previous laryngeal cancer, a stoma positioning for diverticular disease and previous surgery for a left frontal meningioma. Since then, the patient developed focal epilepsy and she was on levetiracetam and valproic acid therapy. The patient was admitted to our department for a focal status epilepticus characterized by non-fluent aphasia and right facio-brachial clonic movements. She also presented with aspiration pneumonia and started intravenous antibiotic treatment. After failure of a first-line antiepileptic drug, lacosamide intravenous treatment was started, with complete reversal of the clinical picture. EEG then showed focal slow waves mixed to interictal epileptiform discharges over the left fronto-temporal regions. The patient was then discharged home with an oral lacosamide treatment and at 3 months she was seizure-free. Our case report confirms the efficacy of lacosamide in status epilepticus, highlighting its safety and tolerability in an elderly and fragile patient with multiple comorbidities and drug therapy.},
}
@article {pmid33937941,
year = {2021},
author = {Loosen, SH and Paffenholz, P and Luedde, T and Kostev, K and Roderburg, C},
title = {Diverticular disease is associated with an increased incidence rate of depression and anxiety disorders.},
journal = {International journal of colorectal disease},
volume = {36},
number = {11},
pages = {2437-2443},
pmid = {33937941},
issn = {1432-1262},
support = {CRC1380/A01//Deutsche Forschungsgemeinschaft/ ; 771083//H2020 European Research Council/ ; 110043/WT_/Wellcome Trust/United Kingdom ; 110043/WT_/Wellcome Trust/United Kingdom ; },
mesh = {Anxiety Disorders/epidemiology ; *Depression/epidemiology ; *Diverticular Diseases ; Female ; Humans ; Incidence ; Male ; Proportional Hazards Models ; },
abstract = {BACKGROUND: Diverticular disease represents a gastrointestinal disorder of high prevalence in developed countries that often leads to psychological distress. Here, we aimed at evaluating a potential association between diverticular disease and depression or anxiety disorders in outpatients in Germany.
METHODS: Using the Disease Analyzer database featuring data of over 8 million patients treated in German general practices, we identified 61.556 patients with diverticular disease (ICD-10: K57) who were 1:1 matched by age, sex, index year, and the Charlson Comorbidity Index to 61.556 patients without diverticular disease. The association between diverticular disease and depression or anxiety disorders was evaluated in Cox regression models.
RESULTS: Within 5 years after the initial diagnosis of diverticular disease, 14.0% of patients with and 10.6% of individuals without diverticular disease were diagnosed with depression (HR 1.34, 95%CI 1.29-1.39, p < 0.001). Similarly, the incidence of anxiety disorder was significantly higher in patients with diverticular disease (HR 1.55, 95%CI 1.46-1.64, p < 0.001). Finally, the prescription rate for antidepressant drugs was significantly higher in diverticular disease patients compared to individuals without diverticular disease (9.4% vs. 6.1%, HR 1.56, 95%CI 1.49-1.62, p < 0.001). These associations were confirmed for different age groups and both sexes.
CONCLUSION: Our data provide evidence that diverticular disease is associated with an increased incidence of depression and anxiety disorders. Despite that fact that confounding factors such as deprivation and patient personality have to be taken into account, we suggest that patients with diverticular disease are regularly screened for symptoms of depression and anxiety disorders.},
}
@article {pmid33937291,
year = {2021},
author = {Grillo, F and Campora, M and Cornara, L and Cascini, A and Pigozzi, S and Migliora, P and Sarocchi, F and Mastracci, L},
title = {The Seeds of Doubt: Finding Seeds in Intriguing Places.},
journal = {Frontiers in medicine},
volume = {8},
number = {},
pages = {655113},
pmid = {33937291},
issn = {2296-858X},
abstract = {Introduction: Seeds may be found in gastrointestinal tissue samples, and their multifaceted appearance may be challenging. The aim is to report a rough incidence of pathology samples which show seeds, specify the most frequent sample types and show an iconography of the most commonly identified seeds. Materials and Methods: Between 2017 and 2020, all gastrointestinal pathology cases in which seeds/seed parts were found, were collected and seed type described by referencing a seed image library. Results: Fifty cases with complete seeds/seed parts were collected: 16 colonic resections for colorectal cancer and diverticulosis, 13 appendiceal resections for appendicitis, 1 gastric resection. Fifteen cases were found in polypectomy specimens and 5 cases in colorectal endoscopic biopsies. Most frequent seed types were tomato, kiwi, blueberry, and blackberry seeds. Conclusion: Seeds may be found in up to 4% of specimens; their recognition may be useful to exclude parasitic infections as well as in forensic sciences.},
}
@article {pmid33930589,
year = {2021},
author = {Cocomazzi, F and Carparelli, S and Cubisino, R and Giuliani, AP and Bossa, F and Biscaglia, G and Parente, P and Andriulli, A and Perri, F and Gentile, M},
title = {Inverted colonic diverticulum (ICD): report of two cases and literature review of a not that unusual endoscopic challenge.},
journal = {Clinics and research in hepatology and gastroenterology},
volume = {45},
number = {5},
pages = {101711},
doi = {10.1016/j.clinre.2021.101711},
pmid = {33930589},
issn = {2210-741X},
abstract = {Inverted colonic diverticulum (ICD) is a rare intraluminal lesion occurring in about 0.7-1.7% of people, often endoscopically indistinguishable from polyps. Some unspecific endoscopic features may assist to distinguish polypoid ICD from true polyps. This differentiation bears relevance for the therapeutic approach, as colonic polyps require snare polypectomy, a practice which may be associated with colonic perforation in case of true ICD. The endoscopist, therefore, should be aware of the likelihood of detecting these lesions during colonoscopy. A close inspection and a gentle probing could assist in a correct diagnosis and avoid risky procedures such as biopsy or polypectomy. Rarely, a neoplasm arising over an ICD and its treatment has been described. We reported two cases, one of which with dysplasia, and their treatment, and reviewed all the ICD endoscopic cases so far reported in the literature, remarking the possibility of finding pedunculated ICDs or neoplasm arising over an ICD.},
}
@article {pmid33919818,
year = {2021},
author = {Piccioni, A and Franza, L and Brigida, M and Zanza, C and Torelli, E and Petrucci, M and Nicolò, R and Covino, M and Candelli, M and Saviano, A and Ojetti, V and Franceschi, F},
title = {Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance.},
journal = {Journal of personalized medicine},
volume = {11},
number = {4},
pages = {},
pmid = {33919818},
issn = {2075-4426},
abstract = {How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms' development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as "gut microbiota", "probiotics and gut disease", "probiotics and acute diverticulitis", "probiotics and diverticular disease", "probiotics mechanism of action". However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms' management in diverticular disease.},
}
@article {pmid33919755,
year = {2021},
author = {Carabotti, M and Falangone, F and Cuomo, R and Annibale, B},
title = {Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review.},
journal = {Nutrients},
volume = {13},
number = {4},
pages = {},
pmid = {33919755},
issn = {2072-6643},
mesh = {Diet, Western/adverse effects ; Dietary Fiber/administration & dosage ; Diverticulitis/epidemiology/etiology/physiopathology/*prevention & control ; Diverticulosis, Colonic/*complications/physiopathology ; Edible Grain ; Feeding Behavior/*physiology ; Fruit ; Gastrointestinal Hemorrhage/epidemiology/etiology/physiopathology/*prevention & control ; Hospitalization/statistics & numerical data ; Humans ; Meat/adverse effects ; Recurrence ; Vegetables ; },
abstract = {Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.},
}
@article {pmid33917780,
year = {2021},
author = {Rocca, A and Brunese, MC and Cappuccio, M and Scacchi, A and Martucci, G and Buondonno, A and Perrotta, FM and Quarto, G and Avella, P and Amato, B},
title = {Impact of Physical Activity on Disability Risk in Elderly Patients Hospitalized for Mild Acute Diverticulitis and Diverticular Bleeding Undergone Conservative Management.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {4},
pages = {},
pmid = {33917780},
issn = {1648-9144},
mesh = {Activities of Daily Living ; Aftercare ; Aged ; Conservative Treatment ; *Diverticular Diseases ; *Diverticulitis ; Exercise ; Female ; Humans ; Male ; Patient Discharge ; Retrospective Studies ; },
abstract = {Background and Objectives: The role of physical activity (PA) in elderly patients admitted to surgical units for mild acute diverticulitis in the development of disability has not been clarified so far. Our aim is to demonstrate the relationship between physical activity and better post-discharge outcomes on disability in elderly population affected by diverticular disease. Materials and Methods: We retrospectively reviewed data of 56 patients (32 Males-24 females) collected from October 2018 and March 2020 at Cardarelli Hospital in Campobasso. We included patients older than 65 yrs admitted for acute bleeding and acute diverticulitis stage ≤II, characterized by a good independence status, without cognitive impairment and low risk of immobilization, as evaluated by activity of daily living (ADL) and the instrumental activity of daily living (IADL) and Exton-Smith Scale. "Physical Activity Scale for the Elderly" (PASE) Score evaluated PA prior to admission and at first check up visit. Results: 30.4% of patients presented a good PA, 46.4% showed moderate PA and 23.2% a low PA score. A progressive reduction in ADL and IADL score was associated with lower physical activity (p value = 0.0038 and 0.0017). We consider cognitive performance reduction with a cut off of loss of more than 5 points in Short Port of ADL and IADL and a loss of more than 15 points on Exton-Smith Scale, (p-value 0.017 and 0.010). In the logistic regression analysis, which evaluated the independent role of PASE in disability development, statistical significance was not reached, showing an Odds Ratio of 0.51 95% CI 0.25-1.03 p value 0.062. Discussion: Reduced physical activity in everyday life in elderly is associated with increased post-hospitalization disability regarding independence, cognitive performance and immobilization. Conclusions: Poor physical performance diagnosis may allow to perform a standardized multidimensional protocol to improve PA to reduce disability incidence.},
}
@article {pmid33915018,
year = {2021},
author = {, },
title = {Diverticulitis Management, a Snapshot Collaborative Audit Study (DAMASCUS): Protocol for an international, multicentre, prospective observational study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {23},
number = {8},
pages = {2182-2188},
doi = {10.1111/codi.15699},
pmid = {33915018},
issn = {1463-1318},
support = {//Bowel Research Bowel Research UK/ ; },
mesh = {Adult ; *Diverticular Diseases ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; Multicenter Studies as Topic ; Observational Studies as Topic ; Prospective Studies ; },
abstract = {AIM: Diverticular disease is an increasingly common problem in Western society with a variety of treatment options for those presenting with acute diverticulitis, dependent on clinical presentation. Additionally, there is significant international variability in the index management, and few published data on real-world clinical practice. The aim of DAMASCUS is to identify areas of practice variability and their potential association with differences in short- and medium-term clinical outcomes.
METHODS AND ANALYSIS: DAMASCUS is an international, collaborative, prospective observational study, recruiting patients from over 200 sites across six continents. The study opened in October 2020, with a rolling start. Identification of new sites ceased in February 2021 and data collection will cease in August 2021. All adult patients diagnosed with acute diverticulitis (radiologically or intra-operatively) at each participating centre will be included. The primary objective of DAMASCUS is to assess for national and international variability in the presentation and index management of acute diverticulitis (medical, interventional radiology and surgical). Secondary objectives include assessing 30-day and 6-month clinical outcome data (readmission, re-intervention, morbidity and mortality) and variations in surgical procedures for those undergoing surgery. All data will be recorded and managed using a secure REDCap electronic data capture tool and analysed using Stata (SE) version 16.1. The results will be reported in accordance with the STROBE statement.
CONCLUSION: By analysing variations in the management of acute diverticulitis and the subsequent outcomes, DAMASCUS will be an important step towards identifying optimal care for patients with diverticulitis.},
}
@article {pmid33906197,
year = {2021},
author = {Gräfitsch, A and Kirchhoff, P and Soysal, SD and Däster, S and Hoffmann, H},
title = {Dynamic Serosal Perfusion Assessment during Colorectal Resection Using Visible Light Spectroscopy.},
journal = {European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes},
volume = {62},
number = {1},
pages = {25-31},
doi = {10.1159/000514921},
pmid = {33906197},
issn = {1421-9921},
mesh = {Anastomosis, Surgical ; Anastomotic Leak/etiology ; *Colorectal Neoplasms/surgery ; Humans ; Light ; Oxygen Saturation ; *Perfusion ; *Serous Membrane ; Spectrum Analysis ; },
abstract = {INTRODUCTION: Anastomotic leakage (AL) in colorectal surgery occurs with an incidence of up to 20%. Bowel perfusion is deemed to be one of the most important factors for anastomotic healing. However, not much is known about its variability during colorectal surgery and its impact on the outcome. Therefore, this study aims to evaluate serosal oxygen saturation patterns during colorectal resections with visible light spectroscopy (VLS).
MATERIALS AND METHODS: Bowel perfusion in patients undergoing left-sided colorectal resections was assessed at different timepoints during surgery using VLS on the colonic serosa. The primary outcome parameter was serosal oxygen saturation (StO2) at the anastomosis during different timepoints of surgery.
RESULTS: We included 50 patients who underwent colorectal resection for bowel cancer (58%) and diverticular disease (34%). StO2 at the proximal site of the anastomosis increased significantly throughout the surgery (mean difference 3.61%; 95% CI -6.22 to -1.00; p = 0.008). However, aberrancy from this identified perfusion pattern had no impact on the postoperative outcome.
CONCLUSION: During colorectal resections, we could demonstrate an increase of the colonic StO2 throughout surgery. Appearance of AL was not associated with lower StO2, underlining the multifactorial genesis of developing AL.},
}
@article {pmid33905404,
year = {2021},
author = {Araya-Quezada, C and Torres-Bavestrello, L and Gómez-Barbieri, G and Zárate-Castillo, A},
title = {Antibiotics for acute uncomplicated diverticulitis in hospitalized patients.},
journal = {Medwave},
volume = {21},
number = {2},
pages = {e8140},
doi = {10.5867/medwave.2021.02.8140},
pmid = {33905404},
issn = {0717-6384},
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Humans ; Length of Stay ; Recurrence ; Treatment Outcome ; },
abstract = {Introduction: Acute diverticulitis is one of the complications of diverticular disease. Nowadays, there is a paradigm shift regarding the use of antibiotics to manage acute uncomplicated diverticulitis in hospitalized patients, with controversial information about it.
Methods: A search was done in Epistemonikos, the most comprehensive health-related systematic review database, maintained by screening multiple information sources including MEDLINE/PubMed, EMBASE, Cochrane, among others. Data were extracted from the identified systematic reviews, data from primary studies were analyzed, which in this work considered only randomized clinical trials, a meta-analysis was done, and a summary table of results was created using GRADE methodology.
Results and conclusions: Eleven systematic reviews were identified that included seven primary studies in total, of which two were randomized control trials. We concluded that the use of antibiotics in acute uncomplicated diverticulitis could slightly increase complications and result in a minor or no difference in the risk of recurrence and need for urgent surgery. However, the certainty of the evidence is low. Regarding hospital stay and readmission, it was not possible to evaluate the effect due to a low certainty of evidence.},
}
@article {pmid33903930,
year = {2021},
author = {Betzler, A and Grün, J and Finze, A and Reißfelder, C},
title = {[Choice of operative procedure in diverticular disease : Taking the latest treatment strategies into consideration].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {702-706},
pmid = {33903930},
issn = {1433-0385},
mesh = {Anastomosis, Surgical ; Colostomy ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Intestinal Perforation/surgery ; *Laparoscopy ; *Peritonitis/surgery ; Quality of Life ; *Robotic Surgical Procedures ; },
abstract = {BACKGROUND: There are various procedures to be considered in the surgical treatment of complicated diverticulitis, which must be selected depending on the classification of diverticular disease (CDD) type and the condition of the patient.
OBJECTIVE: Comparison of surgical procedures with respect to aspects such as morbidity, mortality, reconstructive surgery and postoperative quality of life.
MATERIAL AND METHODS: Evaluation, analysis and assessment of the current literature on surgical treatment of diverticular disease.
RESULTS: Laparoscopic sigmoid resection with primary anastomosis is now considered the standard procedure for complicated sigmoid diverticulitis. It is preferable to open resection because of the better results of the minimally invasive approach with respect to the incidence of wound infections, abdominal abscesses and the occurrence of fascial dehiscence. In an emergency situation with perforation and peritonitis (CDD type 2c1/2), primary anastomosis with protective ileostomy should be favored over discontinuity resection (Hartmann's procedure). In particular, it must be taken into account that in a large proportion of patients there is no restoration of continuity after Hartmann's operation. The damage control strategy can be used in perforated sigmoid diverticulitis with generalized peritonitis (CDD type 2c1/2). In individual cases, laparoscopic lavage with insertion of a drainage may be considered as a therapeutic treatment strategy for perforated sigmoid diverticulitis with purulent peritonitis (CDD type 2c1).
CONCLUSION: Selection of the surgical procedure for complicated sigmoid diverticulitis remains challenging. Randomized controlled trials of new treatment strategies as well as robotic-assisted surgery should be considered in the choice of surgical procedure in the future.},
}
@article {pmid33889950,
year = {2021},
author = {Adiamah, A and Ban, L and Otete, H and Crooks, CJ and West, J and Humes, DJ},
title = {Outcomes after non-operative management of perforated diverticular disease: a population-based cohort study.},
journal = {BJS open},
volume = {5},
number = {2},
pages = {},
pmid = {33889950},
issn = {2474-9842},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Conservative Treatment ; Databases, Factual ; Diverticular Diseases/*mortality/*therapy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Readmission/*statistics & numerical data ; Risk Factors ; Spontaneous Perforation ; Survival Analysis ; Treatment Outcome ; United Kingdom/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: The management of perforated diverticular disease has changed in the past 10 years with a move towards less surgical intervention. This population-based cohort study aimed to define the risk of death and readmission following non-operative management of perforated diverticular disease.
METHODS: Patients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case fatality, readmissions, and surgery at readmission.
RESULTS: In total, 880 patients with perforated diverticular disease were managed without surgery, comprising 523 women (59.4 per cent). The 1-year case fatality rate was 33.2 per cent (293 of 880). The majority of deaths occurred in the first 90 days after the index admission, with a 90-day case fatality rate of 28.8 per cent. The 90-day survival rate varied by age, and was 97.2 per cent among those aged less than 65 years, compared with 85.0 per cent for those aged between 65 and 74 years, and 47.7 per cent in those at least 75 years old. Of 767 patients discharged from hospital, 250 (32.6 per cent) were readmitted (47 elective, 6.1 per cent; 203 emergency, 26.5 per cent) during a median of 1.6 (i.q.r. 0.1-3.9) years of follow-up, with similar proportions in each age category. In the first year of follow-up, only 5.1 per cent of patients required surgery, of whom 16 of 767 (2.1 per cent) required elective and 23 (3.0 per cent) emergency operation.
CONCLUSION: Non-operative management of perforated diverticulitis in those aged less than 65 years is feasible and safe. Reintervention rates following conservative management were low across all age categories.},
}
@article {pmid33885914,
year = {2021},
author = {Schäfer, AO},
title = {[Diverticular disease: stage-related diagnostic imaging].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {688-693},
pmid = {33885914},
issn = {1433-0385},
mesh = {Acute Disease ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; },
abstract = {BACKGROUND: Diverticular disease frequently leads to emergency admissions. Clinical parameters are not sufficiently accurate to determine the extent of acute colonic diverticulitis, thus a quick, reproducible and valid diagnostic imaging procedure is required.
OBJECTIVE: In the following, the imaging methods commonly used for the diagnostic work-up and staging of diverticulitis are presented and classified in the context of the data situation and clinical reality.
RESULTS: Multidetector computed tomography (MDCT) is the current diagnostic gold standard for the imaging evaluation of diverticulitis and the basis for guideline-conform treatment decisions according to the classification of diverticular disease (CDD).
DISCUSSION: The role of magnetic resonance imaging (MRI) in the evaluation of diverticulitis will have to be investigated but a more profound integration of this method can already be predicted. Point-of-care ultrasound for initial diagnosis and follow-up assessment will become more important, analogous to FAST in trauma patients.},
}
@article {pmid33884606,
year = {2021},
author = {Kargın, S and Tanrıkulu, Y},
title = {Diagnostic and prognostic significance of inflammatory parameters in acute diverticulitis: A retrospective cohort study.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {27},
number = {3},
pages = {325-330},
doi = {10.14744/tjtes.2020.92068},
pmid = {33884606},
issn = {1306-696X},
mesh = {Biomarkers/*blood ; Blood Cell Count/*statistics & numerical data ; C-Reactive Protein/analysis ; *Diverticulitis/blood/diagnosis/physiopathology ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; },
abstract = {BACKGROUND: The optimum biochemical or hematological marker to determine diagnosis and severity of acute diverticulitis has not been established. We aimed to compare the utility of hematological parameters in the diagnosis and severity of acute diverticulitis.
METHODS: Sixty-nine patients in diverticular disease (acute diverticulitis and diverticulosis subgroups) and 36 patients in control group were included in the study. The biochemical analysis performed at the time of diagnosis included white blood cell, mean platelet volume, neutrophil count, platelet count (PLT), C-reactive protein, and calculation of neutrophil count/lymphocyte and PLT/lymphocyte ratios. Patients in the diverticulitis group were divided into four stages according to the Hinchey classification based on abdominal CT findings.
RESULTS: The mean platelet-lymphocyte ratio in the diverticulitis and diverticulosis groups was significantly lower than that in the control group (p<0.05). The best sensitivity and specificity values to distinguish acute diverticulitis and diverticulosis were 63.64% and 72.22% for the neutrophil-lymphocyte ratio (NLR) at a cutoff value of 2.78 and above and 30.30% and 86.11% for the platelet-lymphocyte ratio at a cutoff value of 87.46 and above. The diagnostic accuracy rates to distinguish between the diverticulitis and the control groups that the best sensitivity and specificity values were found to be NLR at a cutoff value of 11.55 and above and 100% and 100% for the platelet-lymphocyte ratio at a cutoff value of 12.28 and above. The NLR values were significantly lower in patients with Hinchey Stage 1 disease than those in patients with Stages 2 and 3 disease (respectively, p=0.003 and p=0.006).
CONCLUSION: NLR and platelet-lymphocyte ratio can serve as useful biomarkers for the differential diagnosis and severity in acute diverticulitis.},
}
@article {pmid33880689,
year = {2021},
author = {Mandavdhare, HS and Praveen Kumar, M and Jha, D and Kumar, A and Sharma, V and Desai, P and Shumkina, L and Gupta, P and Singh, H and Dutta, U},
title = {Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis.},
journal = {Esophagus : official journal of the Japan Esophageal Society},
volume = {18},
number = {3},
pages = {436-450},
pmid = {33880689},
issn = {1612-9067},
abstract = {The traditional way to tackle Zenker's diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.},
}
@article {pmid33867449,
year = {2021},
author = {Tursi, A and Elisei, W and Franceschi, M and Picchio, M and Di Mario, F and Brandimarte, G},
title = {The prevalence of symptomatic uncomplicated diverticular disease could be lower than expected: a single-center colonoscopy-based cohort study.},
journal = {European journal of gastroenterology & hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1097/MEG.0000000000002142},
pmid = {33867449},
issn = {1473-5687},
abstract = {AIM: The real prevalence of symptomatic uncomplicated diverticular disease (SUDD) is still unknown. The aim of this study was to assess the prevalence of SUDD, post-diverticulitis SUDD (PD-SUDD) and irritable bowel syndrome (IBS)-like symptoms in a real-life population.
METHODS: A cohort of patients, submitted to colonoscopy from 1st January 2012 to 30th April 2018 was revised.
RESULTS: A cohort of 5451 patients with diverticulosis was identified during the study period. Abdominal pain was recorded in 1141 patients (20.93%), diarrhea in 288 (5.28%) and constipation in 536 (9.83%) patients. SUDD was recorded in 371 patients (6.81% of the patients having diverticulosis and 32.51% of the patients experiencing abdominal pain), PD-SUDD was recorded in 103 patients (1.89% of the patients having diverticulosis and 9.03% of the patients experiencing abdominal pain) and IBS-like was recorded in 348 patients (6.38% of the patients having diverticulosis and 30.5% of the patients experiencing abdominal pain). Three hundred and nineteen patients were not part of any of the previous categories (5.85% of the patients having diverticulosis and 27.96% of the patients experiencing abdominal pain). SUDD and PD-SUDD were more frequent in older ages (>60 years), while IBS-like symptoms were more frequent in younger. Nonspecific abdominal pain was equally distributed in through the ages.
CONCLUSION: The prevalence of SUDD seems to be lower than expected, and most of patients with diverticulosis and abdominal symptoms may suffer from IBS-like or other causes.},
}
@article {pmid33865277,
year = {2021},
author = {Álvarez-Salafranca, M and Bularca, EA and Rivera-Fuertes, I and Lapeña-Casado, A and Soria-Navarro, J and Espuelas-Monge, M},
title = {Multifocal pyoderma gangrenosum secondary to subclinical diverticulitis: case report and brief literature review.},
journal = {Dermatology online journal},
volume = {27},
number = {3},
pages = {},
pmid = {33865277},
issn = {1087-2108},
mesh = {Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Clindamycin/therapeutic use ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/drug therapy ; Drug Therapy, Combination ; Female ; Glucocorticoids/therapeutic use ; Humans ; Metronidazole/therapeutic use ; Prednisone/therapeutic use ; Pyoderma Gangrenosum/diagnosis/drug therapy/*etiology ; },
abstract = {Pyoderma gangrenosum is characteristically associated with inflammatory bowel disease. However, the association between this neutrophilic dermatosis and diverticular disease is scarcely mentioned in the literature. Diverticulitis should be included in the differential diagnosis in patients with pyoderma gangrenosum and gastrointestinal complaints, or even in asymptomatic patients, particularly in the elderly. Misdiagnosis can lead to inadequate treatments and serious complications.},
}
@article {pmid33852018,
year = {2021},
author = {Leifeld, L and Kruis, W},
title = {[Diverticular disease. Clinical appearance, conservative treatment, primary and secondary prophylaxis].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {683-687},
pmid = {33852018},
issn = {1433-0385},
mesh = {Conservative Treatment ; *Diverticular Diseases/therapy ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging/therapy ; *Diverticulum ; Humans ; Secondary Prevention ; },
abstract = {Diverticula of the colon are very common and usually asymptomatic but 20% of people with diverticulosis develop symptoms and sometimes also complications, such as diverticulitis with abscesses or perforation and bleeding. In the long-term stenoses or a conglomerate can occur. The treatment depends on the type of diverticular disease, on the knowledge of risk indicators and imaging with sonography or computed tomography (CT). The uncomplicated diverticular disease is treated on an outpatient and conservative basis, while complicated diverticular disease is treated on an inpatient basis and often surgically.},
}
@article {pmid33851878,
year = {2021},
author = {Gavriilidis, P and Askari, A and Gavriilidis, E and de'Angelis, N and Di Saverio, S and Wheeler, J and Davies, RJ},
title = {Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {103},
number = {7},
pages = {471-477},
doi = {10.1308/rcsann.2021.0013},
pmid = {33851878},
issn = {1478-7083},
mesh = {Diverticular Diseases/diagnosis/*therapy ; Evidence-Based Medicine/methods/standards ; Gastroenterology/methods/*standards ; Humans ; *Practice Guidelines as Topic ; Societies, Medical/*standards ; Stakeholder Participation ; },
abstract = {INTRODUCTION: Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool.
METHODS: PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument.
FINDINGS: A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain 'Scope and purpose'. The domains 'Clarity and presentation' and 'Editorial independence' both scored a median of 72%. The lowest scores were demonstrated in the domains 'Stakeholder involvement' and 'Applicability' at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of 'Stakeholder involvement' ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%.
CONCLUSION: Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.},
}
@article {pmid33849017,
year = {2021},
author = {Lenti, MV and Aronico, N and Giuffrida, P and Costa, S and Costetti, M and Musacchio, C and Pastorelli, L and Mengoli, C and Borrelli de Andreis, F and Cococcia, S and Tinelli, C and Klersy, C and Vecchi, M and Pilotto, A and Di Sabatino, A},
title = {Multidimensional Prognostic Index Predicts Clinical Outcome and Mortality in Hospitalised Older Patients with Diverticular Disease.},
journal = {Gerontology},
volume = {},
number = {},
pages = {1-9},
doi = {10.1159/000515161},
pmid = {33849017},
issn = {1423-0003},
abstract = {INTRODUCTION: The Multidimensional Prognostic Index (MPI) is a validated tool for assessing mortality risk in hospitalised patients. We aimed to evaluate whether the MPI predicted mortality and the risk of developing diverticular disease (DD) complications in older patients.
METHODS: This is a multicentre study conducted in January 2016-March 2018. All patients with DD aged 65 years and older were included. Patients were stratified into three groups according to MPI groups (1, low risk; 2, moderate risk; 3, high risk). Risk of developing DD complications and mortality rate were assessed. Bivariate models were fitted.
RESULTS: One hundred hospitalised patients with DD (mean age 77.9 ± 10.6 years, 53 female patients) were included. Patients with higher MPI groups were more likely to develop DD complications. In particular, 12 (46.2%), 21 (52.5%), and 28 (82.4%) patients with complicated DD were distributed to the MPI 1, MPI 2, and MPI 3 groups (p = 0.0063), respectively. Two patients died in the MPI 1, 4 in the MPI 2, and 29 in the MPI 3 group, with mortality rates of 4.0 per 100 person-year (95% confidence interval [CI] 1.0-15.9), 5.6 (95% CI 2.1-15.0), and 89.2 (95% CI 62-130), respectively (log-rank test p < 0.001). In bivariate analysis, after adjustment for age >80 years, Charlson Comorbidity Index >4, DD complications, and the presence of thromboembolism, higher MPI group was independently associated with higher mortality. Those in the MPI 3 group experienced a greater risk of 1-year hospital readmission (p < 0.001).
CONCLUSION: MPI predicted mortality in patients with DD and also correlated with the risk of developing DD complications. Studies focussing on possible pathophysiological mechanisms between DD complications and MPI are needed.},
}
@article {pmid33817725,
year = {2020},
author = {Val-Bernal, JF and Mayorga, MM and García-Gutierrez, FJ},
title = {Abdominal elastotic lesions. A clinicopathologic study of 23 cases.},
journal = {Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie},
volume = {61},
number = {3},
pages = {841-851},
pmid = {33817725},
issn = {2066-8279},
mesh = {Aged ; Aged, 80 and over ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Mesentery ; Middle Aged ; *Omentum ; *Soft Tissue Neoplasms ; },
abstract = {Abdominal elastotic deposits are uncommon lesions that often presents as polyps. They show three histological patterns: fibroelastosis, angioelastosis, and elastofibroma. We describe 23 cases including rare locations, such as mesentery, greater omentum, hernia sac, spleen, peripancreatic fat, and hypodermal fat. The age of the patients ranged from 49 to 93 years (mean, 76.8 years). Most lesions were discovered incidentally in the microscopic study. The most frequent locations were peritoneal subserosa (43.5%) and mesentery∕mesocolon∕greater omentum (39.1%). The most common pattern was fibroelastosis (69.6%) followed by angioelastosis (26.1%). We observed one case of omental elastofibroma. A review of the 14 abdominal elastofibromas described including our case revealed that the age of the patients ranged from 45 to 88 years (mean, 68.5 years). Female predominance is striking (M:F, 1:12). The most common site was the stomach (50%). The greater omentum (14.3%), small intestine (7.1%), and pancreas (7.1%) are very rare sites for this lesion. Only one case before ours has been published in the greater omentum. The size of the lesions ranged from 0.7 cm to 8 cm (mean 3.2 cm). In 36.4% of the cases located in the digestive tract, the mucosa did not show alterations. Ulcerations (36.4%) or polypoid excrescences (18.2%) were mostly observed. Six (42.9%) cases were asymptomatic and six (42.9%) cases simulated a neoplasm. Two cases were associated with elastofibromas in other locations. Differential diagnosis includes amyloidoma, elastofibrolipoma, mesenteric elastic vascular sclerosis in neuroendocrine tumors, diverticular disease elastosis, pseudoxanthoma elasticum, pulse granuloma, and digestive lesions in patients treated with D-Penicillamine.},
}
@article {pmid33809208,
year = {2021},
author = {Marafini, I and Salvatori, S and Rocchetti, I and Alfieri, N and Scarozza, P and Calabrese, E and Biancone, L and Monteleone, G},
title = {Natural History of Ulcerative Colitis with Coexistent Colonic Diverticulosis.},
journal = {Journal of clinical medicine},
volume = {10},
number = {6},
pages = {},
pmid = {33809208},
issn = {2077-0383},
abstract = {Ulcerative colitis (UC) and colonic diverticulosis can co-exist in some patients. However, the natural history of UC associated with colonic diverticulosis is not well known. We here compared the disease characteristics and outcome of UC patients with and without concomitant colonic diverticulosis. Medical records of 347 UC patients were included in an observational, retrospective, nested-matched case-control study. Cases were 92 patients with UC and concomitant colonic diverticulosis, while controls were 255 UC patients without concomitant colonic diverticulosis. A propensity score matching (PSM) was used to homogenate cases (n = 92) and controls (n = 153) for age. UC patients with concomitant colonic diverticulosis were less likely to have an extensive disease (25/92, 27.1%) and to experience steroid dependence (8/92, 8.6%) compared to patients without concomitant colonic diverticulosis (70/153, 45.7% and 48/153, 31.3%, respectively; p < 0.001). The use of immunosuppressants (9/92, 9.7% vs. 37/153, 24.1%; p = 0.007) or biologics (3/92, 3.2% vs. 26/153, 16.9%, p < 0.001) was significantly lower in UC patients with concomitant diverticulosis compared to the control group. On multivariate analysis, steroid dependence and extensive colitis were significantly less frequent in UC patients with concomitant colonic diverticulosis compared to UC patients without diverticula. UC patients with coexisting colonic diverticulosis are less likely to have an extensive disease and to be steroid-dependent.},
}
@article {pmid33784697,
year = {2021},
author = {Donlon, NE and Kelly, ME and Zafar, M and Boland, PA and Davis, C and Wei Teh, J and Corless, K and Khan, W and Khan, I and Waldron, R and Barry, K},
title = {The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy.},
journal = {Digestive surgery},
volume = {38},
number = {3},
pages = {230-236},
doi = {10.1159/000514777},
pmid = {33784697},
issn = {1421-9883},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Biomarkers/metabolism ; Diagnosis, Differential ; *Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology ; Gastrointestinal Neoplasms/complications/*diagnosis/metabolism ; Hemoglobins/*metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation.
METHODS: Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT).
RESULTS: In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies.
CONCLUSION: HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.},
}
@article {pmid33769883,
year = {2021},
author = {Burch, J},
title = {Bowel dysfunction after surgery.},
journal = {British journal of nursing (Mark Allen Publishing)},
volume = {30},
number = {6},
pages = {S12-S18},
doi = {10.12968/bjon.2021.30.6.S12},
pmid = {33769883},
issn = {0966-0461},
mesh = {*Gastrointestinal Diseases/nursing ; Humans ; *Postoperative Complications/nursing ; },
abstract = {The functions of the lower parts of the bowel, namely the colon and rectum, are predominantly the absorption of fluids and elimination of faeces and flatus. Bowel surgery may be carried out in the treatment of colorectal cancer, inflammatory bowel disease or diverticular disease, and may involve the formation of a permanent or temporary stoma. The type of colorectal surgery carried out depends on the condition and where the problem occurs. Surgery can alter not only the bowel's anatomy but also its functioning. Bowel dysfunction can manifest as constipation, faecal incontinence or diarrhoea. Nurses are well placed to assist patients to resolve many of these problems as well as stoma issues.},
}
@article {pmid33768926,
year = {2021},
author = {Noyes, JD and Mordi, IR and Zeb, Q and Lang, CC},
title = {Nicorandil-induced colovesical fistula in a patient with diverticular disease.},
journal = {Clinical case reports},
volume = {9},
number = {3},
pages = {1737-1741},
pmid = {33768926},
issn = {2050-0904},
abstract = {Nicorandil's adverse effects can cause severe patient morbidity and can present to any specialty. Those with underlying diverticular disease are most susceptible. Medication reviews are vital for patients presenting with ulcer or fistula symptoms.},
}
@article {pmid33758653,
year = {2021},
author = {Tabone, R and Yuide, P and Burstow, M},
title = {Jejunal perforation secondary to migrated biliary stent.},
journal = {Journal of surgical case reports},
volume = {2021},
number = {3},
pages = {rjab057},
pmid = {33758653},
issn = {2042-8812},
abstract = {An 80-year-old female presented with acute left-sided abdominal pain. Cross-sectional imaging demonstrated a contained perforation around a migrated biliary stent within a large incisional hernia. Significant surgical background included an open cholecystectomy complicated by bile leak and insertion of a biliary stent 2.5 years prior. The stent had migrated at the time of attempted retrieval 10 weeks post-insertion. A decision was made to pursue conservative management after which time she remained asymptomatic until her acute presentation. Emergency laparotomy, adhesiolysis, stent removal, small bowel resection and abdominal wall closure were successfully performed in this case. In the setting of the biliary stent migration, it is important to consider individual patient's risk factors for acute perforation, such as intra-abdominal adhesions or diverticular disease, when deliberating conservative management versus elective surgical intervention for stent retrieval.},
}
@article {pmid33745570,
year = {2021},
author = {Di Pierro, F and Pane, M},
title = {Bifidobacterium longum W11: Uniqueness and individual or combined clinical use in association with rifaximin.},
journal = {Clinical nutrition ESPEN},
volume = {42},
number = {},
pages = {15-21},
doi = {10.1016/j.clnesp.2020.12.025},
pmid = {33745570},
issn = {2405-4577},
mesh = {Adult ; Anti-Bacterial Agents/therapeutic use ; *Bifidobacterium longum ; Humans ; *Irritable Bowel Syndrome/drug therapy ; *Probiotics ; Randomized Controlled Trials as Topic ; Rifaximin/therapeutic use ; },
abstract = {BACKGROUNDS & AIMS: Strains belonging to bifidobacteria have been documented as being helpful in adults with intestinal dysbiosis conditions, like those related to irritable bowel syndrome (IBS). This review aims to present the most relevant evidence regarding the efficacy of Bifidobacterium longum W11, a Bifidobacterium used in clinical settings for conditions such as IBS and inflammatory bowel disease.
METHODS: The following electronic databases were systematically searched up to August 2020: MEDLINE (via PubMed), EMBASE, Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and Clinicaltrials.gov.
RESULTS: Data arising from pooled analysis, 7 in vitro/pharmacological studies, 7 clinical trials including 1 randomized, double-blind and placebo-controlled, showed that the probiotic strain B. longum W11 has been extensively studied for its efficacy in subjects with IBS with constipation, leading to a significant reduction in symptoms. In particular, its role in alleviating constipation was also confirmed in subjects for whom a low-calorie weight-loss diet led to the slowing down of gut motility. The probiotic characteristics of B. longum W11 were further demonstrated in the treatment of minimal hepatic encephalopathy and hepatic disease. The most remarkable trait of B. longum W11 is its non-transmissible antibiotic resistance, due to a nucleotide polymorphism mutation in the rpoB gene, making it resistant to antibiotics of the rifampicin group, including rifaximin. The co-administration of B. longum W11 and rifaximin in patients with symptomatic uncomplicated diverticular disease brought about a further significant improvement in the clinical condition compared to patients treated with rifaximin alone. B. longum W11 is a probiotic which could synergize with rifaximin as an adjuvant to antibiotic treatment.
CONCLUSIONS: Taken altogether these findings demonstrate the clinical role of the strain W11 both in some functional and in some inflammatory bowel diseases.},
}
@article {pmid33744774,
year = {2021},
author = {Khor, S and Flum, DR and Strate, LL and Hantouli, MN and Harris, HM and Lavallee, DC and Spiegel, BM and Davidson, GH},
title = {Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease.},
journal = {The Journal of surgical research},
volume = {264},
number = {},
pages = {20-29},
doi = {10.1016/j.jss.2021.01.045},
pmid = {33744774},
issn = {1095-8673},
support = {R01 DK103915/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Colectomy/*standards ; Diverticulitis, Colonic/complications/diagnosis/psychology/*surgery ; Elective Surgical Procedures/*standards ; Female ; Humans ; Male ; Middle Aged ; Minimal Clinically Important Difference ; *Patient Reported Outcome Measures ; Practice Guidelines as Topic ; Prospective Studies ; *Quality of Life ; Severity of Illness Index ; Surveys and Questionnaires/statistics & numerical data ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease can undermine health-related quality of life. The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure patient-reported burden of diverticular disease. However, values reflecting meaningful improvement (i.e., minimal clinically important difference [MCID]) and the patient acceptable symptom state (PASS) have yet to be established. We sought to establish the MCID and PASS of the DV-QOL and describe the characteristics of those with DV-QOL above the PASS threshold.
MATERIALS AND METHODS: We performed a prospective cohort study of adults with diverticular disease from seven centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 mo. To determine the MCID and PASS for DV-QOL, we applied various previously established distribution- and anchor-based approaches and compared the resulting values.
RESULTS: The study included 177 patients (mean age 57 y, 43% women). A PASS threshold of 3.2/10 distinguished between those with and without health-related quality of life-impacting diverticulitis with acceptable accuracy (area under the curve 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the distribution-based MCIDs and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL ≥ PASS were more often men, younger, had Medicaid, had more serious episodes of diverticulitis, and had an occupational degree or high-school education or less.
CONCLUSIONS: Our study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.},
}
@article {pmid33734549,
year = {2021},
author = {Tay, JYI and Hayes, I and Fisher, T and McMullin, R},
title = {Complicated diverticular disease presenting as recurrent epididymo-orchitis: a case report.},
journal = {ANZ journal of surgery},
volume = {91},
number = {11},
pages = {E703-E705},
doi = {10.1111/ans.16751},
pmid = {33734549},
issn = {1445-2197},
mesh = {*Diverticulum ; *Epididymitis/diagnosis ; Humans ; Male ; *Orchitis/diagnostic imaging/etiology ; },
}
@article {pmid33731593,
year = {2021},
author = {Nehring, P and Gromadzka, G and Giermaziak, A and Jastrzębski, M and Przybyłkowski, A},
title = {Genetic variants of tissue inhibitors of matrix metalloproteinase 1 (rs4898) and 2 (rs8179090) in diverticulosis.},
journal = {European journal of gastroenterology & hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1097/MEG.0000000000002122},
pmid = {33731593},
issn = {1473-5687},
abstract = {INTRODUCTION: Diverticulosis affects approximately 60% of population after 60th year of age. Diverticular disease is symptomatic diverticulosis characterized by abdominal pain, flatulence and bloating, and bowel habits change. Age and lifestyle are risk factors for diverticulosis, additionally genetic predisposition is postulated. The aim of the study was to assess whether tissue inhibitors of matrix metalloproteinase (TIMP) 1 rs4898 and TIMP2 rs8179090 genetic variants are related to colonic diverticulosis.
METHODS: The study included 220 patients, 100 with colon diverticulosis diagnosed on colonoscopy and 120 controls. TIMP1 rs4898 and TIMP2 rs8179090 variants were examined using PCR-restriction fragments length polymorphism from a blood sample.
RESULTS: Allele T of TIMP1 rs4898 was more frequent in male patients with diverticulosis than in controls (P < 0.01), whereas in women there were no differences in its distribution, both in heterozygotes and homozygotes or in homozygotes separately, proving a recessive effect. TIMP2 s8179090 allele G frequency was 0.95 in cases and controls, there were no CC homozygotes identified, and no associations with diverticulosis showed.
CONCLUSION: TIMP1 rs4898 allele T may be a genetic determinant of the risk of diverticulosis in men.},
}
@article {pmid33728590,
year = {2021},
author = {Sell, NM and Stafford, CE and Goldstone, RN and Kunitake, H and Francone, TD and Cauley, CE and Hodin, RA and Bordeianou, LG and Ricciardi, R},
title = {Delay to Intervention for Complicated Diverticulitis is Associated with Higher Inpatient Mortality.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {25},
number = {11},
pages = {2920-2927},
pmid = {33728590},
issn = {1873-4626},
mesh = {Abscess ; *Diverticulitis/complications/surgery ; *Diverticulitis, Colonic/complications/surgery ; Female ; Humans ; Inpatients ; *Intestinal Perforation/etiology/surgery ; },
abstract = {BACKGROUND: Patients with diverticular disease complicated by abscess and/or perforation represent the most severely afflicted with the highest mortality and poorest outcomes. This study investigated patient and operative factors associated with poor outcomes from diverticulitis complicated by abscess or perforation.
METHODS: We analyzed the National Inpatient Sample to identify inpatient discharges for colonic diverticulitis in the United States from 1/1988 to 9/2015. We identified patients with perforation and/or intestinal abscess based on ICD-9 codes. The primary outcome was inpatient mortality.
RESULTS: During the study period, a total of 993,220 patients were discharged with diverticulitis from sampled U.S. hospitals. From this group, 10.7% had an abscess and 1.0% had a perforation associated with diverticular disease. Inpatient mortality of diverticulitis patients with a perforation was 5.4% compared to 1.5% in those without a perforation (p<0.001). Patients with a perforation who underwent surgery had an inpatient mortality of 6.3% vs. 3.0% mortality amongst patients with a perforation who did not undergo an operation (p<0.001). Patients with a perforation that underwent surgery had a 31% increased mortality risk for each day after admission that a procedure was delayed (OR 1.31, CI 1.05-1.78; p=0.03). Mortality risk was increased for patients with either abscess or perforation who underwent surgery if they were female, age ≥65, higher comorbidity, were admitted urgently, underwent peritoneal lavage, or had a post-procedural complication.
CONCLUSIONS: Patients with perforated diverticular disease had substantial associated inpatient mortality compared to those with uncomplicated diverticulitis. This increased risk may be associated with performance of peritoneal lavage or because of a delay to procedural intervention.},
}
@article {pmid33727769,
year = {2021},
author = {Hanna, MH and Kaiser, AM},
title = {Update on the management of sigmoid diverticulitis.},
journal = {World journal of gastroenterology},
volume = {27},
number = {9},
pages = {760-781},
pmid = {33727769},
issn = {2219-2840},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/surgery ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/diagnostic imaging/epidemiology ; Elective Surgical Procedures ; Humans ; *Laparoscopy ; },
abstract = {Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc.) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.},
}
@article {pmid33707231,
year = {2022},
author = {Wauters, L and Clarysse, M and Jochmans, I and Monbaliu, D and Ceulemans, LJ and Verbiest, A and Miserez, M and Lauwers, N and Nys, W and Pauwels, N and Hiele, M and Pirenne, J and Vanuytsel, T},
title = {Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy?.},
journal = {Gut},
volume = {71},
number = {1},
pages = {218-219},
doi = {10.1136/gutjnl-2021-324385},
pmid = {33707231},
issn = {1468-3288},
mesh = {*Diverticulum/complications/surgery ; Humans ; *Jejunal Diseases/diagnosis/etiology/surgery ; Jejunum/surgery ; },
}
@article {pmid33660190,
year = {2021},
author = {Martellotto, S and Challine, A and Peveri, V and Paolino, L and Lazzati, A},
title = {Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018.},
journal = {Techniques in coloproctology},
volume = {25},
number = {5},
pages = {549-558},
pmid = {33660190},
issn = {1128-045X},
mesh = {Adult ; Anastomosis, Surgical ; Cohort Studies ; *Colostomy ; *Diverticulitis, Colonic/epidemiology/surgery ; Humans ; Prospective Studies ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease is a common disorder. Several guidelines report on its optimal management. The aim of this study was to describe the evolution of the prevalence of this disease, the treatment strategies, and the mortality rate on a national level.
METHODS: We conducted a retrospective study on prospective data using a nationwide database. All consecutive adult patients diagnosed with diverticular disease and admitted via the emergency department from 2009 to 2018 were included in the study. We performed a descriptive analysis for epidemiologic data, diagnosis, and treatment.
RESULTS: During the data collection period, 233,386 patients were included in the study. The number of admissions for emergent diverticular disease increased by 65.8%, from 16,754 in 2009 to 27,781 in 2018, for both uncomplicated and complicated diverticular disease. Among these patients, 19,350 (8.3%) were operated on. The rate of surgical treatment progressively decreased from 9.7% in 2009 to 7.6% in 2018. The three main interventions were Hartmann's procedure (HP, n = 9111, 47.1%), resection with primary anastomosis (RPA, n = 4335, 22.4%), and peritoneal lavage (PL, n = 4836, 25%). We observed a progressive annual increase in HPs (n = 716 in 2009 and n = 1055 in 2018) as well as a decline in PLs since 2015, while the number of RPAs remained stable.
CONCLUSIONS: Although admissions for emergent diverticular disease have increased during the study period, the rate of surgical treatment has decreased, suggesting an evolution toward more conservative management of this pathology.},
}
@article {pmid33654361,
year = {2021},
author = {Tursi, A and Franceschi, M and Elisei, W and Picchio, M and Mario, FD and Brandimarte, G},
title = {The natural history of symptomatic uncomplicated diverticular disease: a long-term follow-up study.},
journal = {Annals of gastroenterology},
volume = {34},
number = {2},
pages = {208-213},
pmid = {33654361},
issn = {1108-7471},
abstract = {Background: Symptomatic uncomplicated diverticular disease (SUDD) affects about 20% of patients who have diverticulosis. However, the natural history of SUDD is not yet completely understood. Our aim was to assess the outcomes of a cohort of SUDD patients during a long-term follow up.
Methods: One hundred eighty-five patients suffering from SUDD were identified from a large electronic database. Symptoms assessed were abdominal pain, bloating, bowel movement/day, each of which was scored using a visual analogic scale (VAS); the symptom score was calculated by considering the value of the worst symptom present during assessment. Another VAS was used to assess patients' quality of life (QoL). Patients were treated at the physician's discretion (with rifaximin, mesalazine, probiotics, spasmolytics) only when symptoms occurred during the follow up. Follow-up visit was performed every year or whenever patients consider it necessary.
Results: During the follow up (156 months, interquartile range 9-171), 47 patients were lost to follow up. Among these, 9 died from causes not related to SUDD. Acute diverticulitis occurred in 14 patients (7.6% of the overall population): 6 patients (3.2% of the overall population) underwent surgery, and 2 patients (1.1% of the overall population) died because of peritonitis. Both the symptom score and the QoL score were substantially unmodified during the study period.
Conclusions: SUDD is an important disease able to affect patients significantly in the long term. Acute diverticulitis may sometimes occur in these patients, often leading to surgery with possible severe complications.},
}
@article {pmid33648505,
year = {2021},
author = {Papier, K and Fensom, GK and Knuppel, A and Appleby, PN and Tong, TYN and Schmidt, JA and Travis, RC and Key, TJ and Perez-Cornago, A},
title = {Meat consumption and risk of 25 common conditions: outcome-wide analyses in 475,000 men and women in the UK Biobank study.},
journal = {BMC medicine},
volume = {19},
number = {1},
pages = {53},
pmid = {33648505},
issn = {1741-7015},
support = {205212/Z/16/Z/WT_/Wellcome Trust/United Kingdom ; C8221/A29017/CRUK_/Cancer Research UK/United Kingdom ; C8211/A19170/CRUK_/Cancer Research UK/United Kingdom ; C60192/A28516/CRUK_/Cancer Research UK/United Kingdom ; 2019/1953/CRUK_/Cancer Research UK/United Kingdom ; MR/M012190/1//Medical Research Foundation/ ; },
mesh = {Animals ; Biological Specimen Banks ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Red Meat/*adverse effects ; Risk Factors ; United Kingdom ; },
abstract = {BACKGROUND: There is limited prospective evidence on the association between meat consumption and many common, non-cancerous health outcomes. We examined associations of meat intake with risk of 25 common conditions (other than cancer).
METHODS: We used data from 474,985 middle-aged adults recruited into the UK Biobank study between 2006 and 2010 and followed up until 2017 (mean follow-up 8.0 years) with available information on meat intake at baseline (collected via touchscreen questionnaire), and linked hospital admissions and mortality data. For a large sub-sample (~ 69,000), dietary intakes were re-measured three or more times using an online, 24-h recall questionnaire.
RESULTS: On average, participants who reported consuming meat regularly (three or more times per week) had more adverse health behaviours and characteristics than participants who consumed meat less regularly, and most of the positive associations observed for meat consumption and health risks were substantially attenuated after adjustment for body mass index (BMI). In multi-variable adjusted (including BMI) Cox regression models corrected for multiple testing, higher consumption of unprocessed red and processed meat combined was associated with higher risks of ischaemic heart disease (hazard ratio (HRs) per 70 g/day higher intake 1.15, 95% confidence intervals (CIs) 1.07-1.23), pneumonia (1.31, 1.18-1.44), diverticular disease (1.19, 1.11-1.28), colon polyps (1.10, 1.06-1.15), and diabetes (1.30, 1.20-1.42); results were similar for unprocessed red meat and processed meat intakes separately. Higher consumption of unprocessed red meat alone was associated with a lower risk of iron deficiency anaemia (IDA: HR per 50 g/day higher intake 0.80, 95% CIs 0.72-0.90). Higher poultry meat intake was associated with higher risks of gastro-oesophageal reflux disease (HR per 30 g/day higher intake 1.17, 95% CIs 1.09-1.26), gastritis and duodenitis (1.12, 1.05-1.18), diverticular disease (1.10, 1.04-1.17), gallbladder disease (1.11, 1.04-1.19), and diabetes (1.14, 1.07-1.21), and a lower IDA risk (0.83, 0.76-0.90).
CONCLUSIONS: Higher unprocessed red meat, processed meat, and poultry meat consumption was associated with higher risks of several common conditions; higher BMI accounted for a substantial proportion of these increased risks suggesting that residual confounding or mediation by adiposity might account for some of these remaining associations. Higher unprocessed red meat and poultry meat consumption was associated with lower IDA risk.},
}
@article {pmid33647346,
year = {2021},
author = {Saavedra-Perez, D and Curbelo-Peña, Y and Sampson-Davila, J and Albertos, S and Serrano, A and Ibañez, L and Errando, X and Perez, X},
title = {Management of symptomatic uncomplicated diverticular colon disease: A systematic review of diagnosis and treatment.},
journal = {Gastroenterologia y hepatologia},
volume = {44},
number = {7},
pages = {497-518},
doi = {10.1016/j.gastrohep.2020.12.016},
pmid = {33647346},
issn = {0210-5705},
abstract = {Symptomatic uncomplicated diverticular colon disease (SUDCD) is a highly prevalent disease in our setting, which significantly affects the quality of life of patients. Recent changes in understanding the natural history of this disease and technological and pharmacological advances have increased the available options for both diagnosis and treatment. However, consensus regarding the use of these options is scarce and sometimes lacks scientific evidence. The objective of this systematic review is to clarify the existing scientific evidence and analyse the use of the different diagnostic and therapeutic options for SUDCD, comparing their advantages and disadvantages, to finally suggest a diagnostic-therapeutic algorithm for this pathology and, at the same time, propose new research questions.},
}
@article {pmid33642952,
year = {2021},
author = {Wood, EH and Sigman, MM and Hayden, DM},
title = {Special Situations in the Management of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {121-126},
pmid = {33642952},
issn = {1531-0043},
abstract = {Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.},
}
@article {pmid33642951,
year = {2021},
author = {Madiedo, A and Hall, J},
title = {Minimally Invasive Management of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {113-120},
pmid = {33642951},
issn = {1531-0043},
abstract = {Traditionally, management of complicated diverticular disease has involved open damage control operations with large definitive resections and colostomies. Studies are now showing that in a subset of patients who would typically have undergone an open Hartmann's procedure for Hinchey III/IV diverticulitis, a laparoscopic approach is equally safe, and has better outcomes. Similar patients may be good candidates for primary anastomosis to avoid the morbidity and subsequent reversal of a colostomy. While most operations for diverticulitis across the country are still performed open, there has been an incremental shift in practice toward minimally invasive approaches in the elective setting. The most recent data from large trials, most notably the SIGMA trial, found laparoscopic sigmoid colectomy is associated with fewer short-term and long-term complications, decreased pain, improvement in length of stay, and maintains better cost-effectiveness than open resections. Some studies even demonstrate that robotic sigmoid resections can maintain a similar if not more reduction in morbidity as the laparoscopic approach while still remaining cost-effective. Intraoperative approaches also factor into improving outcomes. One of the most feared complications in colorectal surgery is anastomotic leak, and many studies have sought to find ways to minimize this risk. Factors to consider to minimize incidence of leak are the creation of tension-free anastomoses, amount of contamination, adequacy of blood supply, and a patient's use of steroids. Techniques supported by data that decrease anastomotic leaks include preoperative oral antibiotic and mechanical bowel prep, intraoperative splenic flexure mobilization, low-tie ligation of the inferior mesenteric artery, and use of indocyanine green immunofluorescence to assess perfusion. In summary, the management of benign diverticular disease is shifting from open, morbid operations for a very common disease to a minimally invasive approach. In this article, we review those approaches shown to have better outcomes, greater patient satisfaction, and fewer complications.},
}
@article {pmid33642949,
year = {2021},
author = {Coakley, KM and Davis, BR and Kasten, KR},
title = {Complicated Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {96-103},
pmid = {33642949},
issn = {1531-0043},
abstract = {The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.},
}
@article {pmid33642947,
year = {2021},
author = {Langenfeld, SJ},
title = {Evaluation and Medical Management of Uncomplicated Diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {86-90},
pmid = {33642947},
issn = {1531-0043},
abstract = {Uncomplicated diverticulitis is common, and its evaluation and treatment have evolved over time. Most patients present in a nontoxic manner with localized pain, leukocytosis, and reliable findings on computed tomography (CT). Healthy and stable patients are typically treated in the outpatient setting with very high rates of success. Recently, the necessity of antibiotic therapy has come into question, and several alternative agents have emerged, with the jury still out on their relative roles in diverticular disease. Currently, colonoscopy is still recommended after the resolution of an index episode of uncomplicated diverticulitis, and recurrence rates remain low. Several diet and lifestyle modifications have been shown to impact the rates of diverticulitis recurrence.},
}
@article {pmid33642946,
year = {2021},
author = {Talutis, SD and Kuhnen, FAH},
title = {Pathophysiology and Epidemiology of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {81-85},
pmid = {33642946},
issn = {1531-0043},
abstract = {Diverticular disease exists on a spectrum, ranging from asymptomatic diverticulosis to complicated diverticulitis. Incidence of diverticulitis in western nations has increased in recent years, although the factors that influence the progression from diverticulosis to diverticulitis are unknown. Geographic/environmental influences, lifestyle variables, and microbiota of the gastrointestinal tract are some of the factors implicated in diverticular disease.},
}
@article {pmid33607699,
year = {2021},
author = {Jerjen, F and Zaidi, T and Chan, S and Sharma, A and Mudliar, R and Soomro, K and Jimenez, Y and Reed, W},
title = {Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use.},
journal = {Journal of medical radiation sciences},
volume = {68},
number = {3},
pages = {310-319},
pmid = {33607699},
issn = {2051-3909},
mesh = {Australia ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging/therapy ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; },
abstract = {Diverticular disease is one of the most common causes of outpatient visits and hospitalisations across Australia, North America and Europe. According to the Gastroenterological Society of Australia (GESA, 2010), approximately 33% of Australians over 45 years of age and 66% over 85 years of age have some form of colonic diverticulosis. Patients with colonic diverticulosis are known to develop subsequent complications such as acute colonic diverticulitis (ACD), and when more than one attack of diverticulitis occurs, there is a 70-90% chance that the individual will experience ongoing problems and recurring infections throughout their lifetime. Medical imaging is fundamental in the diagnosis, treatment and ongoing management of ACD and its complications, with Computed Tomography (CT) identified as the prevailing gold standard in the last few decades. Cross-database searching highlighted a large gap in the literature regarding the effectiveness of Magnetic Resonance Imaging (MRI) as a non-ionising radiation alternative imaging tool for ACD imaging after the mid-2000s, despite ongoing technological advancements in this modality. This narrative review identified 13 key publications (11 primary prospective cohort studies, 1 systematic review and 1 meta-analysis) that evaluate MRI for ACD imaging, of which five were published within the last decade. Several existing MRI protocols are deemed suitable for ACD imaging, and it is recommended they be re-evaluated in larger cohorts. Future studies should consider the rapidly growing technological improvements of MRI, its cost efficiency and its applicability in modern day healthcare settings when addressing ACD management. This is especially important considering the gradual rise in radiation dose among the Australian population attributable to increased CT referrals, alongside increased reporting of ACD cases in younger individuals.},
}
@article {pmid33606074,
year = {2021},
author = {Wirth, U and Schardey, J and von Ahnen, T and Zimmermann, P and Kühn, F and Werner, J and Schardey, HM and Rau, BM and Gumpp, J},
title = {Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease.},
journal = {International journal of colorectal disease},
volume = {36},
number = {8},
pages = {1667-1676},
pmid = {33606074},
issn = {1432-1262},
mesh = {Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Decontamination ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Retrospective Studies ; },
abstract = {PURPOSE: There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers.
METHODS: Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease.
RESULTS: Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL.
CONCLUSION: Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.},
}
@article {pmid33595203,
year = {2021},
author = {Kameyama, H and Yamazaki, T and Iwaya, A and Uehara, H and Utsumi, S and Hirai, M and Komatsu, M and Kubota, A and Katada, T and Kobayashi, K and Sato, D and Yokoyama, N and Kuwabara, S and Otani, T},
title = {Surgical approach for right-sided colonic diverticular bleeding: A single-center review of 43 consecutive cases.},
journal = {Asian journal of endoscopic surgery},
volume = {14},
number = {4},
pages = {717-723},
doi = {10.1111/ases.12929},
pmid = {33595203},
issn = {1758-5910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colon/surgery ; *Diverticular Diseases ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {INTRODUCTION: While Asian populations develop colonic diverticular disease predominantly in the right colon, Western populations mainly present with left-sided disease. The present study aimed to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding.
METHODS: Medical records of 43 patients who underwent surgery for right-sided colonic diverticular bleeding between 2010 and 2019 were reviewed. Those whose general condition became unstable underwent open surgery at our institution. Patients were then divided into two groups, the open surgery group (n = 17) and laparoscopic surgery group (n = 26), after which operative outcomes between both groups were compared.
RESULTS: This study included 36 men and seven women with a median age of 76 (range: 37-91) years. Laparoscopic surgery had a significantly longer operative time (183.5 minutes vs 110 minutes; P < .001) and significantly lower intraoperative blood transfusion rate (19.2% vs 82.4%; P < .001) than open surgery. The laparoscopic surgery group had earlier resumption of postoperative meals than open surgery group (postoperative day 3 vs postoperative day 4; P = .010). No significant difference in postoperative complications was observed between both groups. With regard to long-term outcomes, none of the cases exhibited rebleeding from the right-sided colon.
CONCLUSION: The present study revealed that laparoscopic surgery promoted lower intraoperative blood transfusion rates and earlier resumption of postoperative meals compared to open surgery for right-sided colonic diverticular bleeding. Hence, laparoscopic surgery can be feasible for right-sided colonic diverticular bleeding provided that the patient's general condition is stable.},
}
@article {pmid33594008,
year = {2021},
author = {Altomare, A and Gori, M and Cocca, S and Carotti, S and Francesconi, M and Ribolsi, M and Emerenziani, S and Perrone, G and Morini, S and Cicala, M and Guarino, MPL},
title = {Impaired Colonic Contractility and Intestinal Permeability in Symptomatic Uncomplicated Diverticular Disease.},
journal = {Journal of neurogastroenterology and motility},
volume = {27},
number = {2},
pages = {292-301},
pmid = {33594008},
issn = {2093-0879},
abstract = {Background/Aims: Impaired intestinal motility seems to play a crucial role in symptomatic uncomplicated diverticular disease (SUDD), although the mechanism is not clear. The aim of the present study is to explore the contractility patterns of colonic smooth muscle strips (MS) and smooth muscle cells (SMCs) and to assess mucosal integrity in SUDD patients.
Methods: MS or SMCs were isolated from specimens of human distal colon of 18 patients undergoing surgery for non-obstructive colonic cancer, among them 9 with SUDD. Spontaneous phasic contractions on strips and morpho-functional parameters on cells were evaluated in basal conditions and in response to acetylcholine (ACh). Mucosal integrity of SUDD colonic biopsies was evaluated by the Ussing Chamber system. Immunohistochemical staining for tight junction protein complex and for Toll-like receptor 4 (TLR4) was performed.
Results: Colonic MS of SUDD group showed a significant reduced basal tone and ACh-elicited contraction, compared to the control group (9.5 g and 47.0% in the SUDD group; 14.16 g and 69.0% in the control group; P < 0.05). SMCs of SUDD group showed a maximal contractile response to ACh significantly reduced compared to control group (8.8% vs 16.5%, P < 0.05). SUDD patients displayed lower transepithelial electrical resistance and increased paracellular permeability compared to control group. Immunohistochemical expression of TLR4 was not different in both groups, while tight junction protein complex expression was lower in SUDD patients compared to control group patients.
Conclusion: It could be hypothesized that in SUDD, in absence of severe inflammation, an increased intestinal mucosal permeability is related to altered colonic motility probably responsible for symptoms genesis.},
}
@article {pmid33592411,
year = {2021},
author = {Faye, PM and Pichvirackboth, D and Abousarhan, F and Mahfoud, A and Sirbu, V and Zaccharia, A and Khaddam, Y and Cagniet, A and Jolidon, C},
title = {Spontaneous colo-vesical and colo-cutaneous fistula complicating a sigmoid diverticulitis: A case report.},
journal = {International journal of surgery case reports},
volume = {80},
number = {},
pages = {105598},
doi = {10.1016/j.ijscr.2021.01.092},
pmid = {33592411},
issn = {2210-2612},
abstract = {INTRODUCTION: Diverticular disease is a challenge in western countries. The occurrence of fistula complicating diverticulitis is uncommon. As a result, spontaneous and synchronous colo-vesical and colo-cutaneous is an even rarer situation.
CASE PRESENTATION: We report the case of a 68 years old patient with medical history of bilateral inguinal hernia surgery and diverticular disease. He was admitted for fecal fistula through to the left inguinal area and recurrent urinary tract infections evolving for 2 months. Clinical examination revealed fecaluria and colo-cutaneous fistula. Abdominal CT scan revealed the presence of air in the bladder associated with fistula tract between the sigmoid colon and the inguinal abdominal wall. Surgical management was realized in two stages. The first stage, consisting to an end-colostomy, was performed. The second stage will be laparoscopic colectomy and is not yet realized. In the follow-up, the patient is doing well with a good quality of life.
CONCLUSION: Spontaneous colo-vesical and colo-cutaneous fistula is an uncommon complication of diverticulitis. There is no guidelines about the management and the treatment should be tailored according to each patient characteristics. Laparoscopic surgery is a feasible and safe approach in the treatment.},
}
@article {pmid33583126,
year = {2021},
author = {Skajaa, N and Schønfeldt Troelsen, F and Pedersen, L and Ekholm, O and Strate, LL and Erichsen, R and Sørensen, HT},
title = {Statins and risk of diverticular disease: Nested case-control study.},
journal = {Pharmacoepidemiology and drug safety},
volume = {30},
number = {6},
pages = {770-778},
doi = {10.1002/pds.5205},
pmid = {33583126},
issn = {1099-1557},
support = {R01 DK101495/DK/NIDDK NIH HHS/United States ; },
mesh = {Case-Control Studies ; *Diverticular Diseases ; Humans ; *Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Logistic Models ; Odds Ratio ; Risk Factors ; },
abstract = {BACKGROUND: Statins exert pleiotropic anti-inflammatory effects and may prevent diverticular disease. However, the association remains poorly understood with previous studies obtaining conflicting results.
AIMS: To examine the effect of statin on the subsequent risk of diverticular disease.
METHODS: We conducted a nested case-control study in Denmark among respondents (>18 years) of the 2010 or the 2013 Danish National Health Survey. Among these, we identified 8809 cases of hospital-diagnosed diverticular disease and risk-set sampled population controls without diverticular disease. Using complete prescription and hospital records, we used conditional logistic regression to compute odds ratios (ORs) associating statin use with diverticular disease. In adjusted analyses, we controlled for hospital-based diagnoses, medication use other than statins, and lifestyle and socioeconomic factors.
RESULTS: The fully adjusted OR for diverticular disease associated with ever use (≥1 statin prescription filling) was 1.19 (95% CI: 1.12-1.27) compared with never use. However, we observed no dose-response relation. For example, among short-term users (<5 years), the OR was 1.18 (95% CI: 1.04-1.35) for low intensity users and 1.13 (95% CI: 1.01-1.26) for high intensity users. Among long-term users (≥5 years), the respective ORs were 1.25 (95% CI: 1.13-1.38) and 1.11 (95% CI: 0.98-1.24). In analyses restricting to cases and controls with a previous colonoscopy, associations were null (OR: 1.01 [95% CI: 0.85-1.20]).
CONCLUSIONS: The observed association of a higher risk of diverticular disease associated with statins could be explained by diagnostic bias. Our study did not support a protective nor harmful effect of statins on the risk of diverticular disease.},
}
@article {pmid33554945,
year = {2020},
author = {Antropoli, M and Fusco, F and Brillantino, A and Lanza, M and Monte, G and Cricrì, AM and Scardi, F and Ciorra, FR and Marra, E and Castriconi, M},
title = {Treatment of acute diverticulitis with open abdomen technique.},
journal = {Annali italiani di chirurgia},
volume = {91},
number = {},
pages = {705-708},
pmid = {33554945},
issn = {2239-253X},
mesh = {Aged ; Anastomosis, Surgical ; Colostomy ; *Diverticulitis, Colonic/complications/surgery ; Humans ; *Open Abdomen Techniques ; Peritonitis ; },
abstract = {AIM: The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy.
MATERIALS AND METHODS: Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy.
RESULTS: No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment.
DISCUSSION: Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera.
CONCLUSION: The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy.
KEY WORDS: Diverticulitis, Damage Control Surgery, Open Abdomen.},
}
@article {pmid33551820,
year = {2020},
author = {Rizea-Savu, S and Duna, SN and Sandulovici, RC},
title = {Single Dose Study Assessing the Pharmacokinetic and Metabolic Profile of Alverine Citrate in Healthy Volunteers.},
journal = {Frontiers in pharmacology},
volume = {11},
number = {},
pages = {620451},
pmid = {33551820},
issn = {1663-9812},
abstract = {Alverine citrate is a spasmolytic commonly prescribed in conditions such as irritable bowel syndrome, painful diverticular disease of the colon, and primary dysmenorrhea. While clinical efficacy data on alverine alone or in combination with simethicone is freely available, surprisingly little information regarding the pharmacokinetics and metabolism of alverine can be found in literature. The first HPLC-MS/MS analytical protocol for determination of alverine parent, 4-hydroxy alverine, N-desethyl alverine and 4-hydroxy alverine glucuronide in human plasma was developed and validated. The two validated methods were used for analyzing plasma samples collected during an open label, non-comparative, single dose, one-period, one-treatment, pharmacokinetic and metabolic profile study of Spasmonal® Forte 120 mg hard capsule, conducted in 12 fasting healthy male and female volunteers of Caucasian descent. The study confirmed previous suspicions that parent alverine is subject to high pharmacokinetic variability and also revealed that the metabolic process most susceptible to outlying performance in Caucasians is hydroxylation to the active metabolite 4-hydroxy alverine. Another interesting observation made is that alverine parent accounts for only 3%, whereas total 4-hydroxy alverine (free and conjugated) accounts for 94% of alverine-related moieties in circulation (based on comparisons of total exposure).},
}
@article {pmid33548127,
year = {2021},
author = {Makar, M and Pisano, TJ and Xia, W and Greenberg, P and Patel, AV},
title = {The Impact of Obesity on Mortality and Clinical Outcomes in Patients with Acute Diverticulitis in the United States.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {30},
number = {1},
pages = {73-80},
doi = {10.15403/jgld-2988},
pmid = {33548127},
issn = {1842-1121},
mesh = {Aged, 80 and over ; *Diverticular Diseases ; *Diverticulitis/diagnosis/therapy ; Hospital Mortality ; Hospitalization ; Humans ; Length of Stay ; *Obesity, Morbid ; Retrospective Studies ; United States/epidemiology ; },
abstract = {BACKGROUND AND AIMS: Diverticular disease represents a leading cause of gastrointestinal-related hospitalizations. We sought to identify the adverse consequences of obesity on acute diverticulitis (AD) hospital admissions. By age 85, approximately two-thirds of individuals will develop diverticular disease and up to 25% will develop AD. Generally, obesity confers an increased risk of morbidity and mortality; however, its impact on hospitalized patients with AD are lacking.
METHODS: Utilizing ICD-9-CM codes from the National Inpatient Sample (January 2012 - October 2015) we identified patients with a primary discharge diagnosis of AD including 660,820 hospitalizations and 115,785 with obesity. Primary outcomes were mortality, length of stay, and hospitalization cost. Secondary outcomes were AD complications and the need for surgical interventions.
RESULTS: On multivariate analysis, obesity was not associated with an increased risk of mortality (OR=1.1, 95%CI: 0.87-1.41; p= 0.43). However, morbid obesity (BMI > 40 kg/m2) showed a significant increased risk of mortality (OR=1.69, 95%CI: 1.23-2.31; p<0.001). Obesity was associated with prolonged hospitalizations length of stay by 0.61 days (0.55-0.68; p <10-6), higher hospital charges $6,320 ($ 5,500-7,140; p<10-6), increased complicated diverticulitis 1.05 (1.01-1.1; p < 0.010) and required more surgical interventions for diverticulitis (OR=1.19, 95%CI: 1.15-1.23; p<10-6).
CONCLUSION: Morbid obesity increases risk for mortality while obesity leads to longer hospitalization stays and greater healthcare cost as well as adverse clinical outcomes and more surgical interventions. Further interventions are required to address obesity and weight loss for patients with diverticulitis to improve clinical outcomes.},
}
@article {pmid33539644,
year = {2021},
author = {Serra-Aracil, X and Mora-Lopez, L and Gomez-Torres, I and Pallisera-Lloveras, A and Serra-Pla, S and Serracant, A and Garcia-Nalda, A and Pino-Perez, O and Navarro-Soto, S},
title = {Minimal invasive surgery for left colectomy adapted to the COVID-19 pandemic: laparoscopic intracorporeal resection and anastomosis, a 'don't touch the bowel' technique.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {23},
number = {6},
pages = {1562-1568},
doi = {10.1111/codi.15562},
pmid = {33539644},
issn = {1463-1318},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; COVID-19/epidemiology/*prevention & control/transmission ; Colectomy/*methods ; Colonic Diseases/*surgery ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional/*prevention & control ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; },
abstract = {AIM: The COVID-19 pandemic has forced surgeons to adapt their standard procedures. The modifications introduced are designed to favour minimally invasive surgery. The positive results obtained with intracorporeal resection and anastomosis in the right colon and rectum prompt us to adapt these procedures to the left colon. We describe a 'don't touch the bowel' technique and outline the benefits to patients of the use of less surgically aggressive techniques and also to surgeons in terms of the lower emission of aerosols that might transmit the COVID-19 infection.
METHODS: This was an observational study of intracorporeal resection and anastomosis in left colectomy. We describe the technical details of intracorporeal resection, end-to-end stapled anastomosis and extraction of the specimen through mini-laparotomy in the ideal location.
RESULTS: We present preliminary results of 17 patients with left-sided colonic pathologies, 15 neoplasia and two diverticular disease, who underwent four left hemicolectomies, six sigmoidectomies and seven high anterior resections. Median operating time was 186 min (range 120-280). No patient required conversion to extracorporeal laparoscopy or open surgery. Median hospital stay was 4.7 days (range 3-12 days). There was one case of anastomotic leak managed with conservative treatment.
CONCLUSION: Intracorporeal resection and end-to-end anastomosis with the possibility of extraction of the specimen by a mini-laparotomy in the ideal location may present benefits and also adapts well to the conditions imposed by the COVID-19 pandemic. Future comparative studies are needed to demonstrate these benefits with respect to extracorporeal anastomosis.},
}
@article {pmid33535255,
year = {2021},
author = {Meyer, S and Schmidbauer, M and Wacker, FK and Ringe, KI},
title = {To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {193},
number = {7},
pages = {804-812},
doi = {10.1055/a-1339-2157},
pmid = {33535255},
issn = {1438-9010},
mesh = {Aged ; Colonic Diseases/classification/*diagnostic imaging ; *Contrast Media ; Diverticular Diseases/classification/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; },
abstract = {PURPOSE: To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon.
MATERIALS AND METHODS: 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k).
RESULTS: 224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748-0.861).
CONCLUSION: Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD.
KEY POINTS: · CT has a high sensitivity and specificity for diagnosis of DD.. · CT staging using the CDD algorithm correlates very well with surgery.. · Positive rectal contrast administration does not improve diagnosis and radiological staging..
CITATION FORMAT: · Meyer S, Schmidbauer M, Wacker FK et al. To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804 - 812.},
}
@article {pmid33506932,
year = {2021},
author = {De Bastiani, R and Sanna, G and Bertolusso, L and Casella, G and De Polo, M and Zamparella, M and Cottone, C and Tosetti, C and Mancuso, M and Pirrotta, E and Lanzarotto, L and Napoli, L and De Bastiani, M and Disclafani, G and Gambaro, P and Scoglio, R and Belvedere, A and Fasulo, S and D'Urso, M and Benedetto, E and Baldi, E and Marchesan, F and Abagnale, G and Turnava, L and Salomè, E and Ingravalle, F and Tursi, A},
title = {General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic.},
journal = {European review for medical and pharmacological sciences},
volume = {25},
number = {1},
pages = {423-430},
doi = {10.26355/eurrev_202101_24410},
pmid = {33506932},
issn = {2284-0729},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Colon/*drug effects/pathology ; Diverticular Diseases/*drug therapy/pathology ; Female ; *General Practitioners ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rifaximin/*therapeutic use ; },
abstract = {OBJECTIVE: Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs.
PATIENTS AND METHODS: This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10.
RESULTS: 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group.
CONCLUSIONS: Rifaximin can be effectively used by GPs in real-life for the management of SUDD.},
}
@article {pmid33505462,
year = {2021},
author = {Manigrasso, M and Pesce, M and Milone, M and Anoldo, P and D'Amore, A and Galasso, G and Gennarelli, N and Maione, F and Vertaldi, S and Sarnelli, G and De Palma, GD},
title = {Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease.},
journal = {Gastroenterology research and practice},
volume = {2021},
number = {},
pages = {8940682},
pmid = {33505462},
issn = {1687-6121},
abstract = {A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.},
}
@article {pmid33504050,
year = {2021},
author = {Viscido, A and Ciccone, F and Vernia, F and Gabrieli, D and Capannolo, A and Stefanelli, G and Necozione, S and Valerii, G and Ashktorab, H and Latella, G},
title = {Association of Colonic Diverticula with Colorectal Adenomas and Cancer.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {2},
pages = {},
pmid = {33504050},
issn = {1648-9144},
mesh = {*Adenoma/complications/epidemiology ; Aged ; *Colonic Polyps/complications/epidemiology ; Colonoscopy ; *Colorectal Neoplasms/complications/epidemiology ; *Diverticulum, Colon/complications/epidemiology ; Humans ; Male ; },
abstract = {Background and Objectives: Conflicting evidence is reported regarding any association between colonic diverticula with colorectal adenomas or cancer. The present study aimed to evaluate, in a cohort of Caucasian patients, the association between colonic diverticula and colorectal polyps and cancer. Materials and Methods: All consecutive patients undergoing colonoscopy at our institution were included in the study. The presence and location of diverticula, polyps, and cancers were recorded. Histologically, polyps were classified as adenoma (with low or high dysplasia), hyperplastic, or inflammatory. The relative risk of the association of polyps and cancer with diverticula was assessed. Multiple logistic regression analyses, including age, sex, family history for colorectal cancer (CRC), and family history for diverticula, were carried out. Results: During the study period, 1490 patients were enrolled; 37.2% (n = 555) showed colonic diverticula or polyps or CRC (308 males, mean age 66 years). Particularly, 12.3% (n = 183) patients presented only diverticula, 13.7% (n = 204) only polyps or cancer, 11.3% (n = 168) both diseases, and 62.7% (n = 935) neither diverticula nor polyps and cancer. A total of 38 patients presented colorectal cancer, 17 of which had also diverticula. A significant increase in relative risk (RR 2.81, 95% CI 2.27-3.47, p < 0.0001) of colorectal adenoma and cancer in patients with colonic diverticula was found. At multivariate analysis, only diverticula resulted to be significantly associated with colorectal adenomas and cancer (Odds Ratio, OR 3.86, 95% CI 2.90-5.14, p < 0.0001). Conclusions: A significant association of colonic diverticula with colorectal adenoma or cancer was found. This implies that patients with colonic diverticula require a vigilant follow-up procedure for the prevention of colorectal cancer from those applicable to the general population.},
}
@article {pmid33497515,
year = {2021},
author = {Goh, B and Harbison, A and Sufyan, W and Thomas, S},
title = {Perforated jejunal diverticular disease: an uncommon cause of the acute surgical abdomen.},
journal = {ANZ journal of surgery},
volume = {91},
number = {9},
pages = {E608-E609},
doi = {10.1111/ans.16618},
pmid = {33497515},
issn = {1445-2197},
mesh = {Abdomen ; *Abdomen, Acute ; *Diverticulum/complications/diagnostic imaging/surgery ; Humans ; *Intestinal Perforation/diagnostic imaging/etiology ; *Jejunal Diseases/diagnostic imaging/etiology/surgery ; },
}
@article {pmid33494679,
year = {2021},
author = {BaŞtuğ, BT},
title = {Computed Tomographic Evaluation of Colonic Diverticulum Complications.},
journal = {Current medical imaging},
volume = {17},
number = {9},
pages = {1054-1058},
doi = {10.2174/1573405617666210120091547},
pmid = {33494679},
issn = {1573-4056},
mesh = {Colon ; *Diverticular Diseases/complications ; *Diverticulitis ; *Diverticulum, Colon/complications ; Humans ; Tomography, X-Ray Computed ; },
abstract = {Cases of diverticulosis of the colon continue to increase, especially in the Western countries. In these countries, two-thirds of the population older than 70 years of age are considered to experience this disease. Medical and surgical treatment for diverticulosis actually begun for the complications of diverticulitis and lower gastrointestinal hemorrhage. The first evaluation of complicated diverticular disease is based on patient's history, physical examination, and laboratory data. But all these exams and data can be inaccurate and are often questionable in the diagnoses of many features of the disease. To describe the position, severity, and presence of complications of a detected diverticulum is crucial to its appropriate treatment. The greater part of the patients have mild disease and can be successfully cured medically. Only a small number of patients admit with acute diverticulitis and need urgent surgical intervention. Determining these patients early is crucial to morbidity and mortality reduction. Radiologic examination is important for exact evaluation of the extent of the course of the disease over the last three decades. This article aims to chart the place of the Computed Tomography (CT) imaging procedure in the assessment of acute complicated diverticular disease.},
}
@article {pmid33477073,
year = {2021},
author = {Perez, AR and Chiong-Perez, ME and Arcilla, CE and Merin, JI},
title = {Colouterine fistula: A case report of a rare complication of diverticular disease managed during the pandemic.},
journal = {International journal of surgery case reports},
volume = {79},
number = {},
pages = {150-155},
doi = {10.1016/j.ijscr.2021.01.036},
pmid = {33477073},
issn = {2210-2612},
abstract = {INTRODUCTION AND IMPORTANCE: Colouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive.
CASE PRESENTATION: We are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann's procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications.
CLINICAL DISCUSSION: Colouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions.
CONCLUSION: This case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.},
}
@article {pmid33443079,
year = {2021},
author = {Doberer, K and Duerr, M and Halloran, PF and Eskandary, F and Budde, K and Regele, H and Reeve, J and Borski, A and Kozakowski, N and Reindl-Schwaighofer, R and Waiser, J and Lachmann, N and Schranz, S and Firbas, C and Mühlbacher, J and Gelbenegger, G and Perkmann, T and Wahrmann, M and Kainz, A and Ristl, R and Halleck, F and Bond, G and Chong, E and Jilma, B and Böhmig, GA},
title = {A Randomized Clinical Trial of Anti-IL-6 Antibody Clazakizumab in Late Antibody-Mediated Kidney Transplant Rejection.},
journal = {Journal of the American Society of Nephrology : JASN},
volume = {32},
number = {3},
pages = {708-722},
pmid = {33443079},
issn = {1533-3450},
mesh = {Adult ; Allografts ; Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use ; Double-Blind Method ; Female ; Glomerular Filtration Rate ; Graft Rejection/immunology/physiopathology/*therapy ; Humans ; Infections/etiology ; Interleukin-6/*antagonists & inhibitors/immunology ; Isoantibodies/blood ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Tissue Donors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Late antibody-mediated rejection (ABMR) is a leading cause of transplant failure. Blocking IL-6 has been proposed as a promising therapeutic strategy.
METHODS: We performed a phase 2 randomized pilot trial to evaluate the safety (primary endpoint) and efficacy (secondary endpoint analysis) of the anti-IL-6 antibody clazakizumab in late ABMR. The trial included 20 kidney transplant recipients with donor-specific, antibody-positive ABMR ≥365 days post-transplantation. Patients were randomized 1:1 to receive 25 mg clazakizumab or placebo (4-weekly subcutaneous injections) for 12 weeks (part A), followed by a 40-week open-label extension (part B), during which time all participants received clazakizumab.
RESULTS: Five (25%) patients under active treatment developed serious infectious events, and two (10%) developed diverticular disease complications, leading to trial withdrawal. Those receiving clazakizumab displayed significantly decreased donor-specific antibodies and, on prolonged treatment, modulated rejection-related gene-expression patterns. In 18 patients, allograft biopsies after 51 weeks revealed a negative molecular ABMR score in seven (38.9%), disappearance of capillary C4d deposits in five (27.8%), and resolution of morphologic ABMR activity in four (22.2%). Although proteinuria remained stable, the mean eGFR decline during part A was slower with clazakizumab compared with placebo (-0.96; 95% confidence interval [95% CI], -1.96 to 0.03 versus -2.43; 95% CI, -3.40 to -1.46 ml/min per 1.73 m2 per month, respectively, P=0.04). During part B, the slope of eGFR decline for patients who were switched from placebo to clazakizumab improved and no longer differed significantly from patients initially allocated to clazakizumab.
CONCLUSIONS: Although safety data indicate the need for careful patient selection and monitoring, our preliminary efficacy results suggest a potentially beneficial effect of clazakizumab on ABMR activity and progression.},
}
@article {pmid33433072,
year = {2021},
author = {Bracale, U and Peltrini, R and DI Nuzzo, MM and Altieri, G and Silvestri, V and Dolce, P and D'Ambra, M and Lionetti, R and Corcione, F},
title = {Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results.},
journal = {Minerva surgery},
volume = {76},
number = {4},
pages = {310-315},
doi = {10.23736/S2724-5691.20.08645-9},
pmid = {33433072},
issn = {2724-5438},
mesh = {Anastomotic Leak ; Colectomy/adverse effects ; *Diverticular Diseases ; Humans ; *Mesenteric Artery, Inferior/surgery ; Retrospective Studies ; },
abstract = {BACKGROUND: The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The aim of this study was to investigate the risk of colorectal anastomosis bleeding when IMA is resected or preserved during left colectomy.
METHODS: A retrospective study of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020 were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two groups: IMA resected (IMA-R) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared.
RESULTS: Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; P=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group.
CONCLUSIONS: IMA preserving left colectomy seems to be associated with a higher risk of mostly self-limited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.},
}
@article {pmid33412260,
year = {2021},
author = {Brand, DH and Brüningk, SC and Wilkins, A and Fernandez, K and Naismith, O and Gao, A and Syndikus, I and Dearnaley, DP and Tree, AC and van As, N and Hall, E and Gulliford, S and , },
title = {Estimates of Alpha/Beta (α/β) Ratios for Individual Late Rectal Toxicity Endpoints: An Analysis of the CHHiP Trial.},
journal = {International journal of radiation oncology, biology, physics},
volume = {110},
number = {2},
pages = {596-608},
pmid = {33412260},
issn = {1879-355X},
support = {7253/CRUK_/Cancer Research UK/United Kingdom ; C1491/A9895/CRUK_/Cancer Research UK/United Kingdom ; C1491/A15955/CRUK_/Cancer Research UK/United Kingdom ; C1491/A25351/CRUK_/Cancer Research UK/United Kingdom ; SP2312/021/CRUK_/Cancer Research UK/United Kingdom ; /DH_/Department of Health/United Kingdom ; },
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anal Canal/physiopathology/radiation effects ; Diarrhea/complications ; Dose Fractionation, Radiation ; Gastrointestinal Hemorrhage/complications ; Humans ; Linear Models ; Male ; Middle Aged ; Organs at Risk/*radiation effects ; Outcome Assessment, Health Care ; Probability ; Proctitis/complications ; Prostatic Neoplasms/*radiotherapy ; Radiation Injuries/complications ; *Radiation Tolerance ; Rectum/diagnostic imaging/*radiation effects ; Urethral Stricture/complications ; },
abstract = {PURPOSE: Changes in fraction size of external beam radiation therapy exert nonlinear effects on subsequent toxicity. Commonly described by the linear-quadratic model, fraction size sensitivity of normal tissues is expressed by the α/β ratio. We sought to study individual α/β ratios for different late rectal effects after prostate external beam radiation therapy.
METHODS AND MATERIALS: The CHHiP trial (ISRCTN97182923) randomized men with nonmetastatic prostate cancer 1:1:1 to 74 Gy/37 fractions (Fr), 60 Gy/20 Fr, or 57 Gy/19 Fr. Patients in the study had full dosimetric data and zero baseline toxicity. Toxicity scales were amalgamated to 6 bowel endpoints: bleeding, diarrhea, pain, proctitis, sphincter control, and stricture. Lyman-Kutcher-Burman models with or without equivalent dose in 2 Gy/Fr correction were log-likelihood fitted by endpoint, estimating α/β ratios. The α/β ratio estimate sensitivity was assessed using sequential inclusion of dose modifying factors (DMFs): age, diabetes, hypertension, inflammatory bowel or diverticular disease (IBD/diverticular), and hemorrhoids. 95% confidence intervals (CIs) were bootstrapped. Likelihood ratio testing of 632 estimator log-likelihoods compared the models.
RESULTS: Late rectal α/β ratio estimates (without DMF) ranged from bleeding (G1 + α/β = 1.6 Gy; 95% CI, 0.9-2.5 Gy) to sphincter control (G1 + α/β = 3.1 Gy; 95% CI, 1.4-9.1 Gy). Bowel pain modelled poorly (α/β, 3.6 Gy; 95% CI, 0.0-840 Gy). Inclusion of IBD/diverticular disease as a DMF significantly improved fits for stool frequency G2+ (P = .00041) and proctitis G1+ (P = .00046). However, the α/β ratios were similar in these no-DMF versus DMF models for both stool frequency G2+ (α/β 2.7 Gy vs 2.5 Gy) and proctitis G1+ (α/β 2.7 Gy vs 2.6 Gy). Frequency-weighted averaging of endpoint α/β ratios produced: G1 + α/β ratio = 2.4 Gy; G2 + α/β ratio = 2.3 Gy.
CONCLUSIONS: We estimated α/β ratios for several common late adverse effects of rectal radiation therapy. When comparing dose-fractionation schedules, we suggest using late a rectal α/β ratio ≤ 3 Gy.},
}
@article {pmid33409567,
year = {2021},
author = {Mastoraki, A and Schizas, D and Tousia, A and Chatzopoulos, G and Gkiala, A and Syllaios, A and Frountzas, M and Vassiliu, P and Theodoropoulos, GE and Felekouras, E},
title = {Evaluation of molecular and genetic predisposing parameters at diverticular disease of the colon.},
journal = {International journal of colorectal disease},
volume = {36},
number = {5},
pages = {903-910},
pmid = {33409567},
issn = {1432-1262},
mesh = {Colon ; *Diverticular Diseases/genetics ; *Diverticulitis ; *Diverticulitis, Colonic/genetics ; *Diverticulum ; *Gastrointestinal Microbiome ; Humans ; },
abstract = {BACKGROUND: Diverticular disease (DD) refers to the presence of diverticula throughout the gastrointestinal (GI) tract, mainly along colon. DD might evolve into diverticulitis that is accompanied by severe clinical presentation, which includes abscess formation, perforation, stricture, obstruction and/or fistula.
AIM: The aim of the present review is to summarize the role of molecular and genetic factors in DD development, as well as their possible contribution towards new prognostic indicators, diagnostic algorithms and new therapeutic approaches.
METHODS AND RESULTS: Except from common predisposing parameters, several genetic mutations, immune factors, neurotransmitters, hormones and protein dysfunctions have been associated to the early onset of DD symptoms, pathogenesis and prognosis of the disease. Specific structural changes in the colonic wall, altered matrix composition and compromised motility have been verified as possible pathogenic factors for the development of DD. Dysregulation in peristaltic activity and reduced ability of the longitudinal muscle to relax following contraction has been also associated with DD evolution. In addition, it has been suspected that genetic defects combined with alterations in intestinal microbiota might play an important role in diverticulitis presentation.},
}
@article {pmid33408751,
year = {2020},
author = {Giacosa, A and Riva, A and Petrangolini, G and Allegrini, P and Fazia, T and Bernardinelli, L and Gasparri, C and Faliva, MA and Peroni, G and Perna, S and Rondanelli, M},
title = {Symptomatic uncomplicated diverticular disease management: an innovative food-grade formulation of Curcuma longa and Boswellia serrata extracts.},
journal = {Drugs in context},
volume = {9},
number = {},
pages = {},
pmid = {33408751},
issn = {1745-1981},
abstract = {Background: The treatment of symptomatic uncomplicated colonic diverticular disease (SUDD) is still under debate, and new data show a pathogenic role of dysbiosis and low-grade inflammation in intestinal mucosa. Recent research has highlighted the anti-inflammatory effects of botanical extracts such as Curcuma longa L. and Boswellia serrata Roxb. ex Colebr. The aim of this work is to investigate the potential role of a new delivery formulation of the association of curcumin and boswellia phytosome extracts (CBP) in SUDD.
Methods: In a 30-day one-group longitudinal explanatory study, patients (men and women) were treated with an innovative association of CBP standardized extracts, 500 mg bid.
Results: Treatment of SUDD with the association of CBP was followed by a significant decrease in abdominal pain (p<0.0001). The study group showed that CBP supplementation was efficacious within 10 days and that efficacy was maintained almost constant until the 30th day of intervention.
Conclusion: A phytosome of curcumin and boswellia extracts may be useful for the relief of SUDD pain. However, controlled studies should be performed for final conclusions to be drawn.},
}
@article {pmid33407154,
year = {2021},
author = {Yoshida, A and Uchima, Y and Hosaka, N and Minaga, K and Kudo, M},
title = {Transverse colonic volvulus due to mesenteric fibromatosis: a case report.},
journal = {BMC gastroenterology},
volume = {21},
number = {1},
pages = {11},
pmid = {33407154},
issn = {1471-230X},
mesh = {*Colon, Transverse/diagnostic imaging/surgery ; *Colonic Diseases ; Female ; *Fibroma ; Humans ; *Intestinal Obstruction ; *Intestinal Volvulus/diagnostic imaging/etiology/surgery ; Middle Aged ; },
abstract = {BACKGROUND: Colonic volvulus, a condition in which a colonic segment partially twists around its base, is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. However, volvulus of the transverse colon is the rarest type of large intestinal volvulus. Moreover, the occurrence of transverse colonic volvulus secondary to a benign tumor originating from outside the intestine has never been reported. We hereby report a case of transverse colonic volvulus caused by mesenteric fibromatosis.
CASE PRESENTATION: A 53-year-old female with a history of rheumatoid arthritis and thyroid tumor presented with abdominal pain for 1 day. Abdominal computed tomography revealed intestinal torsion at the hepatic flexure. Twisted and obstructed mucosa of the transverse colon was observed during colonoscopy, but no tumor invasion of the mucosal surface was detected. A solid mass of a mesenteric origin with involvement of the transverse colon was observed during surgery. The mass was diagnosed surgically as transverse colonic volvulus induced by a mesenteric tumor. Hence, the patient underwent a right hemicolectomy. Histopathological results indicated mesenteric desmoid-type fibromatosis. The postoperative recovery was uneventful, and the patient was discharged 8 days after surgery.
CONCLUSIONS: Although mesenteric fibromatosis is rare, this disease should be considered when managing transverse colonic volvulus resulting from nonmucosal tumors.},
}
@article {pmid33386566,
year = {2021},
author = {Kobayashi, S and Sugiura, K and Miyake, H and Yuasa, N and Yoshikawa, K and Fujino, M},
title = {Mucosal prolapse syndrome-like inflammatory polyp protruding from the appendiceal orifice masquerading as an appendiceal neoplasm: A rare case report.},
journal = {Clinical journal of gastroenterology},
volume = {14},
number = {3},
pages = {787-790},
pmid = {33386566},
issn = {1865-7265},
mesh = {*Appendiceal Neoplasms/diagnostic imaging/surgery ; *Appendix/diagnostic imaging ; *Diverticulitis ; Humans ; Inflammation ; Male ; Middle Aged ; Prolapse ; },
abstract = {We describe a case of a mucosal prolapse syndrome (MPS)-like inflammatory polyp protruding from the appendiceal orifice, mimicking an appendiceal neoplasm. A 48-year-old man presented with lower abdominal pain and elevated white blood cell count and C-reactive protein level. Computed tomography showed a swollen appendix with multiple small saccular lesions and periappendiceal fat stranding and small saccular lesions in the ascending colon and cecum. Ultrasonography showed a swollen appendix 25 mm in diameter with multiple saccular structures and a periappendiceal high-echoic area, suggesting appendiceal diverticulitis. Colonoscopy revealed an erythematous lesion protruding from the appendiceal orifice. An ileocecal resection was performed based on a preoperative diagnosis of appendiceal diverticulitis and tumor. Histopathological examination of the appendix showed multiple mucosal herniations with infiltration of inflammatory cells, indicating appendiceal diverticulitis. The tumor was characterized by glandular duct hyperplasia and stromal expansion with smooth muscle hyperplasia and was diagnosed as an inflammatory polyp resembling an MPS lesion. Although several studies have shown the macroscopic and endoscopic appearance of MPS-like inflammatory lesions associated with colonic diverticular disease, this case was the first to present an inflammatory polyp associated with appendiceal diverticulitis in which the lesion protruding from the appendiceal orifice was masquerading as an appendiceal neoplasm.},
}
@article {pmid33364886,
year = {2020},
author = {Demircioglu, MK and Demircioglu, ZG and Celayir, MF and Kaya, C and Mihmanli, M},
title = {The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.},
journal = {Sisli Etfal Hastanesi tip bulteni},
volume = {54},
number = {4},
pages = {451-456},
pmid = {33364886},
issn = {1302-7123},
abstract = {Objectives: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients.
Methods: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed.
Results: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis.
Conclusion: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.},
}
@article {pmid33362446,
year = {2020},
author = {Sammartino, F and Selvaggio, I and Montalto, GM and Pasecinic, C and Dhimolea, S and Krizzuk, D},
title = {Acute Abdomen in a 91-Year-Old Male due to Perforated Jejunal Diverticulitis.},
journal = {Case reports in gastroenterology},
volume = {14},
number = {3},
pages = {598-603},
pmid = {33362446},
issn = {1662-0631},
abstract = {Non-Meckel small intestine diverticular disease is a rare and mostly asymptomatic condition. However, rare cases of acute and emergent complications bear a high mortality rate. We report a case of a 91-year-old male that presented with an acute abdomen due to perforated jejunal diverticulitis. A review of the literature and key points of the condition are depicted. Although jejunal diverticulosis is rare, it must be considered in the differential diagnosis, especially in the elderly with signs of ambiguous abdominal pain and peritonitis.},
}
@article {pmid33306534,
year = {2021},
author = {Hunt, CW and Chaturvedi, R and Brown, L and Stafford, C and Cauley, CE and Goldstone, RN and Francone, TD and Kunitake, H and Bordeianou, L and Ricciardi, R},
title = {Diverticular Disease Epidemiology: Rising Rates of Diverticular Disease Mortality Across Developing Nations.},
journal = {Diseases of the colon and rectum},
volume = {64},
number = {1},
pages = {81-90},
pmid = {33306534},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Databases, Factual ; Developed Countries/statistics & numerical data ; Developing Countries/economics/*statistics & numerical data ; Diet/statistics & numerical data ; Diverticular Diseases/economics/*mortality ; Female ; Global Health/economics/statistics & numerical data ; Health Expenditures/statistics & numerical data ; *Health Status Disparities ; Humans ; Male ; Middle Aged ; Overweight/economics/epidemiology ; World Health Organization ; },
abstract = {BACKGROUND: The incidence of diverticular disease is growing in the Western world. However, the global burden of disease is unknown in the developing world.
OBJECTIVE: This study aimed to determine the global burden of diverticular disease as measured by disease-specific mortality while identifying indicators of rising disease rates.
DESIGN: We undertook an ecological analysis based on data from the World Health Organization Mortality Database. Then, we analyzed global age-adjusted mortality rates from diverticular disease and compared them to national rates of overweight adults, health expenditures, and dietary composition.
SETTINGS: National vital statistics data were collected.
PATIENTS: Diverticular disease deaths from January 1, 1994 through December 31, 2016 were evaluated.
MAIN OUTCOME MEASURES: The primary outcome measured was the national age-adjusted mortality rate.
RESULTS: The average age-adjusted mortality rate for diverticular disease was 0.51 ± 0.31/100,000 with a range of 0.11 to 1.75/100,000. During the study period, we noted that 57% of nations had increasing diverticular disease mortality rates, whereas only 7% had decreasing rates. More developed nations (40%) than developing nations (24%) were categorized as having high diverticular disease mortality burden over the time period of the study, and developed nations had higher percentages of overweight adults (58.9 ± 3.1%) than developing nations (50.6 ± 6.7%; p < 0.0001). However, developing nations revealed more rapid increases in diverticular disease mortality (0.027 ± 0.024/100,000 per year) than developed nations (0.005 ± 0.025/100,000 per year; p = 0.001), as well as faster expanding proportions of overweight adults (0.76 ± 0.12% per year) than in already developed nations (0.53 ± 0.10% per year; p<0.0001).
LIMITATIONS: Ecological studies cannot define cause and effect.
CONCLUSIONS: There is considerable variability in diverticular disease mortality across the globe. Developing nations were characterized by rapid increases in diverticular disease mortality and expanding percentages of overweight adults. Public health interventions in developing nations are needed to alter mortality rates from diverticular disease. See Video Abstract at http://links.lww.com/DCR/B397. EPIDEMIOLOGÍA DE LA ENFERMEDAD DIVERTICULAR: TASAS CRECIENTES DE MORTALIDAD POR ENFERMEDAD DIVERTICULAR EN LOS PAÍSES EN DESARROLLO: La incidencia de la enfermedad diverticular está creciendo en el mundo occidental. Sin embargo, la carga mundial de la enfermedad es desconocida en el mundo en desarrollo.Determinar la carga global de la enfermedad diverticular medida por la mortalidad específica de la enfermedad mientras se identifican los indicadores de aumento de las tasas de enfermedad.Realizamos un análisis ecológico basado en datos de la Base de datos de mortalidad de la Organización Mundial de la Salud. Luego, analizamos las tasas globales de mortalidad ajustadas por edad por enfermedad diverticular y las comparamos con las tasas nacionales de adultos con sobrepeso, gastos de salud y composición dietética.Datos nacionales de estadísticas vitales.Muertes por enfermedades diverticulares desde el 1 de enero de 1994 hasta el 31 de diciembre de 2016.Tasa nacional de mortalidad ajustada por edad.La tasa promedio de mortalidad ajustada por edad para la enfermedad diverticular fue de 0,51 ± 0,31 / 100,000 con un rango de 0,11 a 1,75 / 100,000. Durante el período de estudio, notamos que el 57% de las naciones tenían tasas crecientes de mortalidad por enfermedades diverticulares, mientras que solo el 7% tenían tasas decrecientes. Las naciones más desarrolladas (40%) que las naciones en desarrollo (24%) se clasificaron como que tienen una alta carga de mortalidad por enfermedad diverticular durante el período de tiempo del estudio, y las naciones desarrolladas tuvieron porcentajes más altos de adultos con sobrepeso (58.9 ± 3.1%) que las naciones en desarrollo (50,6 ± 6,7%) (p <0,0001). Sin embargo, las naciones en desarrollo revelaron aumentos más rápidos en la mortalidad por enfermedades diverticulares (0.027 ± 0.024 / 100,000 por año) que las naciones desarrolladas (0.005 ± 0.025 / 100,000 por año) (p = 0.001), así como proporciones de adultos con sobrepeso en expansión más rápida (0.76 ± 0.12% por año) que en las naciones ya desarrolladas (0.53 ± 0.10% por año) (p <0.0001).Los estudios ecológicos no pueden definir causa y efecto.Existe una considerable variabilidad en la mortalidad por enfermedad diverticular en todo el mundo. Los países en desarrollo se caracterizaron por un rápido aumento en la mortalidad por enfermedades diverticulares y porcentajes crecientes de adultos con sobrepeso. Se necesitan intervenciones de salud pública en los países en desarrollo para alterar las tasas de mortalidad por enfermedad diverticular. Consulte Video Resumen en http://links.lww.com/DCR/B397.},
}
@article {pmid33294164,
year = {2020},
author = {Ghandour, R and Khalifeh, G and Orm, NB and Rakka, M and Dbouk, S and El Sahili, R and Mcheimeche, H},
title = {Jejunal diverticular disease: a report of three cases.},
journal = {Journal of surgical case reports},
volume = {2020},
number = {11},
pages = {rjaa472},
pmid = {33294164},
issn = {2042-8812},
abstract = {Jejunal diverticula (JD) are a rare medical entity. They are often unnoticed, until complications occur. We report herein three cases of such diverticula, analyzed retrospectively, and depicting some of these complications: small bowel obstruction due to enterolith in a giant diverticulum treated surgically, incidental intraoperative finding on an anastomotic jejunal limb affecting the surgical plan and diverticulitis with anemia. In all three cases, the diagnosis of JD was unexpected, which illustrates the importance of being familiar with this disease for adequate management.},
}
@article {pmid33279517,
year = {2021},
author = {Peery, AF and Shaukat, A and Strate, LL},
title = {AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review.},
journal = {Gastroenterology},
volume = {160},
number = {3},
pages = {906-911.e1},
pmid = {33279517},
issn = {1528-0012},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/*therapeutic use ; Aspirin/therapeutic use ; Cardiovascular Diseases/etiology/prevention & control ; Colon/diagnostic imaging/drug effects/immunology/pathology ; Colonoscopy ; Diagnosis, Differential ; Diet Therapy/methods/*standards ; Diverticulitis, Colonic/complications/diagnosis/genetics/*therapy ; Evidence-Based Medicine/methods/*standards ; Gastroenterology/methods/*standards ; Humans ; Intestinal Mucosa/diagnostic imaging/drug effects/immunology/pathology ; Meta-Analysis as Topic ; Observational Studies as Topic ; Patient Education as Topic/standards ; Randomized Controlled Trials as Topic ; Secondary Prevention/methods ; Severity of Illness Index ; Societies, Medical/standards ; Systematic Reviews as Topic ; United States ; },
abstract = {Colonic diverticulitis is a painful gastrointestinal disease that recurs unpredictably and can lead to chronic gastrointestinal symptoms. Gastroenterologists commonly care for patients with this disease. The purpose of this Clinical Practice Update is to provide practical and evidence-based advice for management of diverticulitis. We reviewed systematic reviews, meta-analyses, randomized controlled trials, and observational studies to develop 14 best practices. In brief, computed tomography is often necessary to make a diagnosis. Rarely, a colon malignancy is misdiagnosed as diverticulitis. Whether patients should have a colonoscopy after an episode of diverticulitis depends on the patient's history, most recent colonoscopy, and disease severity and course. In patients with a history of diverticulitis and chronic symptoms, alternative diagnoses should be excluded with both imaging and lower endoscopy. Antibiotic treatment can be used selectively rather than routinely in immunocompetent patients with mild acute uncomplicated diverticulitis. Antibiotic treatment is strongly advised in immunocompromised patients. To reduce the risk of recurrence, patients should consume a high-quality diet, have a normal body mass index, be physically active, not smoke, and avoid nonsteroidal anti-inflammatory drug use except aspirin prescribed for secondary prevention of cardiovascular disease. At the same time, patients should understand that genetic factors also contribute to diverticulitis risk. Patients should be educated that the risk of complicated diverticulitis is highest with the first presentation. An elective segmental resection should not be advised based on the number of episodes. Instead, a discussion of elective segmental resection should be personalized to consider severity of disease, patient preferences and values, as well as risks and benefits.},
}
@article {pmid33237324,
year = {2021},
author = {Ur Rahman, A and Hussain, I and Hasan, B and Ur Rashid, M and Tandon, KS and Castro, F},
title = {Association of Complicated Diverticulitis With Development of De Novo Inflammatory Bowel Disease.},
journal = {Inflammatory bowel diseases},
volume = {27},
number = {7},
pages = {1061-1067},
doi = {10.1093/ibd/izaa299},
pmid = {33237324},
issn = {1536-4844},
abstract = {BACKGROUND: There has been a historic similarity in the epidemiology and pathophysiology of diverticular disease and inflammatory bowel disease (IBD). Because there are limited to no data on the role of diverticulitis as a potential risk factor for de novo IBD, we aimed to evaluate the role of diverticulitis and complicated diverticulitis as a potential predictor of IBD.
METHODS: We performed a retrospective, single-center study including patients older than age 18 years who were diagnosed with diverticulitis from January 2012 until December 2018 without a prior diagnosis of IBD. These patients were then evaluated for development of IBD. Univariate and multivariate analyses were conducted to compare the characteristics and outcomes between patients who did or did not develop IBD.
RESULTS: A total of 2770 patients were diagnosed with diverticulitis from 2012 until 2018. Of these patients, 17 were diagnosed with IBD, resulting in an incidence rate of 0.23% per patient-year. The incidence rate among patients who required surgery for diverticulitis was 0.44% per patient-year, and patients with complicated diverticulitis had an incidence rate of 0.91% per patient-year. Univariate analysis showed that the need for surgery related to diverticulitis (hazard ratio [HR], 6.27; P = 0.003) and complicated diverticulitis was associated with the development of IBD (HR, 14.71; P < 0.001). Multivariate analysis showed that complicated diverticulitis was the sole factor associated with IBD (HR, 10.34; P < 0.001).
CONCLUSIONS: Patients with diverticulitis are at a higher risk of developing de novo IBD. This risk is highest in patients with complicated diverticulitis.},
}
@article {pmid33216498,
year = {2020},
author = {Sell, NM and Perez, NP and Stafford, CE and Chang, D and Bordeianou, LG and Francone, TD and Kunitake, H and Ricciardi, R},
title = {Are There Variations in Mortality From Diverticular Disease By Sex?.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {9},
pages = {1285-1292},
doi = {10.1097/DCR.0000000000001711},
pmid = {33216498},
issn = {1530-0358},
mesh = {Abdominal Abscess/epidemiology/*mortality ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Cohort Studies ; Diverticulitis, Colonic/*mortality ; Female ; Hospices ; Hospitals ; Humans ; Intestinal Fistula/epidemiology/mortality ; Intestinal Obstruction/epidemiology/*mortality ; Intestinal Perforation/epidemiology/mortality ; Male ; Middle Aged ; Nursing Homes ; Pelvis ; Retrospective Studies ; Sepsis/epidemiology/*mortality ; Sex Distribution ; Sex Factors ; United States/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Previous data reveal that females account for a disproportionate majority of all patients diagnosed with diverticulitis.
OBJECTIVE: This study analyzed the variation in mortality from diverticular disease by sex.
DESIGN: This was a nationwide retrospective cohort study.
SETTINGS: Data were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research national registry.
PATIENTS: All citizens of the United States who died from an underlying cause of death of diverticulitis between January 1999 and December 2016 were included.
MAIN OUTCOME MEASURES: The primary outcome addressed was overall mortality rate of diverticulitis by sex. Secondary outcomes included pattern variances in demographics and secondary causes of death.
RESULTS: During the study period, 55,096 patients (0.12%) died with an underlying cause of death of diverticulitis from a total of 44,915,066 deaths. Compared with other causes, females were disproportionally more likely to die from diverticulitis than males (0.17% females vs 0.08% males; p < 0.001). Age-adjusted incidence of death was higher for females compared with males. Female patients were less likely to die within the hospital compared with males (OR = 0.72 (95% CI, 0.69-0.75); p < 0.001). Conversely, female patients were more likely to die either at nursing homes or hospice facilities (OR = 1.64 (95% CI, 1.55-1.73); p < 0.001). In addition, females with an underlying cause of death of diverticulitis were less likely to have a surgical complication as their secondary cause of death (OR = 0.72 (95% CI, 0.66-0.78); p < 0.001) but more likely to have nonsurgical complications related to diverticulitis such as sepsis (OR = 1.04 (95% CI, 1.01-1.05); p < 0.03), nonsurgical GI disorders such as obstruction (OR = 1.16 (95% CI, 1.09-1.24); p < 0.001), or chronic pelvic fistulizing disease (OR = 1.43 (95% CI, 1.23-1.66); p < 0.001).
LIMITATIONS: The study was limited by a lack of more specific clinical data.
CONCLUSIONS: Females have a higher incidence of diverticular disease mortality. Their deaths are more commonly secondary to nonsurgical infections, obstruction, or pelvic fistulae. Female patients represent a particularly vulnerable population that may benefit from more intensive diverticulitis evaluation. See Video Abstract at http://links.lww.com/DCR/B257. ¿EXISTEN VARIACIONES EN LA MORTALIDAD POR ENFERMEDAD DIVERTICULAR POR GÉNERO?: Los datos anteriores revelan que las mujeres representan una mayoría desproporcionada de todos los pacientes diagnosticados con diverticulitis.Este estudio analizó la variación en la mortalidad por enfermedad diverticular por género.Estudio de cohorte retrospectivo a nivel nacional.Los datos se obtuvieron del registro nacional WONDER del Centro de Control de Enfermedades.Se incluyeron todos los ciudadanos de los Estados Unidos que murieron por una causa subyacente de muerte (UCOD por sus siglas en inglés) de diverticulitis del 1 / 1999-12 / 2016.El resultado primario abordado fue la tasa de mortalidad general de la diverticulitis por género. Los resultados secundarios incluyeron variaciones de patrones en la demografía y causas secundarias de muerte.Falta de datos clínicos más específicos.Durante el período de estudio, 55.096 pacientes (0,12%) murieron con un UCOD de diverticulitis de un total de 44.915.066 muertes. En comparación con otras causas, las mujeres tenían una probabilidad desproporcionadamente mayor de morir de diverticulitis que los hombres (0.17% F vs. 0.08% M, p <0.001). La incidencia de muerte ajustada por edad fue mayor para las mujeres que para los hombres. Las pacientes femeninas tenían menos probabilidades de morir en el hospital en comparación con los hombres (OR 0.72, IC 0.69-0.75, p <0.001). Por el contrario, las pacientes femeninas tenían más probabilidades de morir en asilos de ancianos o en centros de cuidados paliativos (OR 1.64, IC 1.55-1.73, p <0.001). Además, las mujeres con una UCOD de diverticulitis tenían menos probabilidades de tener una complicación quirúrgica como causa secundaria de muerte (OR 0.72, CI 0.66-0.78, p <0.001) pero más probabilidades de tener complicaciones no quirúrgicas relacionadas con la diverticulitis, como sepsis (OR 1.04, CI 1.01-1.05, p <0.03), trastornos gastrointestinales no quirúrgicos como obstrucción (OR 1.16, CI 1.09-1.24, p <0.001), o enfermedad fistulizante pélvica crónica (OR 1.43, CI 1.23-1.66, p <0,001).Las mujeres tienen una mayor incidencia de mortalidad por enfermedad diverticular. Sus muertes son más comúnmente secundarias a infecciones no quirúrgicas, obstrucción o fístulas pélvicas. Las pacientes femeninas representan una población particularmente vulnerable que puede beneficiarse de una evaluación más intensiva de diverticulitis. Consulte Video Resumen en http://links.lww.com/DCR/B257.},
}
@article {pmid33213768,
year = {2021},
author = {Wan, D and Krisko, T},
title = {Diverticulosis, Diverticulitis, and Diverticular Bleeding.},
journal = {Clinics in geriatric medicine},
volume = {37},
number = {1},
pages = {141-154},
doi = {10.1016/j.cger.2020.08.011},
pmid = {33213768},
issn = {1879-8853},
mesh = {Abdominal Pain/*etiology ; Aged ; Colon/*pathology ; *Diverticular Diseases/diagnosis/therapy ; *Diverticulum ; Humans ; },
abstract = {Diverticulosis is an anatomic change in the colon that is characterized by outpouching of the mucosa and submucosa through the muscularis. Its prevalence increases with age so most of the elderly patients have this condition. Although diverticulosis is common, diverticular disease, in which there are clinical sequelae, is rare. This collective term includes diverticulitis, diverticular hemorrhage and less well-defined entities such as segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Diverticulitis presents as acute lower abdominal pain, and initial management traditionally includes antibiotics, with surgery reserved for complicated disease, although newer evidence questions the optimal role and timing of both interventions.},
}
@article {pmid33189181,
year = {2021},
author = {Aziz, I and Simrén, M},
title = {The overlap between irritable bowel syndrome and organic gastrointestinal diseases.},
journal = {The lancet. Gastroenterology & hepatology},
volume = {6},
number = {2},
pages = {139-148},
doi = {10.1016/S2468-1253(20)30212-0},
pmid = {33189181},
issn = {2468-1253},
mesh = {Blind Loop Syndrome/complications/*diagnosis ; Celiac Disease/complications/*diagnosis ; Colitis, Microscopic/complications/*diagnosis ; Colorectal Neoplasms/complications/*diagnosis ; Diagnosis, Differential ; Humans ; Inflammatory Bowel Diseases/complications/*diagnosis ; Irritable Bowel Syndrome/complications/*diagnosis ; },
abstract = {Irritable bowel syndrome (IBS) is a common functional bowel disorder characterised by symptoms of recurrent abdominal pain associated with a change in bowel habit. This condition is one of the most frequent reasons to seek a gastroenterology consultation in primary and secondary care. The diagnosis of IBS is made by identifying characteristic symptoms, as defined by the Rome criteria, and excluding organic gastrointestinal diseases that might otherwise explain these symptoms. Organic conditions that can be mistaken for IBS include coeliac disease, inflammatory bowel disease (IBD), colorectal cancer, and, in those with diarrhoea-predominant symptoms, chronic gastrointestinal infections, microscopic colitis, and primary bile acid diarrhoea. The concept of small intestinal bacterial overgrowth being associated with IBS is shrouded with controversy and uncertainty, mainly because of invalid tests due to poor sensitivity and specificity, potentially leading to incorrect assumptions. There is insufficient evidence to link IBS-type symptoms with exocrine pancreatic insufficiency or with symptomatic uncomplicated diverticular disease, since both are hampered by conflicting data. Finally, there is growing appreciation that IBS can present in patients with known but stable organic gastrointestinal diseases, such as quiescent IBD or coeliac disease. Recognising functional gut symptoms in these individuals is paramount so that potentially harmful escalations in immunosuppressive therapy can be avoided and attention can be focused on addressing disorders of gut-brain interaction. This Review endeavours to aid clinicians who practise adult gastroenterology in recognising the potential overlap between IBS and organic gastrointestinal diseases and highlights areas in need of further research and clarity.},
}
@article {pmid33185931,
year = {2021},
author = {Formisano, G and Giuliani, G and Salaj, A and Salvischiani, L and Ferraro, L and Luca, M and Bianchi, PP},
title = {Robotic elective colectomy for diverticular disease: short-term outcomes of 80 patients.},
journal = {The international journal of medical robotics + computer assisted surgery : MRCAS},
volume = {17},
number = {2},
pages = {e2204},
doi = {10.1002/rcs.2204},
pmid = {33185931},
issn = {1478-596X},
mesh = {Colectomy ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; *Robotic Surgical Procedures ; Treatment Outcome ; },
abstract = {BACKGROUND: This study aimed to evaluate the impact of the robotic approach on the minimally invasive elective treatment of diverticular disease.
METHODS: Data from patients who underwent elective robotic colectomy for diverticular disease from January 2015 to February 2020 were prospectively collected and retrospectively analysed. Intraoperative and 30-day postoperative outcomes were the variables assessed.
RESULTS: A total of 80 patients (71% with prior complicated diverticulitis) met the inclusion criteria. Mean operative time was 241 min, one intraoperative complication (1.2%) was observed, the conversion rate was 2.5%. Mean hospital stay was 6.4 days and overall 30-day complication rate was 22.5%. Fourteen patients (17.5%) had minor complications, while major postoperative complications occurred in four patients (5%). Anastomotic leak rate was 3.9% and the 30-day readmission rate was 3.7%.
CONCLUSIONS: Robotic colectomy for diverticular disease has proven to be feasible and safe, with low intraoperative complications, conversion, and anastomotic leak rates.},
}
@article {pmid33179127,
year = {2021},
author = {Germer, CT and Reibetanz, J},
title = {[Validation of the German classification of diverticular disease (CDD)].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {1},
pages = {72},
doi = {10.1007/s00104-020-01311-7},
pmid = {33179127},
issn = {1433-0385},
mesh = {*Diverticular Diseases ; *Diverticulitis, Colonic/diagnosis/surgery ; Humans ; },
}
@article {pmid33162407,
year = {2020},
author = {Dobrinja, C and Bortul, M and Silvestri, M and Tretjak, M and Turoldo, A and de Manzini, N},
title = {Acute and complicated diverticulitis: are there significant differences between young and elderly patients?.},
journal = {Annali italiani di chirurgia},
volume = {91},
number = {},
pages = {378-384},
pmid = {33162407},
issn = {2239-253X},
mesh = {*Age Factors ; Aged ; Anastomosis, Surgical ; Colon, Sigmoid/surgery ; Colostomy ; *Diverticulitis, Colonic/epidemiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {AIM: The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD).
MATERIAL OF STUDY: 279 patients with diagnosis of AD treated at the General Surgery Department of Trieste from January 2007 to December 2015 were retrospectively examined and then followed for a minimum of 4 years. We divided patients in two categories: young ≤ 50 years and elderly > 50. Gender, American Society of Anesthesiologists status (ASA score), Hinchey's stage, type and timing of surgery, morbidity, length of hospital stay, recurrence, and overall mortality were retrospectively analyzed.
RESULTS: There were 279 patients, 64 (22,9 %) were young and 215 (77,1%) were elderly. Female gender was more frequent in elderly cohort (150 pts 69,7 % F vs 65 pts 30,3 % M) than in the young (16 pts, 25% F vs 48 pts, 75% M), (p<0,001). Higher ASA scores were registered in elderly patients with statistically significant correlation with Hinchey's stage. 229 patients (82,07 %) received as initial treatment antibiotic therapy (conservative treatment), 50 (17,93 %) pts underwent EM-S, and 11 underwent to DEL-S.
DISCUSSION: In our experience, none significant differences were recorded about Hinchey's stage, timing of surgery, morbidity, length of hospital stay, and recurrence; whereas, regarding the type of surgery (resection-anastomosis (R-A), Hartmann's procedures, and Lavage/Drainage) there were a significant difference (p=0,04).
CONCLUSIONS: Hartmann's procedures have been effectuated more frequently in the elderly than in the young with recanalization in less than half of elderly. These data seems to confirm that there is no significant difference in incidence or the natural course of acute and complicated colonic diverticulitis among the young or the elderly. The best surgical treatment, with the least morbidity, may be resection with primary anastomosis.
KEY WORDS: Diverticular Disease, Elderly Patients, Sigmoidectomy, Young Patients.},
}
@article {pmid33161943,
year = {2020},
author = {Lock, JF and Galata, C and Reißfelder, C and Ritz, JP and Schiedeck, T and Germer, CT},
title = {The Indications for and Timing of Surgery for Diverticular Disease.},
journal = {Deutsches Arzteblatt international},
volume = {117},
number = {35-36},
pages = {591-596},
pmid = {33161943},
issn = {1866-0452},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Diverticulitis/surgery ; *Elective Surgical Procedures ; Germany ; Humans ; Middle Aged ; *Quality of Life ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in Germany. The disease has a number of subtypes, each of which has an appropriate treatment. In this article, we present the current surgical indications and optimal timing of surgery for diverticular disease.
METHODS: This review is based on publications that were retrieved by an extensive, selective search in Medline and the Cochrane Library (1998-2018) for studies and guidelines with information on the indications for surgery in diverticular disease.
RESULTS: Studies of evidence grades 2 to 4 were available. Patients receiving a diagnosis of freely perforated diverticulitis and peritonitis (Classification of Diverticular Disease [CDD] type 2c) should be operated on at once. Covered perforated diverticulitis with a macroabscess (>1 cm, CDD type 2b) may be an indication for elective surgery after successful conservative treatment. New evidence from a randomized, controlled trial suggests that elective surgery should also be considered for patients with chronic recurrent diverticulitis (CDD type 3b). The decisive factor in such cases is the impairment of the quality of life for the individual patient. Elective surgery is indicated in chronic recurrent diverticulitis with complications (fistulae, stenoses). Asymptomatic diverticulosis (CDD type 0) and uncomplicated diverticulitis (CDD type 1) are not surgical indications. Likewise, in diverticular hemorrhage (CDD type 4), surgery is only indicated in exceptional cases, when conservative treatment fails.
CONCLUSION: The surgical indication and the proper timing of surgery depend on the type of disease that is present. Future studies should more thoroughly investigate the effect of surgery on the quality of life in patients with the various types of diverticular disease.},
}
@article {pmid33156365,
year = {2021},
author = {Zaborowski, AM and Winter, DC},
title = {Evidence-based treatment strategies for acute diverticulitis.},
journal = {International journal of colorectal disease},
volume = {36},
number = {3},
pages = {467-475},
pmid = {33156365},
issn = {1432-1262},
mesh = {Anastomosis, Surgical ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Drainage ; Humans ; *Laparoscopy ; *Surgical Stomas ; },
abstract = {PURPOSE: Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a spectrum of pathological processes with varying clinical manifestations. The purpose of this review was to update the reader on modern evidence-based treatment strategies for acute diverticulitis.
METHODS: A literature search of the PUBMED database was performed using the keywords 'diverticulosis', 'diverticular disease' and 'diverticulitis'. Only articles published in the English language were included.
RESULTS: Evidence-based treatment strategies for acute diverticulitis have evolved over time. Data have questioned the need for antibiotic therapy for Hinchey I disease and the role of percutaneous abscess drainage for Hinchey II. Clinical trials have demonstrated laparoscopic lavage is an appropriate option for select patients with Hinchey III disease and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease.
CONCLUSION: Risk-adapted treatment strategies and operative decision-making for acute diverticulitis are increasingly based on a combination of patient and disease factors.},
}
@article {pmid33155148,
year = {2021},
author = {Nascimbeni, R and Amato, A and Cirocchi, R and Serventi, A and Laghi, A and Bellini, M and Tellan, G and Zago, M and Scarpignato, C and Binda, GA},
title = {Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper.},
journal = {Techniques in coloproctology},
volume = {25},
number = {2},
pages = {153-165},
pmid = {33155148},
issn = {1128-045X},
mesh = {Anastomosis, Surgical ; Colostomy ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Intestinal Perforation/etiology/surgery ; Italy ; *Laparoscopy ; *Peritonitis/complications/surgery ; },
abstract = {Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann's procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.},
}
@article {pmid33094052,
year = {2020},
author = {Lucas, JP and Roberts, CA and Gunderson, CA and Liuzzi, FJ and Rosenthal, OD},
title = {Acquired Diverticulosis of the Entire Colon in a Cadaver.},
journal = {Cureus},
volume = {12},
number = {9},
pages = {e10511},
pmid = {33094052},
issn = {2168-8184},
abstract = {Diverticulosis involving the entire colon is rare in Western society. During a routine dissection of a 74-year-old Caucasian female cadaver, who died from vascular disease complications, diverticula were observed in the ascending, transverse, and descending colon. A total of 413 diverticula were manually counted. The majority of diverticula arose from the right and transverse colon, which is atypical of the disease in Western society. Histological examination of sections from sample diverticula reveals morphology consistent with pseudodiverticula, suggestive of acquired disease. Pancolonic diverticulosis may be associated with systemic diseases such as collagen disorders, vascular complications, and increased risk of recurrent diverticulitis. This case is an example of a rare manifestation of diverticular disease that is important for clinicians to recognize when evaluating and treating patients with gastrointestinal symptoms.},
}
@article {pmid33093692,
year = {2020},
author = {Piscopo, N and Ellul, P},
title = {Diverticular Disease: A Review on Pathophysiology and Recent Evidence.},
journal = {The Ulster medical journal},
volume = {89},
number = {2},
pages = {83-88},
pmid = {33093692},
issn = {2046-4207},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Colon/surgery ; Diverticular Diseases/etiology/*physiopathology/*therapy ; Humans ; Male ; Obesity/complications ; Risk Factors ; Smoking/adverse effects ; },
abstract = {Diverticular disease is common condition globally, especially in Western countries. Diverticulitis, Symptomatic uncomplicated Diverticular disease and Segmental Colitis associated with diverticula constitute diverticular disease. Although most patients with diverticula are asymptomatic, around 25% of patients will experience symptoms whilst 5% of patients have an episode of acute diverticulitis. The prevalence increases with age with more than one theory being put forward to explain its pathogenesis. Faecolith entrapment in diverticula results in colonic mucosal damage and oedema, bacterial proliferation and toxin accumulation leading to perforation. This mechanism may explain diverticulitis in elderly patients with multiple, larger diverticula. Ischaemic damage could be the cause of acute diverticulitis in younger patients with sparse diverticula where more frequent and forceful muscular contractions in response to colonic stimuli occlude the vasculature leading to ischaemia and microperforation. Chronic colonic active inflammation in the presence of diverticular disease is termed Segmental colitis associated with diverticulosis. Its pathophysiology is still indeterminate but together with its clinical picture, may mimic Inflammatory Bowel Disease. Treatment includes a high fibre diet together with antibiotics and/or salicylates with surgery in severe cases. Indications for elective surgery in diverticular disease have changed over the past decades as this may not suggest a reduction in morbidity and mortality. Prophylaxis with probiotics, laxatives, anti-spasmotics, anticholinergic drugs and salicylates are at the centre of recent studies. Studies are also challenging previously believed facts regarding dietary fibre, nuts and seeds whilst emphasizing the effect of healthy lifestyle and smoking on the increasing incidence of DD.},
}
@article {pmid33082088,
year = {2021},
author = {Arena, R and Lisotti, A and Mussetto, A and Merighi, A and Pezzoli, A and Triossi, O},
title = {Right-sided diverticulosis is an independent risk factor for bleeding in patients admitted for diverticular disease.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {7},
pages = {835-840},
doi = {10.1016/j.dld.2020.09.027},
pmid = {33082088},
issn = {1878-3562},
abstract = {BACKGROUND: Diverticular bleeding is the main cause of lower gastrointestinal bleeding in both Eastern and Western countries. Several risk factors have been identified, such as comorbidities and concomitant medications. In Eastern population, the prevalence of right-side diverticulosis is higher than in Western one, and some Authors identified bilateral diverticulosis as a risk factor for bleeding.
AIMS: To identify risk factors for diverticular bleeding in patients admitted for diverticular disease (DD).
METHODS: All patients admitted for DD from January 2017 to December 2018 were retrieved from the hospital Information System. For each patient, age, gender, clinical presentation and concomitant medication were recorded. All patient underwent imaging assessment (computed tomography, ultrasound or MRI) and colonoscopy during hospitalization or within one month.
RESULTS: Among 1248 patients discharged with a diagnosis of DD during the study period, 293 (52.2% male, median age 75 years) were finally analyzed; of them, 105 (35.8%) for diverticular bleeding. On multivariate analysis, male gender (OR 4.27), age (OR 1.12), anti-thrombotic medications (OR 2.60) and right-sided DD (OR 5.70) were independently correlated to diverticular bleeding.
CONCLUSION: Our study provides evidence that, together with age, male gender and concomitant anti-thrombotic treatment, right-sided DD represents an independent risk factor for bleeding.},
}
@article {pmid33029997,
year = {2020},
author = {Trubacheva, YL and Orlova, LP and Moskalev, AI and Skridlevskiy, SN and Belov, DM and Shakhmatov, DG and Achkasov, SI},
title = {[Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease].},
journal = {Khirurgiia},
volume = {},
number = {9},
pages = {14-19},
doi = {10.17116/hirurgia202009114},
pmid = {33029997},
issn = {0023-1207},
mesh = {Colonoscopy ; *Diverticular Diseases/diagnostic imaging ; *Diverticulosis, Colonic/diagnostic imaging ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {OBJECTIVE: To evaluate the feasibility of ultrasound in diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease.
MATERIAL AND METHODS: We analyzed ultrasonic findings in 216 patients with chronic inflammatory complications of colonic diverticular disease. Chronic paracolic inflammatory mass as the most common and significant chronic complication of diverticular disease was analyzed in 116 patients. Ultrasonic findings were compared with specimen assessment, intraoperative data, irrigoscopy, colonoscopy, endoscopic ultrasound and computed tomography data.
RESULTS: Sensitivity of ultrasound for diagnosis of chronic paracolic inflammatory mass was 76,7%, specificity - 100%, overall accuracy - 87,5%. CT and endoscopic ultrasound were the most informative among different diagnostic tools (sensitivity 79,6% and 77,8%, respectively).
CONCLUSION: Ultrasonic examination and computed tomography are the most valuable methods for diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. Ultrasound is a first-line method for diagnosis and follow-up of complicated diverticular disease due to its availability, safety and unnecessary special preparation of patients.},
}
@article {pmid33019419,
year = {2020},
author = {Lin, H and Zhuang, Z and Huang, X and Li, Y},
title = {The role of emergency laparoscopic surgery for complicated diverticular disease: A systematic review and meta-analysis.},
journal = {Medicine},
volume = {99},
number = {40},
pages = {e22421},
doi = {10.1097/MD.0000000000022421},
pmid = {33019419},
issn = {1536-5964},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods/mortality ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; },
abstract = {BACKGROUND: Laparoscopic surgery develops rapidly in both elective and emergency settings. The study aimed to determine the role of different laparoscopic methods for the emergency treatment of complicated diverticulitis.
METHODS: MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to November 2019 to identify all published articles related to the topic. Statistical analysis was performed using Stata 15.
RESULTS: Fourteen publications were included in the analysis. Laparoscopic surgery was applied in 425 patients, and 493 patients underwent open colon resection (OCR). Postoperative mortality, morbidity, severe complications, and reoperation rates were not significantly different between the laparoscopic and open surgery groups. Subgroup analysis was performed based on the different laparoscopic methods (laparoscopic colon resection [LCR] and laparoscopic lavage and drainage [LLD]). Subgroup analysis indicated that LCR was superior to OCR in terms of morbidity, while OCR was superior to LLD in terms of severe complications.
CONCLUSIONS: The safety of laparoscopic surgery for the emergency treatment of complicated diverticulitis is related to different surgical methods. LCR is suggested to be a better choice according to the postoperative outcomes. More definite conclusions can be drawn in future randomized controlled trials.},
}
@article {pmid32998474,
year = {2020},
author = {Maconi, G and Pini, A and Pasqualone, E and Ardizzone, S and Bassotti, G},
title = {Abdominal Symptoms and Colonic Diverticula in Marfan's Syndrome: A Clinical and Ultrasonographic Case Control Study.},
journal = {Journal of clinical medicine},
volume = {9},
number = {10},
pages = {},
pmid = {32998474},
issn = {2077-0383},
abstract = {BACKGROUND: Marfan's syndrome (MFS) seems to be frequently associated with colonic diverticulosis, but the prevalence of diverticula and symptoms evocative of diverticular disease in this population are still unknown.
METHODS: This prospective case control study included 90 consecutive patients with MFS, 90 unselected controls, and 90 asymptomatic subjects. The clinical characteristics, including lower gastrointestinal symptoms, and ultrasonographic features of the bowel, including diverticula and thickening of the muscularis propria of the sigmoid colon, were investigated. In addition, the genotype of MFS patients was assessed. The characteristics of patients and controls were compared using parametric tests.
RESULTS: Complaints of abdominal symptoms were made by 23 (25.6%) patients with MFS and 48 (53%) control subjects (p < 0.01). Constipation and bloating were reported less frequently by MFS patients than controls (constipation: 13.3% vs. 26.6%, p = 0.039; bloating: 3.3% vs. 41.1%, p < 0.0001), while other symptoms were not significantly different. Sigmoid diverticulosis was detected in 12 (12.3%) patients with MFS, as well as in 3 (3.3%) asymptomatic healthy subjects and 4 (4.4%) random controls (p = 0.0310). The genetic variants of MFS were not correlated with symptoms or diverticula.
CONCLUSION: Patients with MFS have a greater prevalence of diverticula, although less abdominal symptoms, compared to the general population. Symptoms and diverticula in MFS are not correlated with any genetic variant.},
}
@article {pmid32990867,
year = {2021},
author = {Ripoli, MC and Lauro, A and Vaccari, S and Mastrocola, G and Lanci-Lanci, A and D'Andrea, V and Marino, IR and Cervellera, M and Tonini, V},
title = {Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression.},
journal = {Digestive diseases and sciences},
volume = {66},
number = {1},
pages = {41-44},
pmid = {32990867},
issn = {1573-2568},
mesh = {Aged ; Diverticulum, Colon/*complications/*diagnostic imaging/surgery ; Female ; Humans ; Urinary Bladder/diagnostic imaging/surgery ; Urinary Bladder Neck Obstruction/*diagnostic imaging/*etiology/surgery ; },
abstract = {Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.},
}
@article {pmid32989503,
year = {2021},
author = {Longchamp, G and Abbassi, Z and Meyer, J and Toso, C and Buchs, NC and Ris, F},
title = {Surgical resection does not avoid the risk of diverticulitis recurrence-a systematic review of risk factors.},
journal = {International journal of colorectal disease},
volume = {36},
number = {2},
pages = {227-237},
pmid = {32989503},
issn = {1432-1262},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Elective Surgical Procedures/adverse effects ; Humans ; *Laparoscopy ; Recurrence ; Risk Factors ; Treatment Outcome ; },
abstract = {PURPOSE: Fifteen percent of patients undergoing elective sigmoidectomy will present a diverticulitis recurrence, which is associated with significant costs and morbidity. We aimed to systematically review the risk factors associated with recurrence after elective sigmoidectomy.
METHODS: PubMed/MEDLINE, Embase, Cochrane, and Web of Science were searched for studies published until May 1, 2020. Original studies were included if (i) they included patients undergoing sigmoidectomy for diverticular disease, (ii) they reported postoperative recurrent diverticulitis, and (iii) they analyzed ≥ 1 variable associated with recurrence. The primary outcome was the risk factors for recurrence of diverticulitis after sigmoidectomy.
RESULTS: From the 1463 studies initially screened, six studies were included. From the 1062 patients included, 62 patients recurred (5.8%), and six variables were associated with recurrence. Two were preoperative: age (HR = 0.96, p = 0.02) and irritable bowel syndrome (33.3% with recurrence versus 12.1% without recurrence, p = 0.02). Two were operative factors: uncomplicated recurrent diverticulitis as indication for surgery (73.3% with recurrence versus 49.9% without recurrence, p = 0.049) and anastomotic level (colorectal: HR = 11.4, p = 0.02, or colosigmoid: OR = 4, p = 0.033). Two were postoperative variables: the absence of active diverticulitis on pathology (39.6% with recurrence versus 26.6% without recurrence) and persistence of postoperative pain (HR = 4.8, p < 0.01).
CONCLUSION: Identification of preoperative variables that predict the occurrence of diverticulitis recurrence should help surgical decision-making for elective sigmoidectomy, while peri- and postoperative factors should be taken into account for optimal patient follow-up.},
}
@article {pmid32972892,
year = {2020},
author = {Di Buono, G and Bonventre, G and Buscemi, S and Randisi, B and Romano, G and Agrusa, A},
title = {The colovescical fistula in diverticular disease: Laparoscopic approach in two different cases.},
journal = {International journal of surgery case reports},
volume = {77S},
number = {},
pages = {S112-S115},
pmid = {32972892},
issn = {2210-2612},
abstract = {INTRODUCTION: The colovescical fistula is one of the complications of diverticular disease. It can cause significant symptoms like pneumaturia and fecaluria affecting the quality of life and sometimes leading to death, usually secondary to sepsis. We describe two cases of colovescical fistula treated by laparoscopic approach in patients with diagnosis of complicated acute diverticulitis.
CASE REPORT: We studied two patients with clinical, radiological and endoscopic diagnosis of colovescical fistula as a consequence of diverticular disease. We performed a totally laparoscopic treatment with colonic resection and colo-proctoanastomosis after the closure of the fistula with intracorporeal sutures.
DISCUSSION: Colovescical fistula should be suspected in patients who present fever with persistent dysuria, pneumaturia or fecaluria. The diagnosis is confirmed by a CT abdominal scan, a colonoscopy in order to rule out a colon cancer and a cystoscopy to assess the grade of bladder involvement.
CONCLUSION: Although colovescical fistulas caused by diverticular disease were once considered a contraindication to laparoscopic resection, nowadays they are increasingly treated by experienced surgeons using laparoscopic techniques. Compared with laparoscopic surgery for uncomplicated diverticulitis the mini-invasive treatment of colovescical fistulas requires a longer operative time and advanced surgical skills.},
}
@article {pmid32957717,
year = {2020},
author = {Darii Plopa, N and Gica, N and Gerard, M and Nollevaux, MC and Pavlovic, M and Anton, E},
title = {A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {56},
number = {9},
pages = {},
pmid = {32957717},
issn = {1648-9144},
mesh = {Aged ; *Diverticulitis ; Female ; Humans ; *Intestinal Fistula/diagnostic imaging/etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology.
CASE REPORT: A 69-year-old patient with uncomplicated diverticular disease was referred to our department for recurrent vaginal discharge. The clinical examination was unremarkable, hysteroscopy revealed the presence of air in the uterine cavity in the absence of a uterine fistula. A preliminary diagnosis of colosalpingeal fistula was made and was confirmed by computed tomography (CT) scan and hysterosalpingography. A one-stage surgery via laparotomy was successfully performed with remission of the symptoms.
CONCLUSION: Colotubal fistula is a rare complication resulting from intestinal diverticular disease. The purpose of this paper was to emphasize the presence of a rare, but serious complication occurring in diverticular disease with atypical symptoms and one-stage surgery treatment.},
}
@article {pmid32941354,
year = {2020},
author = {Mari, GM and Crippa, J and Roscio, F and Scandroglio, I and Cocozza, E and Borroni, G and Berselli, M and Achilli, P and Costanzi, ATM and Maggioni, D and , },
title = {Quality of Life After Elective Laparoscopic Sigmoidectomy for Symptomatic Uncomplicated Diverticular Disease.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {31},
number = {2},
pages = {193-195},
doi = {10.1097/SLE.0000000000000860},
pmid = {32941354},
issn = {1534-4908},
mesh = {Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Humans ; *Laparoscopy ; Quality of Life ; Retrospective Studies ; },
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain and altered bowel function and may affect quality of life. When symptoms are severe and conservative therapy is ineffective, surgical intervention becomes an option.
OBJECTIVE: This study aims to investigate quality of life after elective sigmoidectomy for patients affected by SUDD.
MATERIALS AND METHODS: Retrospective multicenter review of consecutive patients affected by SUDD that underwent elective laparoscopic sigmoidectomy from January 2015 to March 2018. SUDD was defined as the presence of diverticula with persistent localized pain and diarrhea or constipation without macroscopic inflammation. Quality of life was investigated using the Gastrointestinal Quality of Life Index questionnaire at baseline, and at 6 and 12 months after surgery. Readmissions, unplanned clinical examination, mesalazine resumption, and emergency department visit for abdominal symptoms were recorded.
RESULTS: Fifty-two patients were included in the analysis. Gastrointestinal Quality of Life Index score at 6 months from surgery did not statistically differ from baseline (96±10.2 vs. 89±11.2; P>0.05), while patients reported a better quality of life at 12 months after surgery (109±8.6; P<0.05). Within the first year of follow-up, 3 patients (5.8%) were readmitted for acute enteritis, 8 patients (15.4%) had emergency room access for abdominal pain, and 8 patients had unplanned outpatients' medical examinations for referred lower abdominal pain and bowel changes. Mesalazine was resumed in 17.3% of patients.
CONCLUSION: Elective laparoscopic sigmoidectomy for SUDD is safe and effective in improving quality of life, although in some cases symptoms may persist.},
}
@article {pmid32938529,
year = {2021},
author = {Napolitano, MA and Sparks, AD and Randall, JA and Brody, FJ and Duncan, JE},
title = {Elective surgery for diverticular disease in U.S. veterans: A VASQIP study of national trends and outcomes from 2004 to 2018.},
journal = {American journal of surgery},
volume = {221},
number = {5},
pages = {1042-1049},
doi = {10.1016/j.amjsurg.2020.08.050},
pmid = {32938529},
issn = {1879-1883},
mesh = {Colectomy/adverse effects/statistics & numerical data ; Colon/surgery ; Diverticular Diseases/*surgery ; Elective Surgical Procedures/adverse effects/*statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; United States ; Veterans/*statistics & numerical data ; },
abstract = {BACKGROUND: Treatment for diverticular disease has evolved over time. In the United States, there has been a trend towards minimally invasive surgical approaches and fewer postoperative complications, but no study has investigated this subject in the Veterans Health Administration.
METHODS: This retrospective review identified patients undergoing elective surgery for diverticular disease from 2004 to 2018. Demographics, comorbidities, operative approach, rates of ostomy creation, and 30-day outcomes were compared. The 15-year time period was divided into 3-year increments to assess changes over time.
RESULTS: 4198 patients were identified. Complication rate decreased significantly over time (28.1%-15.7%, p < 0.001), as did infectious complications (21.5-6.3%, p < 0.001). Median hospital length-of-stay decreased from 7 to 5 days (p < 0.001). Rates of laparoscopic surgery increased over time (17.7%-48.1%, p < 0.001).
CONCLUSIONS: Increased utilization of laparoscopy in veterans undergoing elective surgery for diverticular disease coincided with fewer complications and a shorter length-of-stay. These trends mirror outcomes reported in non-veterans.},
}
@article {pmid32937926,
year = {2020},
author = {Sbeit, W and Khoury, T and Kadah, A and Asadi, W and Shahin, A and Lubany, A and Safadi, M and Haddad, H and Abu Ahmad, R and Abu El Hija, S and Abboud, R and Mahamid, M and Pellicano, R and Mari, A},
title = {Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It's Severity among Patients with Colonic Diverticulosis: A Multicenter Study.},
journal = {Journal of clinical medicine},
volume = {9},
number = {9},
pages = {},
pmid = {32937926},
issn = {2077-0383},
abstract = {Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that the use of Proton Pump Inhibitors PPIs caused dysbiosis. In this study, we searched for a relationship between PPI use and the onset and severity of diverticulitis in patients with colonic diverticulosis. In a retrospective study, patients who were hospitalized for documented diverticulitis were enrolled as cases and compared with a control group of patients with uncomplicated diverticulosis. Overall, 613 patients who had a diagnosis of diverticulosis were included in the study, 217 of whom had diverticulitis. After multivariate analysis, the non-modifiable risk factors associated with diverticulitis included: age (p < 0.0001), hypertension (p < 0.0001), chronic renal failure (p = 0.007), diabetes mellitus (p < 0.0001), and left colon location (p = 0.02). However, among the modifiable factors, only PPI use (p < 0.0001) showed a significant association. Advanced disease severity (according to Hinchey classification of diverticulitis stages II-IV) was associated with aspirin use (p = 0.0004) and pan-colonic location (p = 0.02). PPI use was the only modifiable factor significantly associated with diverticulitis, but not with its severity, among patients with diverticulosis. This observation should be confirmed in future multicenter prospective studies.},
}
@article {pmid32919816,
year = {2021},
author = {Wu, Z and Broad, J and Sluyter, J and Waayer, D and Camargo, CA and Scragg, R},
title = {Effect of monthly vitamin D on diverticular disease hospitalization: Post-hoc analysis of a randomized controlled trial.},
journal = {Clinical nutrition (Edinburgh, Scotland)},
volume = {40},
number = {3},
pages = {839-843},
doi = {10.1016/j.clnu.2020.08.030},
pmid = {32919816},
issn = {1532-1983},
mesh = {Aged ; *Dietary Supplements ; *Diverticular Diseases ; Double-Blind Method ; Female ; *Hospitalization ; Humans ; Male ; Vitamin D/administration & dosage/*analogs & derivatives ; Vitamins/*administration & dosage ; },
abstract = {BACKGROUND & AIMS: Some studies have linked low vitamin D status and high risk of diverticular disease, but the causal relationship between vitamin D and diverticular disease remains unclear; clinical trial data are warranted. The objective was to assess the efficacy of vitamin D3 supplementation on diverticular disease hospitalization.
METHODS: Post-hoc analysis of a community-based randomized double-blind placebo-controlled trial (RCT) with 5108 participants randomized to receive monthly 100,000 IU vitamin D (n = 2558) or identical placebo (n = 2550). The outcome was time to first diverticular disease hospitalization from randomization to the end of intervention (July 2015), including a prespecified subgroup analysis in participants with baseline deseasonalized 25-hydroxyvitamin D (25(OH)D) levels < 50 nmol/L.
RESULTS: Over a median of 3.3 years follow-up, 74 participants had diverticular disease hospitalization. There was no difference in the risk of diverticular disease hospitalization between vitamin D supplementation (35/2558 = 1.4%) and placebo (39/2550 = 1.5%) groups (adjusted hazard ratio (HR) = 0.90; p = 0.65), although in participants with deseasonalized 25(OH)D < 50 nmol/L (n = 1272), the risk was significantly lower in the vitamin D group than placebo (HR = 0.08, p = 0.02).
DISCUSSION: Monthly 100,000 IU vitamin D3 does not reduce the risk of diverticular disease hospitalization in the general population. Further RCTs are required to investigate the effect of vitamin D supplementation on the diverticular disease in participants with low 25(OH)D levels.},
}
@article {pmid32902199,
year = {2020},
author = {Alexandersson, BT and Stefánsson, T},
title = {Incidence and recurrence rate of sigmoid diverticulitis in patients requiring admission to hospital in Iceland from 1985 to 2014: nationwide population-based register study.},
journal = {BJS open},
volume = {},
number = {},
pages = {},
pmid = {32902199},
issn = {2474-9842},
abstract = {BACKGROUND: Diverticulitis is the most common complication of diverticular disease, affecting 10-25 per cent of patients with diverticula. A retrospective, nationwide, population-based cohort study was performed to analyse the incidence and recurrence rate of sigmoid diverticulitis requiring hospital admission.
METHODS: All patients discharged from hospital in Iceland during 1985-2014 who were diagnosed with diverticular disease were included. The χ2 test was used to analyse the trend of the incidence in the period 2002-2014. The Kaplan-Meier method and the Cox model were used to analyse recurrence.
RESULTS: Of 8660 admissions for diverticular disease, 4746 were due to diverticulitis, of which 2939 were for diverticulitis diagnosed for the first time. After the first attack, surgery was used to treat 661 patients. Of 2278 patients not treated by resection, 537 had a second attack (23·6 per cent). There was a significant decrease in the incidence of diverticulitis in patients aged 40-89 years during the period from 2002 to 2014 (P = 0·033). The risk of recurrence was associated with younger age at first attack and female sex (P < 0·001).
CONCLUSION: There was a decline in the incidence of patients hospitalized with diverticulitis between 1995 and 2014, most prominent in older age groups. Different recurrence rates were reported in men and women, and in younger compared with older age groups.},
}
@article {pmid32886196,
year = {2021},
author = {Lauscher, JC and Lock, JF and Aschenbrenner, K and Strobel, RM and Leonhardt, M and Stroux, A and Weixler, B and Germer, CT and Kreis, ME},
title = {Validation of the German Classification of Diverticular Disease (VADIS)-a prospective bicentric observational study.},
journal = {International journal of colorectal disease},
volume = {36},
number = {1},
pages = {103-115},
pmid = {32886196},
issn = {1432-1262},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; Prospective Studies ; Quality of Life ; Recurrence ; Treatment Outcome ; },
abstract = {PURPOSE: The German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment.
METHODS: This was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications.
RESULTS: A total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the "Mental Component Summary" scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment.
CONCLUSION: Differentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up.
TRIAL REGISTRATION: https://www.drks.de ID: DRKS00005576.},
}
@article {pmid32885687,
year = {2020},
author = {Ponziani, FR and Scaldaferri, F and De Siena, M and Mangiola, F and Matteo, MV and Pecere, S and Petito, V and Sterbini, FP and Lopetuso, LR and Masucci, L and Cammarota, G and Sanguinetti, M and Gasbarrini, A},
title = {Increased Faecalibacterium abundance is associated with clinical improvement in patients receiving rifaximin treatment.},
journal = {Beneficial microbes},
volume = {11},
number = {6},
pages = {519-525},
doi = {10.3920/BM2019.0171},
pmid = {32885687},
issn = {1876-2891},
mesh = {Adult ; Bacterial Load/drug effects ; Bacteroidetes/growth & development ; Clostridiales/growth & development ; Diverticular Diseases/*drug therapy/microbiology ; Faecalibacterium/*growth & development ; Female ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome/*drug effects ; Humans ; Inflammatory Bowel Diseases/*drug therapy/microbiology ; Irritable Bowel Syndrome/*drug therapy/microbiology ; Male ; Middle Aged ; Rifaximin/*therapeutic use ; },
abstract = {Compositional and functional alterations of the gut microbiota are involved in the pathogenesis of several gastrointestinal diseases. Rifaximin is often used to induce disease remission due to its eubiotic effects on the gut microbiota. To investigate the correlation between changes in the gut microbiota composition and symptoms improvement in patients who present a clinical response to rifaximin treatment. Patients with ulcerative colitis (UC), Crohn's disease (CD), irritable bowel syndrome (IBS) and diverticular disease (DD) undergoing rifaximin treatment for clinical indication were enrolled in the study. Rifaximin was administered at the dose of 1,200 mg/day for 10 days. Faecal samples were collected at baseline and at the end of treatment; clinical improvement was assessed by Mayo score for UC, CD Activity Index (CDAI) for CD, IBS severity scoring system (IBS-SSS) for IBS and global symptomatic score (GSS) for DD. Twenty-five patients were included in the analysis and a clinical improvement was recorded for 10/25 (40%) of them. Microbial alpha diversity showed a slight increase in clinical responders (P=0.271), while it decreased in patients who did not improved (P=0.05). A significant post-treatment increase in Faecalibacterium abundance was observed in patients with a positive response (log2FC 1.959, P=0.042). Roseburia abundance decreased in both groups, whereas Ruminococcus decreased only in patients who clinically improved. Clinical improvement consequent to rifaximin treatment is associated with an increase in Faecalibacterium abundance. Achieving a positive shift in the gut microbiota composition seems a key event to obtain a clinical benefit from treatment.},
}
@article {pmid32875409,
year = {2021},
author = {Portale, G and Cipollari, C and Zuin, M and Spolverato, Y and Fiscon, V},
title = {Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients.},
journal = {Surgical endoscopy},
volume = {35},
number = {8},
pages = {4315-4320},
pmid = {32875409},
issn = {1432-2218},
mesh = {Colectomy/adverse effects ; *Colorectal Surgery ; Humans ; Internal Hernia ; *Laparoscopy/adverse effects ; Postoperative Complications/epidemiology/etiology/surgery ; Prevalence ; Retrospective Studies ; },
abstract = {BACKGROUND: Internal hernia (IH) is an infrequent complication following colorectal resection with minimally invasive technique. The real prevalence is difficult to define and there are only few large series reporting data on this complication, often focusing only on left-sided resections. Aim of the study was to evaluate the occurrence of IH following laparoscopic colorectal resection (LCR), reporting clinical presentation and treatment.
METHODS: Data from 1297 patients undergoing elective LCR for cancer or benign disease in a 15-year period (June 2005-March 2020) were prospectively collected. A database query was performed to search for small bowel obstructions requiring reintervention.
RESULTS: Five patients presented symptomatic IH (prevalence = 0.38%) and required reintervention. The preceding surgical procedure was left hemicolectomy for diverticular disease in all patients. The mesenteric defect had been originally closed in 4/5 patients. The median time interval between initial surgery and the occurrence of IH was 1 (range: 0.3-10) month. In all cases a small bowel loop was found herniating through the mesocolic defect. Small bowel resection was required in one patient only. The median hospital stay following reintervention was 7 (range: 4-17) days.
CONCLUSIONS: IH following LCR is a rare but severe complication, potentially leading to death, if not promptly diagnosed and treated. Awareness of this complication, early recognition, and proper diagnostic and therapeutic management is mandatory allowing laparoscopic approach and often avoiding small bowel resection.},
}
@article {pmid32875377,
year = {2021},
author = {Duarte-Chavez, R and Stoltzfus, J and Yellapu, V and Martins, N and Nanda, S and Longo, S and Geme, B and Schneider, Y},
title = {Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis.},
journal = {International journal of colorectal disease},
volume = {36},
number = {1},
pages = {83-91},
pmid = {32875377},
issn = {1432-1262},
mesh = {*Diverticular Diseases/complications/epidemiology ; *Diverticulitis/complications/epidemiology ; *Diverticulosis, Colonic ; Humans ; *Kidney Transplantation ; *Polycystic Kidney, Autosomal Dominant/complications/epidemiology ; Risk Factors ; },
abstract = {PURPOSE: Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are to clarify this association using a larger patient population and to identify risk factors in general to develop diverticular disease.
METHODS: The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the population with ADPKD compared with the general population without ADPKD. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease in the general population.
RESULTS: The prevalence of diverticulosis, diverticulitis, and diverticular bleeding were considerably increased in patients with ADPKD compared with the general population without ADPKD. The prevalence of colonic surgery was less in ADPKD patients with diverticulitis. In patients with kidney transplant, the prevalence of diverticulitis was increased in the ADPKD group, but colonic surgery was not significantly different between both groups. The prevalence of diverticular bleeding was slightly elevated in patients with ADPKD, but colonic surgery was significantly increased in patients with ADPKD. NSAID use, hypertension, constipation, and ADPKD had increased odds ratios for diverticular disease during multivariate analysis.
CONCLUSION: There is an increased prevalence of colonic diverticular disease in the population with ADPKD.},
}
@article {pmid32820657,
year = {2020},
author = {Abdulazeez, Z and Kukreja, N and Qureshi, N and Lascelles, S},
title = {Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {9},
pages = {744-747},
pmid = {32820657},
issn = {1478-7083},
mesh = {Acute Disease ; Aftercare/methods ; Aged ; Aged, 80 and over ; *Colonoscopy/methods ; Diverticulitis, Colonic/*diagnosis/diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; *Sigmoidoscopy/methods ; Tomography, X-Ray Computed ; },
abstract = {INTRODUCTION: The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure.
MATERIALS AND METHODS: A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy.
RESULTS: All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes.
CONCLUSIONS: There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.},
}
@article {pmid32814626,
year = {2021},
author = {McKechnie, T and Lee, Y and Kruse, C and Qiu, Y and Springer, JE and Doumouras, AG and Hong, D and Eskicioglu, C},
title = {Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis.},
journal = {American journal of surgery},
volume = {221},
number = {1},
pages = {72-85},
doi = {10.1016/j.amjsurg.2020.06.035},
pmid = {32814626},
issn = {1879-1883},
mesh = {Diverticulitis, Colonic/*surgery ; Humans ; *Immunosuppression Therapy ; Treatment Outcome ; },
abstract = {BACKGROUND: Immunosuppressed patients with diverticular disease are at higher risk of postoperative complications, however reported rates have varied. The aim of this study is to compare postoperative outcomes in immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.
METHODS: Medline, EMBASE, and CENTRAL were searched. Articles were included if they compared immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.
RESULTS: From 204 citations, 11 studies with 2,977 immunosuppressed patients and 780,630 immunocompetent patients were included. Mortality was greater in immunosuppressed patients compared to immunocompetent patients for emergent surgery (RR 1.91, 95%CI 1.24-2.95, p < 0.01), but not elective surgery (RR 1.70, 95%CI 0.14-20.47, p = 0.68). Morbidity was greater in immunosuppressed patients compared to immunocompetent patients for elective surgery (RR 2.18, 95%CI 1.02-4.65, p = 0.04), but not emergent surgery (RR 1.40, 95%CI 0.68-2.90, p = 0.37).
CONCLUSIONS: Increased consideration for elective operation may preclude the need for emergent surgery and the associated increase in postoperative mortality.},
}
@article {pmid32796358,
year = {2021},
author = {Jiang, Y and Rodgers, B and Damiris, K and Choi, C and Ahlawat, S},
title = {The effects of diabetes mellitus on clinical outcomes of hospitalized patients with acute diverticulitis.},
journal = {European journal of gastroenterology & hepatology},
volume = {33},
number = {11},
pages = {1354-1360},
doi = {10.1097/MEG.0000000000001895},
pmid = {32796358},
issn = {1473-5687},
mesh = {Adult ; Colectomy ; *Diabetes Mellitus/epidemiology ; *Diverticulitis/diagnosis/epidemiology/therapy ; *Diverticulitis, Colonic/complications/diagnosis/epidemiology ; Humans ; Retrospective Studies ; },
abstract = {OBJECTIVES: Acute diverticulitis is a common gastrointestinal illness due to diverticular inflammation and focal necrosis. Diabetes mellitus has been reported to influence the outcomes of patients with diverticular disease. Our study aimed to examine the inpatient outcomes and complications of patients with acute diverticulitis and coexisting diabetes mellitus.
METHODS: The Nationwide Inpatient Sample was used to identify adult patients in 2014 admitted for acute diverticulitis. Primary outcomes were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes were complications of acute diverticulitis and interventions.
RESULTS: In total, 44 330 of patients with acute diverticulitis and diabetes mellitus were included in the analysis. Acute diverticulitis patients with diabetes mellitus had a higher rate of diverticular bleeding (P < 0.0001), but lower rates of abscess (P < 0.0001), obstruction (P < 0.0001) and colectomy (P < 0.0001) when compared to acute diverticulitis patients without diabetes mellitus. Complicated diabetes mellitus was associated with a longer LOS (P = 0.00003) and greater total hospitalization charges (P = 0.0021) compared to uncomplicated diabetes mellitus when coexisting with acute diverticulitis.
CONCLUSIONS: Acute diverticulitis with diabetes mellitus is associated with a higher rate of diverticular bleeding, lower rates of abscess, obstruction, and colectomy compared to acute diverticulitis without diabetes mellitus. When coexisting with acute diverticulitis, complicated diabetes mellitus is not associated with higher rates of mortality or diverticulitis-related complications compared to uncomplicated diabetes mellitus.},
}
@article {pmid32785905,
year = {2021},
author = {Storz, C and Rospleszcz, S and Askani, E and Rothenbacher, T and Linseisen, J and Messmann, H and De Cecco, CN and Machann, J and Kiefer, LS and Elser, S and Rathmann, W and Peters, A and Schlett, CL and Bamberg, F},
title = {Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {193},
number = {1},
pages = {33-41},
doi = {10.1055/a-1212-5669},
pmid = {32785905},
issn = {1438-9010},
mesh = {Adipose Tissue/*diagnostic imaging ; Aged ; Case-Control Studies ; Cross-Sectional Studies ; Diverticular Diseases/*diagnostic imaging ; Female ; Germany ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Whole Body Imaging ; },
abstract = {PURPOSE: To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population.
MATERIALS AND METHODS: Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated.
RESULTS: A total of 371 subjects were included in the analysis (58.2 % male, 56.2 ± 9.2 years). Based on MRI, 154 participants (41.5 %) had diverticular disease with 62 cases (17 %) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9 ± 5.1 vs. 27.5 ± 4.6, p < 0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e. g. VAT: 6.0 ± 2.8 vs. 4.2 ± 2.6 and SAT: 9.2 ± 3.6 vs. 7.8 ± 3.6, all p < 0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p = 0.002).
CONCLUSION: Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development.
KEY POINTS: · Diverticular disease is associated with constitutional risk factors such as BMI.. · Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease.. · Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease.. · MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state..
CITATION FORMAT: · Storz C, Rospleszcz S, Askani E et al. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2021; 193: 33 - 41.},
}
@article {pmid32773048,
year = {2020},
author = {Manuelyan, Z and Siomara Muñiz, K and Stein, E},
title = {Common Urinary and Bowel Disorders in the Geriatric Population.},
journal = {The Medical clinics of North America},
volume = {104},
number = {5},
pages = {827-842},
doi = {10.1016/j.mcna.2020.06.009},
pmid = {32773048},
issn = {1557-9859},
mesh = {Aged ; Constipation/epidemiology ; Fecal Incontinence/epidemiology ; Geriatric Assessment ; Humans ; *Intestinal Diseases/diagnosis/physiopathology/psychology ; Prevalence ; *Quality of Life ; Urinary Incontinence/epidemiology ; *Urologic Diseases/diagnosis/physiopathology/psychology ; },
abstract = {The prevalence of urinary incontinence and other lower urinary tract symptoms increases with older age. These symptoms are more noticeable in men after the seventh decade of life and in women after menopause. Constipation and fecal incontinence are major causes of symptoms in elderly patients and can significantly impair quality of life. This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population.},
}
@article {pmid32772693,
year = {2020},
author = {Kohler, A and Studer, P and Brügger, L},
title = {[Update: Management of colonic diverticulitis].},
journal = {Therapeutische Umschau. Revue therapeutique},
volume = {77},
number = {4},
pages = {157-163},
doi = {10.1024/0040-5930/a001170},
pmid = {32772693},
issn = {0040-5930},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis/*drug therapy/*surgery ; Diverticulitis, Colonic/*diagnosis ; Drainage ; Elective Surgical Procedures ; Humans ; },
abstract = {Update: Management of colonic diverticulitis Abstract. Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of Diverticular Disease" (CDD) to grade the severity of disease. This classification is based on imaging by CT scan or ultrasound. The CDD system divides patients into categories with a common therapeutic strategy. Acute uncomplicated diverticulitis is treated by oral or intravenous antibiotics. For the majority of patients with uncomplicated diverticulitis, antibiotic therapy might be omitted in favor of a solely symptomatic therapy. Acute diverticulitis complicated by a relevant abscess or a perforation is treated by interventional drainage or surgical therapy. Resection with primary anastomosis replaces more and more resection with end colostomy (Hartmann's procedure). For patients with sepsis, the concept of damage control surgery has been introduced. The indication for elective surgery after conservative treatment of diverticulitis shall be dictated by the degree of the patient's symptoms, rather than the number of conservatively treated episodes of diverticulitis. Persisting complications, as fistulas and stenosis, represent an indication for elective colonic resection.},
}
@article {pmid32769744,
year = {2020},
author = {Mari, G and Montroni, I and Origi, M and Crippa, J and Achilli, P and Costanzi, A and Ferrari, G and Ugolini, G and Maggioni, D and , },
title = {Functional and Short-term Outcomes in Elective Laparoscopic Colectomy for Symptomatic Diverticular Disease With Either Low Ligation or Inferior Mesenteric Artery Preservation: A Randomized Trial.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {31},
number = {1},
pages = {40-43},
doi = {10.1097/SLE.0000000000000850},
pmid = {32769744},
issn = {1534-4908},
mesh = {Colectomy ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Ligation ; Mesenteric Artery, Inferior/surgery ; Quality of Life ; },
abstract = {BACKGROUND: The current treatment of symptomatic diverticular disease is left colectomy/sigmoidectomy with low ligation of the inferior mesenteric artery versus the inferior mesenteric artery preservation. Up to now, there is no strong evidence in favor of one of the 2 strategies. The aim of this study is to compare the bowel-specific quality of life and functional outcomes between these 2.
METHODS: Between June 2015 and February 2019, patients were randomly assigned to inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for diverticular disease. Gastrointestinal, genitourinary functions and surgical outcomes were compared postoperatively between groups.
RESULTS: One-hundred sixty-eight patients were randomized providing 2 homogenous groups. Gastrointestinal and genitourinary functions were not significantly different between groups after 1 and 6 months postoperative. In both groups, the function was restored to the preoperative level 6 months after surgery. There was no statistically significant difference in terms of conversion rate, blood loss, length of surgery, between groups. There was no difference in the overall complication rate and the anastomotic leak rate among groups.
CONCLUSIONS: Inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for a diverticular disease can be considered equivalent in affecting the postoperative bowel-related quality of life, genitourinary function, and surgical outcomes.},
}
@article {pmid32767345,
year = {2020},
author = {Stefanelli, G and Viscido, A and Valvano, M and Vernia, F and Frieri, G and Ashktorab, H and Latella, G},
title = {Is mesalazine treatment effective in the prevention of diverticulitis? A review.},
journal = {European review for medical and pharmacological sciences},
volume = {24},
number = {15},
pages = {8164-8176},
doi = {10.26355/eurrev_202008_22504},
pmid = {32767345},
issn = {2284-0729},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis/*prevention & control ; Humans ; Mesalamine/*therapeutic use ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Diverticulitis is the most severe form of Diverticular disease (DD). An effective treatment strategy for its prevention has not yet been defined. This review aimed to provide a viewpoint on the role of mesalazine, also note as 5-aminosalicylic acid (5-ASA), in the prevention of diverticulitis. A systematic electronic search of relevant articles was performed using PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials (RCTs), open trials, and retrospective studies, published between January 1999 and January 2020, were identified. Twelve eligible studies that analyzed primary or secondary outcomes of diverticulitis were included. The population included patients with symptomatic uncomplicated diverticular disease (SUDD), or patients with a history of diverticulitis. All studies compared 5-ASA to placebo, rifaximin, or other treatments. Two studies, including 359 patients, assessed the efficacy of 5-ASA in preventing the first appearance of diverticulitis in patients with SUDD. Of these, one showed that 5-ASA was effective, and one did not. Ten studies, including 2.995 patients, assessed the efficacy of 5-ASA treatment in preventing the recurrence of diverticulitis in patients with a history of diverticulitis. Four studies showed that 5-ASA had a certain degree of efficacy. All four RCTs demonstrated that 5-ASA did not significantly reduce the rate of diverticulitis recurrence. In a retrospective trial, 5-ASA was less effective than rifaximin in preventing diverticulitis recurrence. In an open trial, there was no difference between 5-ASA and probiotic treatment. Overall, there is currently conflicting evidence regarding the efficacy of 5-ASA treatment in the prevention of diverticulitis and further RCTs are needed.},
}
@article {pmid32766000,
year = {2020},
author = {Payne, A and Than, NN and Jalan, R and Yu, D},
title = {An Unusual Case of Hematochezia.},
journal = {Cureus},
volume = {12},
number = {7},
pages = {e8957},
pmid = {32766000},
issn = {2168-8184},
abstract = {Lower gastrointestinal bleeding (LGIB) is a serious and potentially life-threatening condition warranting hospital admission. The most frequent causes include diverticular disease, colitis, hemorrhoids, neoplasm, inflammatory bowel disease, and varices. Varices usually occur secondary to liver cirrhosis and are frequently located in the gastroesophageal region. Those occurring elsewhere are known as ectopic varices. The diagnosis and management of ectopic varices is challenging, and guidelines are not currently available. We report the case of recurrent large-volume hematochezia secondary to a cecal varix in a 60-year-old female with alcoholic liver cirrhosis. Initial investigation with CT angiography and endoscopy failed to identify the source of bleeding. A second CT angiogram identified a large varix in the cecum, and the patient was successfully managed with radiological embolization and transjugular intra-hepatic porto-systemic shunt (TIPSS).},
}
@article {pmid32754697,
year = {2019},
author = {Beresneva, O and Hall, J},
title = {Influence of body mass index on outcomes in patients undergoing surgery for diverticular disease.},
journal = {Surgery open science},
volume = {1},
number = {2},
pages = {80-85},
pmid = {32754697},
issn = {2589-8450},
abstract = {Background: We hypothesized that increasing body mass index is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of body mass index and surgical complications following surgery for diverticular disease.
Methods: We used National Surgical Quality Improvement Program database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their body mass index (< 18.5, 18.6-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, 50.0-54.9, > 55). Outcomes of interest were complications of superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, pneumonia, ventilator dependence > 48 hours, acute renal failure, myocardial infarction, return to operating room, and 30-day mortality.
Results: Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher American Society of Anesthesiologists classification and were more likely to have emergency and open cases. Interestingly, increased body mass index was inversely associated with age. Increasing body mass index was associated with worse outcomes including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to operating room. Risk of developing pneumonia didn't have similar correlation with body mass index. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of myocardial infarction were noted. Underweight patients also developed worse outcomes.
Conclusion: Obesity is associated with a number of complications following surgery for diverticulitis. Elevated body mass index adds significant risk to procedures for diverticulitis and should be accounted for in risk stratification models. Patients should be counseled on weight reduction before undergoing elective surgery for diverticular disease.},
}
@article {pmid32754291,
year = {2020},
author = {Alnzaer, AA and Mohamedahmed, AYY and Adam, YA and Eltyiep, E and Suliman, SH},
title = {Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan.},
journal = {The Pan African medical journal},
volume = {36},
number = {},
pages = {64},
pmid = {32754291},
issn = {1937-8688},
mesh = {Abdominal Pain/*epidemiology/etiology ; Adult ; Aged ; Aged, 80 and over ; *Colonoscopy ; Constipation/epidemiology ; Cross-Sectional Studies ; Diverticular Diseases/*epidemiology/physiopathology ; Diverticulosis, Colonic/*epidemiology/physiopathology ; Female ; Gastrointestinal Hemorrhage/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Sudan ; Young Adult ; },
abstract = {Introduction: diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan.
Methods: this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population.
Results: prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%.
Conclusion: the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.},
}
@article {pmid32748338,
year = {2021},
author = {Perez, NP and Chang, DC and Goldstone, RN and Bordeianou, L and Ricciardi, R and Cavallaro, PM},
title = {Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {25},
number = {5},
pages = {1297-1306},
pmid = {32748338},
issn = {1873-4626},
support = {T32 DK007754/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Colectomy/adverse effects ; Colon, Sigmoid/surgery ; *Diverticular Diseases ; Humans ; *Incisional Hernia ; *Laparoscopy/adverse effects ; New York ; Retrospective Studies ; },
abstract = {BACKGROUND: Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery.
METHODS: The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31, 2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks.
RESULTS: Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5-year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated that patients with diverticulitis experienced a two-fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and these findings persisted after stratification by colectomy route.
CONCLUSIONS: Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence-based guidelines for fascial closure to prevent this important complication.},
}
@article {pmid32748249,
year = {2021},
author = {Flor, N and Pickhardt, PJ and Maconi, G and Panella, S and Falleni, M and Merlo, V and Di Leo, G},
title = {CT colonography followed by elective surgery in patients with acute diverticulitis: a radiological-pathological correlation study.},
journal = {Abdominal radiology (New York)},
volume = {46},
number = {2},
pages = {491-497},
pmid = {32748249},
issn = {2366-0058},
mesh = {Acute Disease ; *Colonography, Computed Tomographic ; Correlation of Data ; *Diverticulitis ; *Diverticulitis, Colonic/complications/diagnostic imaging/surgery ; Humans ; Retrospective Studies ; },
abstract = {PURPOSE: To perform a radiologic-pathologic correlation analysis of sigmoid colon in patients undergoing pre-operative CT Colonography (CTC) after an episode of acute diverticulitis (AD).
METHODS: Fifty-nine consecutive patients (31/28 M/F; 58 ± 13 years) underwent CTC 55 ± 18 days after AD, 8 ± 4 weeks before surgery. Thirty-seven patients (63%) underwent conventional abdominal CT at time of AD. An experienced blinded radiologist retrospectively analyzed all images: disease severity was graded according to the Ambrosetti classification on conventional CT and according to the diverticular disease severity score (DDSS) on CTC. A GI pathologist performed a dedicated analysis, evaluating the presence of acute and chronic inflammation, and fibrosis, using 0-3 point scale for each variable.
RESULTS: Of 59 patients, 41 (69%) had at least one previous AD episode; twenty-six patients (44%) had a complicated AD. DDSS was mild-moderate in 34/59 (58%), and severe in 25/59 (42%). All patients had chronic inflammation, while 90% had low-to-severe fibrosis. Patients with moderate/severe fibrosis were older than those with no/mild fibrosis (61 ± 13 versus 54 ± 13). We found a significant correlation between DDSS and chronic inflammation (p = 0.004), as well as DDSS and fibrosis (p = 0.005). Furthermore, fibrosis was correlated with complicated acute diverticulitis (p = 0.0.27), and with age (p = 0.067). At multivariate analysis, complicated diverticulitis was the best predictor of fibrosis (odds ratio 4.4). Patient age and DDSS were other independent predictors.
CONCLUSION: DDSS-based assessment on preoperative CTC was a good predictor of chronic colonic inflammation and fibrosis. In addition, the presence of complicated diverticulitis on CT during the acute episode was most predictive of fibrosis.},
}
@article {pmid32740245,
year = {2020},
author = {Hawkins, AT and Samuels, LR and Rothman, R and Geiger, TM and Penson, DF and Resnick, MJ},
title = {National Variation in Elective Colon Resection for Diverticular Disease.},
journal = {Annals of surgery},
volume = {},
number = {},
pages = {},
doi = {10.1097/SLA.0000000000004236},
pmid = {32740245},
issn = {1528-1140},
abstract = {OBJECTIVE: This study aims to characterize the extent of geographic variation in elective sigmoid resection for diverticulitis and to identify factors associated with observed variation.
INTRODUCTION: National guidelines for treatment of recurrent diverticulitis fail to offer strong recommendations for or against surgical intervention. We hypothesize that healthcare market factors will be significantly associated with geographic variation in colon resection for diverticulitis, a discretionary surgical intervention.
METHODS: We used Center for Medicare Services 100% inpatient Limited Data Set (LDS) files from January 2013 through September 2015 to calculate an observed to expected standardized colon resection ratio for each hospital referral region (HRR). We then analyzed patient, hospital-, and market-level factors associated with variation of colectomy. For each HRR, a Herfindahl-Hirschman index, a measure of market competition, was calculated.
RESULTS: A total of 19,557 Medicare patients underwent an elective colon resection for diverticulitis at 2462 hospitals over the study period. Standardized colon resection ratios ranged from 0 in the Tuscaloosa HRR to 3.7 in the Royal Oak, MI HRR. Few patient factors were associated with variation, but a number of hospital factors (size, area, profit status, and critical access designation) all were associated with variation. In an analysis of market factors, increased surgeon density, and decreased market competition were associated with higher predicted rates of colon resection.
CONCLUSION: We observed pronounced variation (excess of 3-fold) in standardized colon resection ratios for recurrent diverticulitis. Surgeon density and hospital level factors were strongly associated with this variation and may be the main drivers of colonic resection for diverticular disease. Further investigation and stronger national guidelines are needed to optimize patient selection for colectomy.},
}
@article {pmid32671425,
year = {2020},
author = {Galata, C and Lock, JF and Reißfelder, C and Germer, CT},
title = {[Recommendations for treatment of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {91},
number = {9},
pages = {720-726},
doi = {10.1007/s00104-020-01239-y},
pmid = {32671425},
issn = {1433-0385},
mesh = {Colon, Sigmoid ; *Diverticulitis, Colonic ; Germany ; Humans ; *Laparoscopy ; Quality of Life ; },
abstract = {BACKGROUND: Diverticular disease is of major clinical and health economic importance in Germany. Treatment recommendations in many international guidelines have changed significantly in recent years. The German national S2k guidelines are currently being revised.
OBJECTIVE: To summarize the most important clinical aspects in the management of diverticular disease from a surgical perspective.
MATERIAL AND METHODS: The recommendations were compiled based on current national and international guidelines and a selective literature search.
RESULTS: Acute uncomplicated diverticulitis without risk factors can be treated on an outpatient basis without antibiotics. For patients with complicated diverticulitis, hospital admission with parenteral antibiotic treatment is recommended. In the case of abscess formation >5 cm, percutaneous drainage can be performed. The indications for immediate sigmoid resection are free perforation and failure of conservative treatment. Elective resection is indicated in chronic recurrent diverticulitis with complications; all other indications are increasingly based on the individual quality of life of the patient.
CONCLUSION: Uncomplicated diverticulitis is increasingly being treated on an outpatient basis and without antibiotics. Apart from emergency settings, the indications for surgery are increasingly dependent on the quality of life. Elective sigmoid resection should be performed as laparoscopic surgery with primary anastomosis after obtaining results of computed tomography and total colonoscopy.},
}
@article {pmid32638537,
year = {2020},
author = {Schultz, JK and Azhar, N and Binda, GA and Barbara, G and Biondo, S and Boermeester, MA and Chabok, A and Consten, ECJ and van Dijk, ST and Johanssen, A and Kruis, W and Lambrichts, D and Post, S and Ris, F and Rockall, TA and Samuelsson, A and Di Saverio, S and Tartaglia, D and Thorisson, A and Winter, DC and Bemelman, W and Angenete, E},
title = {European Society of Coloproctology: guidelines for the management of diverticular disease of the colon.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22 Suppl 2},
number = {},
pages = {5-28},
doi = {10.1111/codi.15140},
pmid = {32638537},
issn = {1463-1318},
support = {//European Society of Coloproctology/ ; },
mesh = {Colon ; Consensus ; *Diverticular Diseases/therapy ; Humans ; },
abstract = {AIM: The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons.
METHODS: The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements.
RESULTS: This guideline contains 38 evidence based consensus statements on the management of diverticular disease.
CONCLUSION: This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.},
}
@article {pmid32635383,
year = {2020},
author = {Nasef, NA and Mehta, S},
title = {Role of Inflammation in Pathophysiology of Colonic Disease: An Update.},
journal = {International journal of molecular sciences},
volume = {21},
number = {13},
pages = {},
pmid = {32635383},
issn = {1422-0067},
mesh = {Animals ; Colitis/etiology/immunology/*physiopathology ; Colonic Diseases/etiology/immunology/*physiopathology ; Colorectal Neoplasms/physiopathology ; Disease Progression ; Diverticular Diseases/physiopathology ; Female ; Gastrointestinal Microbiome/immunology/physiology ; Humans ; Inflammation/etiology/immunology/physiopathology ; Inflammatory Bowel Diseases/physiopathology ; Irritable Bowel Syndrome/physiopathology ; Male ; Models, Biological ; Risk Factors ; },
abstract = {Diseases of the colon are a big health burden in both men and women worldwide ranging from acute infection to cancer. Environmental and genetic factors influence disease onset and outcome in multiple colonic pathologies. The importance of inflammation in the onset, progression and outcome of multiple colonic pathologies is gaining more traction as the evidence from recent research is considered. In this review, we provide an update on the literature to understand how genetics, diet, and the gut microbiota influence the crosstalk between immune and non‑immune cells resulting in inflammation observed in multiple colonic pathologies. Specifically, we focus on four colonic diseases two of which have a more established association with inflammation (inflammatory bowel disease and colorectal cancer) while the other two have a less understood relationship with inflammation (diverticular disease and irritable bowel syndrome).},
}
@article {pmid32632489,
year = {2021},
author = {Pedrazzani, C and Park, SY and Conti, C and Turri, G and Park, JS and Kim, HJ and Polati, E and Guglielmi, A and Choi, GS},
title = {Analgesic efficacy of pre-emptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: results from a randomized, multicenter, single-blind, non-inferiority trial.},
journal = {Surgical endoscopy},
volume = {35},
number = {7},
pages = {3329-3338},
pmid = {32632489},
issn = {1432-2218},
mesh = {Abdominal Muscles ; Analgesics/therapeutic use ; Analgesics, Opioid ; Anesthetics, Local ; *Colorectal Neoplasms/surgery ; Humans ; *Laparoscopy ; Pain, Postoperative/prevention & control ; Single-Blind Method ; },
abstract = {BACKGROUND: Transversus abdominis plane (TAP) block is considered a reliable locoregional technique for pain control after laparoscopic colorectal surgery. However, no clear benefit of TAP block over wound infiltration has been demonstrated by the current literature. This multicenter randomized clinical trial tested the non-inferiority of wound infiltration (WI) compared to WI plus laparoscopic-assisted TAP block (L-TAP).
METHODS: All patients with colorectal cancer and diverticular disease scheduled for laparoscopic resection at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, Verona, Italy and at the Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University, Daegu, Korea, between April 2018 and March 2019 were considered for the trial. Patients were randomly allocated to either the WI group or the WI plus L-TAP group in a 1:1 allocation ratio. In total, 108 patients entered the study and 102 patients were analyzed; 50 patients received WI plus L-TAP and 52 patients received WI. The primary end point was the efficacy in pain control at 6 h measured according to Numeric Rating Scale (NRS). Secondary aims evaluated pain control at 12, 24, 48 and 72 h and other short-term results related to pain management.
RESULTS: Estimation of pain intensity at 6 h was comparable between the two groups (p = 0.16) with a mean (95% CI) difference in pain scores of 0.94 (- 0.13 to 2.02). No differences in pain scores were observed at other interval times or considering analgesic consumption, return of bowel function, postoperative complications and length of hospital stay.
CONCLUSION: This study suggests that adding TAP block to WI does not affect pain control, amount of analgesics and other short-term outcomes.
TRIAL REGISTRATION: NCT03376048 (https://www.clinicaltrials.gov).},
}
@article {pmid32614290,
year = {2020},
author = {Toh, PY and Parys, S and Watanabe, Y},
title = {Appendiceal Diverticular Disease: A 10-year Retrospective Study of Cases from Tertiary Hospitals in Western Australia.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {115},
number = {3},
pages = {348-356},
doi = {10.21614/chirurgia.115.3.348},
pmid = {32614290},
issn = {1221-9118},
mesh = {Appendicitis ; *Diverticular Diseases ; Humans ; Retrospective Studies ; Tertiary Care Centers ; Treatment Outcome ; Western Australia ; },
abstract = {Background: Appendiceal diverticular disease (ADD) is typically a histological diagnosis. Our paper aims to investigate the implications of ADD compared to acute appendicitis (AA). Methods: We conducted a retrospective data collection of patients who had undergone an appen dicectomy in three tertiary hospitals across Western Australia between 2009-2019 and included patients with histopathological diagnoses of ADD and AA. Results: Thirty-seven patients with ADD and forty with AA were included. The mean age in the ADD group was significantly older (p 0.001) at 50.1 compared to the AA group (37.3). The mean white cell count (WCC) in the ADD group was lower than the AA group (11x109/L vs. 13.3x109/L, p 0.001), whereas the C-Reactive Protein (CRP) level was greater, although not statistically significant. The ADD group had a greater risk of major surgery (p 0.05) and complications such as appendiceal perforation and appendiceal mass (p 0.05). Post-operative colonoscopy also demon strated a higher incidence of polyps in patients with ADD (19% vs. 2.5%, p 0.001). Conclusion: ADD frequently presents with clinical features indiscernible from AA. Our study demonstrates that ADD is associated with higher rates of appendiceal perforation, polyps and malignancy. We recommend that patients with ADD be advised to have a colonoscopy post-opera tively to rule out underlying malignancy.},
}
@article {pmid32601752,
year = {2020},
author = {Meyer, DC and Hill, SS and Bebinger, DM and McDade, JA and Davids, JS and Alavi, K and Maykel, JA},
title = {Resolution of multiply recurrent and multifocal diverticulitis after fecal microbiota transplantation.},
journal = {Techniques in coloproctology},
volume = {24},
number = {9},
pages = {971-975},
doi = {10.1007/s10151-020-02275-w},
pmid = {32601752},
issn = {1128-045X},
mesh = {*Clostridioides difficile ; *Clostridium Infections ; *Diverticulitis ; Fecal Microbiota Transplantation ; Feces ; Female ; Humans ; Middle Aged ; Recurrence ; Treatment Outcome ; },
abstract = {BACKGROUND: The exact pathophysiology of diverticulitis is not well understood and may be multifactorial. Recent studies highlight dysbiosis as a plausible mechanism. FMT is a safe strategy to restore commensal colon microbiota and has proven to be an effective treatment for gastrointestinal dysbiosis such as Clostridium difficile infection (CDI). There have been no studies reporting the treatment of diverticulitis with FMT. Our aim was to describe the novel application of fecal microbiota transplantation (FMT) for the treatment of recurrent diverticulitis.
CASE: We report a case of a 63-year-old woman who had a 13-year history of multiply recurrent and multifocal diverticulitis previously treated with numerous short courses of intravenous and oral antibiotics for acute flares, two segmental colon resections, and suppressive antibiotic therapy for recurrent disease. Secondary to multiple courses of antibiotics , the patient developed CDI. She was treated with a single round of FMT and subsequently stopped all antibiotics at the time of FMT.
RESULTS: In 20 months of follow-up, the patient has had no further recurrence of diverticulitis or CDI.
CONCLUSIONS: FMT could prove to be a novel therapy for refractory diverticulitis but requires further investigation.},
}
@article {pmid32595204,
year = {2020},
author = {Katerji, R and Huber, AR},
title = {Giant Inflammatory Polyps in Diverticular Disease Mimicking a Colonic Mass: A Potential Malignant Masquerader.},
journal = {The American journal of case reports},
volume = {21},
number = {},
pages = {e923242},
pmid = {32595204},
issn = {1941-5923},
mesh = {Aged ; Carcinoembryonic Antigen/analysis ; Colon, Sigmoid/diagnostic imaging ; Colonic Neoplasms/diagnosis ; Colonic Polyps/*diagnosis/surgery ; Constipation/etiology ; Diagnosis, Differential ; Diverticulum/*diagnosis/surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND Inflammatory pseudopolyps (IPPs) are a common manifestation in inflammatory bowel disease (IBD) with more cases reported with ulcerative colitis than Crohn's disease. IPPs can grow to form large polyps which are called giant inflammatory polyps (GIPs). These polyps may cause an obstruction and form a mass-like lesion and surgical resection may be warranted. CASE REPORT A 65-year-old male without a previous history of IBD presented with abdominal discomfort, poor appetite, constipation, weight loss, and hematochezia. Due to the high suspicion of malignancy, a computed tomography (CT) scan was performed and showed a fixed lesion in the mid sigmoid colon highly concerning for a primary colon carcinoma, with scattered diverticula, and associated with elevated carcinoembryonic antigen (CEA). Colonoscopy was done but the scope could not be passed due to obstruction. Sigmoidectomy was performed which showed a huge noninvasive lesion, which looked like pseudopolypoid serpiginous mass as giant inflammatory polyp, with scattered diverticula. On microscopic examination, pathology showed a villous polyp with numerous inflammatory cells, without any dysplasia or carcinoma. CONCLUSIONS GIPs are rarely reported without a history of IBD. Diagnosis of GIPs can be very challenging, and surgery is sometimes indicated for definitive diagnosis.},
}
@article {pmid32589496,
year = {2020},
author = {Anteby, R and Zager, Y and Barash, Y and Nadler, R and Cordoba, M and Klang, E and Klein, Y and Ram, E and Gutman, M and Horesh, N},
title = {The Impact of the Coronavirus Disease 2019 Outbreak on the Attendance of Patients with Surgical Complaints at a Tertiary Hospital Emergency Department.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {30},
number = {9},
pages = {1001-1007},
doi = {10.1089/lap.2020.0465},
pmid = {32589496},
issn = {1557-9034},
mesh = {Adolescent ; Adult ; Aged ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/*epidemiology ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Health Personnel ; Hospitalization ; Humans ; Intestinal Diseases/epidemiology ; Israel/epidemiology ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/*epidemiology ; Retrospective Studies ; SARS-CoV-2 ; Sex Factors ; Surgery Department, Hospital/*statistics & numerical data ; Tachycardia/epidemiology ; Tertiary Care Centers/*statistics & numerical data ; Young Adult ; },
abstract = {Introduction: Emergency departments (EDs) during the novel coronavirus disease 2019 (COVID-19) pandemic are perceived as possible sources of infection. The effects of COVID-19 on patients presenting to the hospital with surgical complaints remain uncertain. Methods: A single tertiary center retrospective study analysis compared the ED attendance rate and severity of patients with surgical complaints between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2019 and 2018. Results: Overall, 6,017 patients were included. The mean daily ED visits of patients with nontrauma surgical complaints in the COVID-19 outbreak period declined by 27%-32% (P value <.01) compared with pre-COVID-19 periods. The log number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Israel in March 2020 was negatively correlated with the number of ED visits (Pearson's r = -0.59, P < .01). The proportion of patients requiring hospitalization increased by up to 8% during the outbreak period (P < .01), and there was a higher proportion of tachycardic patients (20% versus 15.5%, P = .01). The percentage of visits to the ED by men declined by 5% (P < .01). The ED diagnosis distribution significantly changed during COVID-19 (P = .013), with an 84% decrease in the number of patients hospitalized for diverticular disease (P < .05). Conclusion: During the COVID-19 outbreak, the overall number of patients presenting at the ED with surgical complaints decreased significantly, and there was a higher admissions ratio. The extent to which the pandemic affects hospital ED attendance can help health care professionals prepare for future such events. ClinicalTrials.gov ID: NCT04338672.},
}
@article {pmid32567170,
year = {2020},
author = {Marek, T and Mahan, MA and Amrami, KK and Blackburn, PR and Caffes, PL and Carter, JM and Camilleri, M and Spinner, RJ},
title = {Expanding the phenotypic spectrum of lipomatosis of the sciatic nerve: Early-onset colonic diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {32},
number = {10},
pages = {e13917},
doi = {10.1111/nmo.13917},
pmid = {32567170},
issn = {1365-2982},
mesh = {Adult ; Diverticulitis, Colonic/*diagnostic imaging/etiology ; Female ; Humans ; Lipomatosis/complications/*diagnostic imaging ; Lumbosacral Plexus/*diagnostic imaging ; Middle Aged ; *Phenotype ; Sciatic Nerve/*diagnostic imaging ; },
abstract = {BACKGROUND: Lipomatosis of nerve (LN) is a complex peripheral nerve disorder characterized by fibrofatty nerve enlargement. MRI of this pathology is pathognomonic and obviates a diagnostic biopsy. Mutation in PIK3CA has been associated with LN cases with nerve-territory overgrowth which may occur in some cases. We evaluate an association of LN of the sciatic nerve and early-onset colonic diverticular disease and discuss the potential pathogenesis.
METHODS: Our institutional database was searched for LN cases. Available information of identified cases was reviewed, and cases with a confirmed diagnosis of LN affecting the lumbosacral plexus and/or sciatic nerve; available MRI of the affected nerve(s); and diverticular disease occurring in the area supplied by the nerve(s) affected by LN were further analyzed. PIK3CA mutation testing was performed on available tissue samples.
RESULTS: We identified 10 LN cases of lumbosacral plexus and/or sciatic nerve. Of these, three fulfilled our inclusion criteria. All three patients had concomitant colonic diverticular disease, diagnosed at a relatively young age. MRI studies of these cases showed LN involvement of the sacral nerves innervating the sigmoid colon. All three also had abnormal diagnostic workup including various GI tests and evidence of associated nerve-territory overgrowth. Colonic tissue samples for PIK3CA mutation were negative.
CONCLUSION: While the pathogenesis of the colonic diverticular disease is increasingly recognized as being multifactorial, our observations are consistent with the potential role of autonomic nervous system dysfunction affecting either the pelvic floor musculature, or the colon itself (or both) in a subset of patients with early-onset diverticular disease.},
}
@article {pmid32556770,
year = {2021},
author = {Williams, J and Stocchi, L and Aiello, A and Bhama, A and Kessler, H and Gorgun, E and Delaney, CP and Steele, S and Valente, M},
title = {No need to watch the clock: persistence during laparoscopic sigmoidectomy for diverticular disease.},
journal = {Surgical endoscopy},
volume = {35},
number = {6},
pages = {2823-2830},
pmid = {32556770},
issn = {1432-2218},
mesh = {Aged ; Colectomy ; *Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Laparoscopic sigmoidectomy is the preferred approach in the elective surgical management of diverticulitis. However, it is unclear if the benefits of laparoscopy persist when operative times are prolonged. We aimed to investigate if the recovery benefits associated with laparoscopy are retained when operative times are long.
METHODS: A retrospective review of a prospectively maintained database of patients who underwent elective laparoscopic sigmoidectomy from 2010-2015 at a single academic tertiary institution was performed. Operative times among laparoscopic completed cases were divided into quartiles, and patient outcomes were compared between the groups.
RESULTS: A total of 466 patients (median age: 58 ± 11.6 years, 58% females) underwent sigmoidectomy: 430 completed laparoscopically and 36 (7.7%) converted. Median operative time in laparoscopically completed cases was 188 min (IQR 154-230). There were no differences in morbidity (P = 0.52) or readmission rates (P = 0.22) among the quartiles. The 2nd and 4th operative time quartiles were associated with significantly longer length of stay (LOS) when compared to the fastest quartile (P = 0.003 and P = 0.002, respectively), but there was no increase in LOS as operative times progressed between the 2nd, 3rd, and 4th quartiles. LOS after conversion was longer but did not reach statistical significance when compared to laparoscopically completed operations in the longest quartile (5.0 vs 6.5 days, P = 0.075) CONCLUSIONS: Our data do not support preemptive conversion of laparoscopic sigmoidectomy to avoid prolonged operative times. As long as progress is safely being made, surgeons are justified to continue pursuing laparoscopic completion.},
}
@article {pmid32555171,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Author Correction: Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {50},
doi = {10.1038/s41572-020-0192-y},
pmid = {32555171},
issn = {2056-676X},
abstract = {An amendment to this paper has been published and can be accessed via a link at the top of the paper.},
}
@article {pmid32554687,
year = {2020},
author = {Kiandee, M and Sripada, R},
title = {Should diverticulitis be managed in primary care? An audit on the management of diverticulitis in primary care.},
journal = {The British journal of general practice : the journal of the Royal College of General Practitioners},
volume = {70},
number = {suppl 1},
pages = {},
doi = {10.3399/bjgp20X711665},
pmid = {32554687},
issn = {1478-5242},
abstract = {BACKGROUND: The prevalence of diverticulosis and acute diverticulitis is increasing in developed countries. For those with diverticulosis the lifetime risk of developing acute diverticulitis is about 4-25%. Mild, uncomplicated diverticulitis can be, and often is, managed safely in a primary care setting, avoiding unnecessary admission.
AIM: To evaluate management of suspected diverticulitis in primary care against standards set by the National Institute for Health and Care Excellence (NICE) and review admission rates following primary care management.
METHOD: An electronic search on EMIS Web using Read codes 'diverticulitis', 'diverticulosis', and 'diverticular disease', with a specified period of 2017-2019. All consultations with suggestions of an infective flare of diverticular disease were included in the study. Clinical data from the consultations were extracted and retrospectively audited.
RESULTS: A total of 64 patients were identified with diverticular disease or diverticulosis. Of those, 42% (n = 27) presented to primary care with presenting complaints suspicious of diverticulitis. A total of 64 consultations were reviewed, as several patients presented more than once in the study period. Of the consultations reviewed, 12.5% (n = 8) resulted in referral to the surgical assessment unit. Antibiotics were prescribed after 68.4% (n = 39) of consultations. Bloods for inflammatory markers were performed after 19.3% (n = 11) of consultations. Only 3.5% (n = 2) of patients were reviewed within the recommended 48-hour timeframe. Only 3.5% (n = 2) of patients subsequently deteriorated and required admission.
CONCLUSION: The management of diverticulitis in this primary care centre is not fully concordant with NICE guidelines. There is a need to improve adherence, in particular antibiotic regimen when deciding to prescribe antibiotics.},
}
@article {pmid32553704,
year = {2021},
author = {Carabotti, M and Morselli Labate, AM and Cremon, C and Cuomo, R and Pace, F and Andreozzi, P and Falangone, F and Barbara, G and Annibale, B and , },
title = {Distinguishing features between patients with acute diverticulitis and diverticular bleeding: Results from the REMAD registry.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {2},
pages = {202-209},
doi = {10.1016/j.dld.2020.05.045},
pmid = {32553704},
issn = {1878-3562},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticular Diseases/*epidemiology ; Diverticulitis/*epidemiology ; Female ; Humans ; Italy/epidemiology ; *Life Style ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Registries ; Risk Factors ; },
abstract = {BACKGROUND: Pathogenesis of acute diverticulitis and diverticular bleeding remains poorly defined, and few data compare directly risk factors for these complications.
AIMS: to assess differences in clinical features, lifestyles factors and concurrent drug use in patients with acute diverticulitis and those with diverticular bleeding.
METHODS: Data were obtained from the REMAD Registry, an ongoing 5-year prospective, observational, multicenter, cohort study conducted on 1,217 patients. Patient- and clinical- related factors were compared among patients with uncomplicated diverticular disease, patients with previous acute diverticulitis, and patients with previous diverticular bleeding.
RESULTS: Age was significantly lower (OR 0.48, 95% CI: 0.34-0.67) and family history of diverticular disease was significantly higher (OR 1.60, 95% CI: 1.11-2.31) in patients with previous diverticulitis than in patients with uncomplicated diverticular disease, respectively. Chronic obstructive pulmonary disease was significantly higher in patients with previous diverticular bleeding as compared with both uncomplicated diverticular disease (OR 8.37, 95% CI: 2.60-27.0) and diverticulitis (OR 4.23, 95% CI: 1.11-16.1).
CONCLUSION: This ancillary study from a nationwide Registry showed that some distinctive features identify patients with acute diverticulitis and diverticular bleeding. These information might improve the assessment of risk factors for diverticular complications.},
}
@article {pmid32551027,
year = {2020},
author = {Keady, C and Hechtl, D and Joyce, M},
title = {When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement.},
journal = {World journal of gastrointestinal surgery},
volume = {12},
number = {5},
pages = {208-225},
pmid = {32551027},
issn = {1948-9366},
abstract = {Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.},
}
@article {pmid32546262,
year = {2020},
author = {Ogawa-Ochiai, K and Yoshimura, K and Shirai, A and Sakai, S and Moriyama, H and Nakamura, K and Murayama, T and Ishikawa, H},
title = {Study protocol for daiobotanpito combined with antibiotic therapy for treatment of acute diverticulitis: a study protocol for a randomized controlled trial.},
journal = {Trials},
volume = {21},
number = {1},
pages = {531},
pmid = {32546262},
issn = {1745-6215},
support = {18lk0310044h0001//Japan Agency for Medical Research and Development/ ; },
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Drugs, Chinese Herbal/*therapeutic use ; Humans ; Japan ; Medicine, Kampo ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {BACKGROUND: Colonic diverticular disease has been increasing in prevalence due to the rapidly aging global population, but standard treatment has not changed dramatically in recent years. Daiobotanpito (DBT; Da Huang Mu Dan Tang in Chinese) has been used in medical treatment of acute abdominal abscesses, such as appendicitis or diverticulitis in traditional Japanese (Kampo) medicine for many years, based on more than 3000 years of experience. Prior to this study, a retrospective open-label trial was conducted to compare patients with acute diverticulitis who received oral DBT combined with intravenous antibiotics with those who received intravenous antibiotic alone; it showed a positive effect of DBT on acute diverticulitis. We aim to investigate whether moderate to severe acute diverticulitis shows greater improvement with intravenous antibiotics plus orally administered DBT compared with intravenous antibiotics plus placebo.
METHODS: This is a two-group, randomized, double-blind, placebo-controlled, multi-center trial, which is designed to evaluate the efficacy and safety of DBT in patients with moderate to severe diverticulitis treated with intravenous antibiotics. Eligible participants will be randomized to either a treatment group receiving a 10-day oral DBT regimen plus conventional therapy or a control group receiving a 10-day placebo regimen plus conventional therapy. The primary outcome will be success in treating diverticulitis: the success rate will be defined as elimination of abdominal pain within 4 days in all patients, and in patients with fever (body temperature ≧ 37.5 °C) on inclusion into this study, fever relief with reduction in body temperature to < 37.5 °C within 3 days. Secondary endpoints will include the number of hospitalization days, changes in inflammatory response (C-reactive protein (CRP), white blood cell (WBC) and neutrophil counts), fever type, number of days before beginning food intake, recurrence rate (observation for 1 year after registration), and adverse event expression rate. Assessments will be performed at baseline and on the day of discharge. The recurrence rate will be recorded at 1 year after registration.
DISCUSSION: This study is expected to provide evidence to support the clinical benefits of DBT in the treatment of acute diverticulitis. It may also provide evidence on the efficacy and safety of DBT in the recurrence of acute diverticulitis.
TRIAL REGISTRATION: UMIN-CTR: UMIN000027381. Registered on 27 April 2017. https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000031377, and changed to jRCTs041180063, registered on 30 July 2019; as a result of the revision of the domestic law in 2018 in Japan.},
}
@article {pmid32542557,
year = {2020},
author = {Maguire, LH},
title = {Genetic Risk Factors for Diverticular Disease-Emerging Evidence.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {10},
pages = {2314-2317},
pmid = {32542557},
issn = {1873-4626},
support = {K08 DK124687/DK/NIDDK NIH HHS/United States ; },
mesh = {Constipation ; Diet ; *Diverticular Diseases/genetics ; *Genome-Wide Association Study ; Humans ; Risk Factors ; },
abstract = {Diverticular disease is traditionally understood as an environmental disease caused by diet and constipation. However, genes are increasing understood to play a role in pathogenesis. Twin studies suggest a substantial component of individual risk is due to heritable factors. Association of diverticular disease with other traits suggests an underlying biological mechanism and recently genome-wide association studies have described the genetic architecture underlying this complex phenotype. These studies suggest a new paradigm for understanding this common surgical disease.},
}
@article {pmid32535905,
year = {2020},
author = {Noyes, JD and Mordi, IR and Doney, AS and Palmer, CNA and Pearson, ER and Lang, CC},
title = {Genetic Risk of Diverticular Disease Predicts Early Stoppage of Nicorandil.},
journal = {Clinical pharmacology and therapeutics},
volume = {108},
number = {6},
pages = {1171-1175},
doi = {10.1002/cpt.1941},
pmid = {32535905},
issn = {1532-6535},
mesh = {Aged ; Cardiovascular Agents/administration & dosage/*adverse effects ; Clinical Decision-Making ; Databases, Factual ; Digestive System Fistula/diagnosis/*etiology/prevention & control ; Diverticular Diseases/complications/diagnosis/*genetics ; Drug Administration Schedule ; Female ; Genetic Predisposition to Disease ; Genetic Testing ; Humans ; Male ; Middle Aged ; Nicorandil/administration & dosage/*adverse effects ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Scotland ; Time Factors ; },
abstract = {Gastrointestinal fistulation has been widely reported as an adverse effect of nicorandil therapy in Europe. People who have underlying diverticular disease are most at risk of this side effect. In Western countries, diverticular disease is highly prevalent and can be clinically silent. This study aimed to identify diverticular disease genetic risk scores (GRSs) associated with early nicorandil stoppage, a surrogate marker for drug intolerance. A case-control study was carried out on 1,077 patients from the Genetics of Diabetes Audit and Research Tayside Scotland (GoDARTS) database. Cases were defined as having < 9 nicorandil prescriptions with no identifiable reason for stopping (n = 230). Controls had either ≥ 9 prescriptions, treatment continuation to death/study end or stoppage post-myocardial infarction. Two diverticular GRSs were created and used in logistic regression models. Isosorbide mononitrate was used as a control analysis. Patients with a raised diverticular GRS, based on 23 replicable loci, had increased risk of stopping nicorandil therapy early (univariate (odds ratio (OR) 2.26; P = 0.04], multivariate (OR 3.96; P = 0.01)). Similar trends were noted when using the full 42 variant diverticular score but statistical significance was not reached. The isosorbide control analysis did not reach statistical significance. Our analysis demonstrates a novel positive association between a raised diverticular GRS and early stoppage of nicorandil therapy.},
}
@article {pmid32523619,
year = {2020},
author = {Lahat, A and Fidder, HH and Ben-Horin, S},
title = {Development and validation of a diverticular clinical score for symptomatic uncomplicated diverticular disease after acute diverticulitis in a prospective patient cohort.},
journal = {Therapeutic advances in gastroenterology},
volume = {13},
number = {},
pages = {1756284820913210},
pmid = {32523619},
issn = {1756-283X},
abstract = {Background: Following an attack of acute diverticulitis (AD), many patients continue to suffer from a complex of symptoms, titled 'symptomatic uncomplicated diverticular disease (SUDD)'. To date, there is no validated clinical score for standardized assessment of patients with SUDD, thereby hampering the interpretation of observational studies and the conductance of clinical trials.We aimed to develop a validated SUDD clinical score.
Methods: Data from previous prospective study of patients after AD was used to devise the score's first version. Validation was first performed using a focus group of patients after AD SUDD who underwent a structured cognitive personal interview. Thereafter, the diverticular clinical score (DICS) was applied for a second validation cohort. DICS scores of validation cohort were compared with physicians' global assessment for disease severity and inflammatory markers.
Results: In DICS second validation using 48 patients prospectively recruited after AD SUDD, a correlation matrix demonstrated strong correlation between total questionnaire's score and the presence of elevated inflammatory markers (ρ = 0.84). Mean score in patients with elevated inflammatory markers compared with those without inflammation was 17.8 versus 6.2, respectively, p < 0.001. Cronbach's α for measuring internal consistency was 0.91. DICS discriminated accurately between patients with/without active disease, as gauged by the physicians global assessment (area under the curve receiver operating characteristic = 0.989).
Conclusions: Patients suffering from post-AD SUDD exhibit a wide range of symptoms. The newly developed DICS accurately and reproducibly quantitates SUDD-related symptom severity. The DICS may prove useful for monitoring SUDD in clinical practice and in research settings, as well as facilitating patient stratification and therapeutic decisions.},
}
@article {pmid32494547,
year = {2020},
author = {Elfanagely, Y and Tse, CS and Patil, P and Lueckel, S},
title = {Jejunal Diverticulosis Complicated by Diverticulitis and Small Bowel Obstruction.},
journal = {Cureus},
volume = {12},
number = {5},
pages = {e8347},
pmid = {32494547},
issn = {2168-8184},
abstract = {Diverticular disease is common in the Western population and can cause considerable morbidity. The prevalence of colonic diverticulosis reaches 60% by the age of 60 years. Small bowel diverticulosis is much rarer and, when present, most commonly occurs in the duodenum. We herein report an elderly woman with jejunal diverticulosis complicated by diverticulitis and small bowel obstruction, who subsequently underwent small bowel resection and primary anastomosis. As demonstrated by this case, jejunal diverticulitis can cause serious complications and given the possibility of recurrence and serious complications, surgical options should be discussed early in the course of medical care.},
}
@article {pmid32483125,
year = {2020},
author = {Pesce, A and Barchitta, M and Agodi, A and Salerno, M and La Greca, G and Magro, G and Latteri, S and Puleo, S},
title = {Comparison of clinical and pathological findings of patients undergoing elective colectomy for uncomplicated diverticulitis.},
journal = {Scientific reports},
volume = {10},
number = {1},
pages = {8854},
pmid = {32483125},
issn = {2045-2322},
mesh = {Age Factors ; Aged ; Colectomy ; Colonic Diseases/pathology/*surgery ; Diverticulitis/pathology/*surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Severity of Illness Index ; Sex Factors ; },
abstract = {Diverticular disease affects ∼5-10% people worldwide, yet the indications for elective colectomy in uncomplicated diverticulitis are unclear. As there is no strong scientific evidence regarding histology in diverticular disease, the primary outcome of the study was to analyze the degree of inflammation of colonic wall in patients that underwent elective colectomy for uncomplicated diverticulitis and to retrospectively assess the correlation between patient clinical history and pathological features of surgical specimens in order to find some predictive factors that may be strictly correlated with histology. An observational retrospective study was conducted. Patients undergoing elective colectomy for uncomplicated diverticulitis between January 2014 and January 2016 in an academic medical center were collected. The majority of patients (46.2%) had previously encountered one episode of acute diverticulitis prior to colectomy, while 21.5% and 10.8% had experienced two and three or more prior episodes respectively. Most patients had recurrent or chronic abdominal pain in the left iliac fossa (66.2%) for diverticular disease and a large proportion also experienced constipation (40.0%). Diverticulitis was identified pathologically as being "mild" in 44.6% patients and "severe" in 55.4% patients. The mean age was significantly lower in patients with severe diverticulitis (56.7 years) than in patients with mild diverticulitis (67.0 years). 71.9% of males had severe diverticulitis compared to 39.4% of females. Males have a 3.9 times higher risk of histological severe diverticulitis than females (OR = 3.932; 1.390-11.122; p = 0.008). Multivariate logistic regression analysis confirmed that age and gender were independent factors associated with histological diagnosis. Single-institution data and retrospective design were main limitations of this study. Age and gender are independent factors associated with severity inflammation index derived at histological analysis and they could be translated to clinical practice to better categorize patients with uncomplicated diverticulitis at the bedside.},
}
@article {pmid32483087,
year = {2020},
author = {Tursi, A and Violi, A and Cambie', G and Franceschi, M and Baldassarre, G and Rodriguez, KI and Miraglia, C and Brandimarte, G and Elisei, W and Picchio, M and Di Mario, F},
title = {Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study.},
journal = {European journal of gastroenterology & hepatology},
volume = {32},
number = {9},
pages = {1123-1129},
doi = {10.1097/MEG.0000000000001787},
pmid = {32483087},
issn = {1473-5687},
mesh = {Case-Control Studies ; Colonoscopy ; *Diverticular Diseases/diagnosis/epidemiology ; *Diverticulosis, Colonic/diagnosis/epidemiology ; Female ; Humans ; Risk Factors ; },
abstract = {BACKGROUND: Diverticular disease is an increasing global problem.
AIMS: To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population.
METHODS: A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification.
RESULTS: A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs.
CONCLUSIONS: Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.},
}
@article {pmid32462452,
year = {2020},
author = {Gilshtein, H and Yellinek, S and Maenza, J and Wexner, SD},
title = {Surgical management of colovesical fistulas.},
journal = {Techniques in coloproctology},
volume = {24},
number = {8},
pages = {851-854},
pmid = {32462452},
issn = {1128-045X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; *Diverticulum/surgery ; Female ; Humans ; *Intestinal Fistula/etiology/surgery ; *Laparoscopy ; Middle Aged ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The most common etiology of colovesical fistulas is complicated diverticular disease and the treatment of choice is surgical resection. There are very few reports of the application of minimally invasive approaches for these surgeries. The aim of our study was to evaluate the role of laparoscopy in this challenging surgical setting.
METHODS: A retrospective analysis of patients who underwent transabdominal surgery for colovesical fistula in 2008-2018 was performed. Patients were divided into 2 groups: patients who had open surgery and patients treated with laparoscopy. The postoperative course was reviewed for the length of stay, postoperative complications, readmission, emergency re-operation, and mortality RESULTS: Thirty-five patients were included (13 females [37%]; median age 68 [range 28-84] years) with a mean body mass index of 29 ± 7.19 kg/m2. The main fistula etiology was diverticulitis (91%). Seventeen patients (48.5%) had laparoscopic surgery and 2 patients in whom laparoscopy was attempted underwent conversion to laparotomy. The benefits of laparoscopy included significant reductions in morbidity including surgical site infections and medical complications following laparoscopy.
CONCLUSIONS: Laparoscopic management of colovesical fistula is both safe and feasible in a high volume laparoscopic colorectal surgery center. Laparoscopy offers potential benefits including a decreased incidence of surgical site infections and medical complications.},
}
@article {pmid32422553,
year = {2020},
author = {Sugi, MD and Sun, DC and Menias, CO and Prabhu, V and Choi, HH},
title = {Acute diverticulitis: Key features for guiding clinical management.},
journal = {European journal of radiology},
volume = {128},
number = {},
pages = {109026},
doi = {10.1016/j.ejrad.2020.109026},
pmid = {32422553},
issn = {1872-7727},
mesh = {Abscess/etiology/therapy ; Acute Disease ; Colon/diagnostic imaging ; Diagnostic Imaging/*methods ; Digestive System Surgical Procedures ; Diverticulitis, Colonic/complications/*diagnostic imaging/*therapy ; Drainage ; Fistula/etiology/therapy ; Humans ; Intestinal Obstruction/etiology/therapy ; Peritonitis/etiology/therapy ; },
abstract = {Diverticular disease of the colon and small bowel is an important cause of pathology leading to emergency department visits and urgent gastrointestinal surgery. CT is a highly sensitive and specific modality for the diagnosis of acute diverticulitis and its complications as well as for the exclusion of alternate causes of pathology. Ultrasound, MRI and virtual CT colonoscopy have important adjunct roles for screening and workup of complications in specific patient populations. While diverticular disease most commonly involves the descending and sigmoid colon, it can also affect the proximal colon and small bowel. Acute diverticulitis may be categorized as uncomplicated or complicated according to the degree of inflammatory changes and related complications it induces, although some degree of overlap exists in clinical practice. Uncomplicated diverticulitis is classically characterized by localized inflammation surrounding a diverticulum ranging from wall thickening and phlegmonous change to the development of small, localized pericolic abscesses. Complicated forms of disease manifest with larger pericolic and distant abscesses, fistulae to adjacent organs, perforation, and peritonitis. Recurrent episodes of diverticulitis may lead to muscular hypertrophy of the bowel wall and luminal narrowing, potentially leading to bowel obstruction. Several imaging features may help to differentiate diverticulitis from colonic malignancy, however this remains a diagnostic imaging challenge that often requires further evaluation with colonoscopy. In this review, we discuss the pathophysiology and key imaging features of acute diverticulitis and its complications. We explore both common and uncommon presentations of the disease involving the colon and small bowel, acute and chronic manifestations of disease, and pitfalls to recognize when imaging alone may be insufficient to distinguish benign from malignant.},
}
@article {pmid32419870,
year = {2020},
author = {Miulescu, AM},
title = {Colonic Diverticulosis. Is there a Genetic Component?.},
journal = {Maedica},
volume = {15},
number = {1},
pages = {105-110},
pmid = {32419870},
issn = {1841-9038},
abstract = {Diverticular disease is a common condition among the elderly, with a steady increase in prevalence over time. Also, it has a temporal, geographic, and ethnic variation in incidence and prevalence, the genetic component having only recently been studied. For many years, environmental factors were the main link to the etiology. Recent studies estimated the heritability in this disease and identified genetic variants associated with diverticulosis. The interaction between structural changes of the colonic wall, diet, lifestyle, and genetic factors results in the development of diverticular disease. The purpose of this article is to review the existing data about genetic influence in this disease.},
}
@article {pmid32399665,
year = {2021},
author = {Jaung, R and Varghese, C and Lin, AY and Paskaranandavadivel, N and Du, P and Rowbotham, D and Dinning, P and O'Grady, G and Bissett, I},
title = {High-Resolution Colonic Manometry Pressure Profiles Are Similar in Asymptomatic Diverticulosis and Controls.},
journal = {Digestive diseases and sciences},
volume = {66},
number = {3},
pages = {832-842},
pmid = {32399665},
issn = {1573-2568},
mesh = {Adult ; Aged ; Asymptomatic Diseases ; Case-Control Studies ; Colon, Descending/physiopathology ; Colon, Sigmoid/physiopathology ; Diverticulum/*physiopathology ; Female ; Gastrointestinal Motility/*physiology ; Humans ; Male ; Manometry/methods/*statistics & numerical data ; Meals/physiology ; Middle Aged ; Postprandial Period/physiology ; Pressure ; },
abstract = {BACKGROUND: Elevated colonic pressures and increased colonic activity have been thought to contribute to the pathophysiology of diverticulosis. However, evidence for this has been limited to low-resolution manometry, which is of limited accuracy.
AIMS: This study aimed to evaluate the contraction pressures, counts, and distance of propagation recorded by high-resolution colonic manometry in diverticulosis vs control patients.
METHODS: High-resolution colonic manometry was used to record descending and sigmoid colon activity pre- and post-meal in patients with established, asymptomatic diverticulosis and in healthy controls. Antegrade and retrograde propagating contractions, distance of propagation (mm), and mean contraction pressures (mmHg) in the descending and sigmoid colon were compared between patients and controls for all isolated propagating contractions, the cyclic motor pattern, and high-amplitude propagating contractions independently.
RESULTS: Mean manometry pressures were not different between controls and diverticulosis patients (p > 0.05 for all comparisons). In the descending colon, diverticulosis patients had lower post-meal mean distance of propagation for all propagating contractions [10.8 (SE1.5) mm vs 20.0 (2.0) mm, p = 0.003] and the cyclic motor pattern [6.0 (2.5) mm vs 17.1 (2.8) mm, p = 0.01]. In the sigmoid colon, diverticulosis patients showed lower post-meal mean distance of propagation for all propagating contractions [10.8 (1.5) mm vs 20.2 (5.9) mm, p = 0.01] and a lower post-meal increase in retrograde propagating contractions (p = 0.04).
CONCLUSIONS: In this first high-resolution colonic manometry study of patients with diverticular disease, we did not find evidence for increased manometric pressures or increased colonic activity in patients with diverticular disease.},
}
@article {pmid32384399,
year = {2020},
author = {Flum, DR and Read, TE},
title = {Evidence-Based Management of Diverticular Disease: What's New and What's Missing?.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {6},
pages = {715-717},
doi = {10.1097/DCR.0000000000001678},
pmid = {32384399},
issn = {1530-0358},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Clinical Decision-Making/methods ; Colorectal Surgery/organization & administration ; Constriction, Pathologic/epidemiology/etiology ; Diverticular Diseases/classification/complications/epidemiology/*therapy ; Elective Surgical Procedures/methods ; Evidence-Based Practice/standards ; Fistula/epidemiology/etiology ; Gastrointestinal Diseases/*pathology ; Humans ; Mesalamine/therapeutic use ; Meta-Analysis as Topic ; Practice Guidelines as Topic/*standards ; Probiotics/therapeutic use ; Quality of Life ; Randomized Controlled Trials as Topic ; Rifaximin/therapeutic use ; Societies, Scientific/organization & administration ; United States/epidemiology ; },
}
@article {pmid32378533,
year = {2020},
author = {Kikuta, S and Iwanaga, J and Koga, M and Kusukawa, J},
title = {Diverticular Pouch of the Buccal Mucosa: A Rare Case Report.},
journal = {The Kurume medical journal},
volume = {66},
number = {1},
pages = {81-84},
doi = {10.2739/kurumemedj.MS661013},
pmid = {32378533},
issn = {1881-2090},
mesh = {Aged ; Cheek/pathology ; *Diverticulum/diagnosis/pathology ; Humans ; Male ; *Mouth Mucosa/pathology ; },
abstract = {Diverticular pouch in the oral cavity is a rare disease, and its etiology is unclear. The authors present a rare case of diverticular pouch in the buccal mucosa. A 79-year-old man visited our hospital with a chief complaint of food impaction in the right buccal mucosa. Intraoral examination revealed a pouch just inferior to the parotid papilla. Histopathological examination after excisional biopsy showed that the epithelial cells lining the pouch were continuous with the mucous membrane and a diagnosis was made of diverticular pouch of the buccal mucosa. Twenty-five months after the patient's initial visit no recurrence has been noted. Further clinico-pathological studies are required to understand diverticular disease in the buccal mucosa. This case might help dentists to become more aware of these lesions and collect data for further investigations.},
}
@article {pmid32374180,
year = {2020},
author = {Kong, CY and Goh, HL and Anderson, JE},
title = {Portal venous gas as a radiological sign in a sigmoid diverticular abscess and its non-surgical management: a case report.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {7},
pages = {e173-e175},
pmid = {32374180},
issn = {1478-7083},
mesh = {Abscess/diagnosis/etiology/*therapy ; *Colon, Sigmoid ; Conservative Treatment/*methods ; Diverticulum, Colon/*complications/diagnosis/therapy ; Humans ; Male ; Middle Aged ; Portal Vein/*diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {A 62-year old man who presented unwell with no specific symptoms or signs was found to have portal venous circulation gas complicating a small diverticular abscess. He was successfully managed with a course of antibiotics and had full resolution of symptoms, therefore avoiding the need for surgical intervention. While most commonly associated with bowel ischaemia and therefore often warranting emergency laparotomy, portal venous gas within the context of other underlying pathology often presents opportunities for delayed surgery or more conservative management options.},
}
@article {pmid32367291,
year = {2020},
author = {Clement, EA and Rouleau-Fournier, F and Brown, CJ},
title = {Techniques for safe laparoscopic anterior resection for complicated diverticular disease.},
journal = {Techniques in coloproctology},
volume = {24},
number = {9},
pages = {979},
doi = {10.1007/s10151-020-02215-8},
pmid = {32367291},
issn = {1128-045X},
mesh = {Colectomy ; *Diverticulitis, Colonic/complications/surgery ; *Diverticulum ; Humans ; *Laparoscopy ; },
}
@article {pmid32350266,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Publisher Correction: Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {35},
doi = {10.1038/s41572-020-0176-y},
pmid = {32350266},
issn = {2056-676X},
abstract = {An amendment to this paper has been published and can be accessed via a link at the top of the paper.},
}
@article {pmid32325012,
year = {2020},
author = {Espin Basany, E and Solís-Peña, A and Pellino, G and Kreisler, E and Fraccalvieri, D and Muinelo-Lorenzo, M and Maseda-Díaz, O and García-González, JM and Santamaría-Olabarrieta, M and Codina-Cazador, A and Biondo, S},
title = {Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial.},
journal = {The lancet. Gastroenterology & hepatology},
volume = {5},
number = {8},
pages = {729-738},
doi = {10.1016/S2468-1253(20)30075-3},
pmid = {32325012},
issn = {2468-1253},
mesh = {Administration, Intravenous ; Administration, Oral ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Ciprofloxacin/administration & dosage/*therapeutic use ; Colectomy/adverse effects/methods ; Colon/pathology/*surgery ; Elective Surgical Procedures/adverse effects ; Female ; Humans ; Incidence ; Male ; Metronidazole/administration & dosage/*therapeutic use ; Middle Aged ; Preoperative Care/*standards ; Single-Blind Method ; Spain/epidemiology ; Surgical Wound Infection/epidemiology/*prevention & control ; },
abstract = {BACKGROUND: Previous studies have found that mechanical bowel preparation with oral antibiotics can reduce the incidence of surgical-site infections, but no randomised controlled trial has assessed oral antibiotics alone without mechanical bowel preparation. The aim of this study was to determine whether prophylaxis with oral antibiotics the day before elective colon surgery affects the incidence of postoperative surgical-site infections.
METHODS: In this multicentre, pragmatic, randomised controlled trial (ORALEV), patients undergoing colon surgery were recruited from five major hospitals in Spain and 47 colorectal surgeons at these hospitals participated. Patients were eligible for inclusion if they were diagnosed with neoplasia or diverticular disease and if a partial colon resection or total colectomy was indicated. Participants were randomly assigned (1:1) using online randomisation tables to either administration of oral antibiotics the day before surgery (experimental group) or no administration of oral antibiotics before surgery (control group). For the experimental group, ciprofloxacin 750 mg was given every 12 h (two doses at 1200 h and 0000 h) and metronidazole 250 mg every 8 h (three doses at 1200 h, 1800 h, and 0000 h) the day before surgery. All patients were given intravenous cefuroxime 1·5 g and metronidazole 1 g at the time of anaesthetic induction. The primary outcome was incidence of surgical-site infections. Patients were followed up for 1 month after surgery and all postsurgical complications were registered. This study was registered with EudraCT, 2014-002345-21, and ClinicalTrials.gov, NCT02505581, and is closed to accrual.
FINDINGS: Between May 2, 2015, and April 15, 2017, we assessed 582 patients for eligibility, of whom 565 were eligible and randomly assigned to receive either no oral antibiotics (n=282) or oral antibiotics (n=282) before surgery. 13 participants in the control group and 16 in the experimental group were subsequently excluded; 269 participants in the control group and 267 in the experimental group received their assigned intervention. The incidence of surgical-site infections in the control group (30 [11%] of 269) was significantly higher than in the experimental group (13 [5%] of 267; χ2 test p=0·013). Oral antibiotics were associated with a significant reduction in the risk of surgical-site infections compared with no oral antibiotics (odds ratio 0·41, 95% CI 0·20-0·80; p=0·008). More complications (including surgical-site infections) were observed in the control group than in the experimental group (76 [28%] vs 51 [19%]; p=0·017), although there was no difference in severity as assessed by Clavien-Dindo score. No differences were noted between groups in terms of local complications, surgical complications, or medical complications that were not related to septic complications.
INTERPRETATION: The administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery.
FUNDING: Fundación Asociación Española de Coloproctología.},
}
@article {pmid32313744,
year = {2020},
author = {Hanna, M and Ng, C and Slater, K},
title = {Small Bowel Diverticulosis As a Cause of Chronic Pneumoperitoneum.},
journal = {Cureus},
volume = {12},
number = {3},
pages = {e7303},
pmid = {32313744},
issn = {2168-8184},
abstract = {Pneumoperitoneum, or the accumulation of free air in the peritoneal cavity, is commonly associated with visceral perforation, mandating emergent surgical intervention. Non-surgical pneumoperitoneum, where visceral perforation is not the cause, does not commonly require surgical management. Chronic pneumoperitoneum secondary to small bowel diverticulosis is rare. Of all gastrointestinal diverticular diseases, jejunoileal diverticulosis is the rarest form. We describe a case of chronic pneumoperitoneum in an 83-year-old male presenting with intermittent abdominal distension and constipation over five years resulting in many presentations to his rural hospital. There were never any associated signs of sepsis such as fever or tachycardia. A computed tomography scan revealed large volume pneumoperitoneum without evidence of perforated viscera or free fluid. An elective diagnostic laparoscopy revealed extensive small bowel diverticular disease. One of the diverticuli exhibited pneumotosis intestinalis where bubbles of gas were noted within the diverticulum wall and mesentery in the local vicinity. Given the extent of the small bowel diverticular disease, the patient's advanced age, and relative lack of symptoms, bowel resection was not undertaken and the patient was managed conservatively. This article illustrates a case of chronic pneumoperitoneum due to small bowel diverticulosis. It highlights the differential diagnoses for chronic pneumoperitoneum, increases awareness of this rare and challenging condition, and portrays the utility of conservative management avoiding major surgery and its potential complications.},
}
@article {pmid32312914,
year = {2020},
author = {Pietrzak, AM and Banasiewicz, T and Skoczylas, K and Dziki, A and Szczepkowski, M},
title = {Combined therapy: rifaximin-α and arabinogalactan with lactoferrin combination effectively prevents recurrences of symptomatic uncomplicated diverticular disease.},
journal = {Polski przeglad chirurgiczny},
volume = {92},
number = {2},
pages = {22-28},
doi = {10.5604/01.3001.0014.0946},
pmid = {32312914},
issn = {2299-2847},
mesh = {Adult ; Aged ; Diverticular Diseases/*drug therapy/prevention & control ; Drug Therapy, Combination ; Female ; Galactans/*therapeutic use ; Gastrointestinal Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Patient Compliance ; Poland ; Retrospective Studies ; Rifamycins/*therapeutic use ; Treatment Outcome ; },
abstract = {INTRODUCTION: Background: Diverticulosis is the most common finding in the GI tract. Nearly half of the people with diverticula experience symptomatic uncomplicated diverticular disease (SUDD).
AIMS: The primary endpoints of our study were to assess the effectiveness of combined therapy with rifaximin-α and arabinogalactan-lactoferrin in symptom reduction and normalization of bowel movements. The secondary endpoints were an assessment of efficacy in SUDD recurrence prevention and patients' compliance to the combined therapy.
METHODS: A retrospective observational survey study was performed in 2019 among physicians experienced in diverticular disease (DD) treatment in Poland. Patients with previous episodes of recurrences treated with combined therapy (cyclic rifaximin-α at least 400 mg b.i.d/7 days/every month and continuous arabinogalactan-lactoferrin supplementation 1 sachet daily) were assessed after 3 and 6 months regarding symptoms' resolution in the three-point scale. The patients' SUDD history, diagnostic methods, treatment, and results, as well as patients' compliance were evaluated.
RESULTS: 281 patients met inclusion criteria, and were further evaluated (67.6% women, median age 65 years). After 6 months of combined treatment, there was a statistically significant reduction in the total severity score (median from 1.7 [max 3 points] to 0.26; P < 0.0001; sum from 8.5 [max 15 points] to 1.28; P < 0.0001) and improvement in each symptom score. Stool frequency statistically normalized in every group. As many as 31.7% had complete symptom resolution. Patients' compliance with the therapy was very good and good in 92.9% of cases. C onclusions and discussion: Combination therapy with cyclic rifaximin-α and continuous arabinogalactan combined with lactoferrin are effective in SUDD treatment in terms of symptom resolution, bowel movement normalization, prevention of recurrences with very good patient's compliance.},
}
@article {pmid32309469,
year = {2019},
author = {Al-Obaid, L and McCarty, TR and Bazarbashi, AN and Wieczorek, TJ and Rangel, E and Homenko, D},
title = {Segmental Colitis Associated With Diverticulosis Causing Hydroureteronephrosis.},
journal = {ACG case reports journal},
volume = {6},
number = {11},
pages = {e00253},
pmid = {32309469},
issn = {2326-3253},
abstract = {Segmental colitis associated with diverticulosis (SCAD) is a rare inflammatory condition affecting segments of the colon with diverticular disease. We present an 85-year-old woman with flank pain, fevers, and chills found on imaging to have left colonic wall thickening and left-sided hydroureteronephrosis and workup confirming a diagnosis of SCAD. A detailed review of SCAD and discussion of the differential diagnosis are provided. This case emphasizes disease-specific clinical pearls and highlights hydroureteronephrosis as a rare complication seen in a patient with SCAD.},
}
@article {pmid32301257,
year = {2020},
author = {Azhar, N and Buchwald, P and Ansari, HZ and Schyman, T and Yaqub, S and Øresland, T and Schultz, JK},
title = {Risk of colorectal cancer following CT-verified acute diverticulitis: a nationwide population-based cohort study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22},
number = {10},
pages = {1406-1414},
doi = {10.1111/codi.15073},
pmid = {32301257},
issn = {1463-1318},
support = {265956//Helse Sør-Øst RHF/ ; 2719011//Helse Sør-Øst RHF/ ; },
mesh = {Acute Disease ; Cohort Studies ; Colonoscopy ; *Colorectal Neoplasms/epidemiology ; *Diverticulitis/diagnostic imaging/epidemiology ; *Diverticulitis, Colonic/diagnostic imaging/epidemiology ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {AIM: Routine colonoscopy to exclude colorectal cancer (CRC) after CT-verified acute diverticulitis is controversial. This study aimed to compare the incidence of CRC in patients with acute diverticulitis with that in the general population.
METHOD: Patients with an emergency admission for diverticular disease to any Norwegian hospital between 1 January 2008 and 31 December 2010 were included through identification in the Norwegian Patient Registry using International Classification of Diseases (ICD-10) codes K57.1-9. To estimate the age-specific distribution of CT-verified acute uncomplicated diverticulitis (AUD) and acute complicated diverticulitis (ACD) in this nationwide study population, numbers from the largest Norwegian emergency hospital were used. Patients diagnosed with CRC within 1 year following their admission for acute diverticulitis were detected through cross-matching with the Cancer Registry of Norway. Based on both Norwegian age-specific incidence of CRC and estimated age-specific distribution of CT-verified diverticulitis, standard morbidity ratios (SMRs) were calculated.
RESULTS: A total of 7473 patients with emergency admissions for diverticular disease were identified (estimated CT-verified AUD n = 3523, ACD n = 1206); of these 155 patients were diagnosed with CRC within 1 year. Eighty had a CT-verified diverticulitis at index admission [41 AUD (51.3%); 39 ACD (49.7%)]. Compared with the general population, the SMR was 6.6 following CT-verified AUD and 16.3 following ACD, respectively.
CONCLUSION: In the first year after CT-verified acute diverticulitis, especially after ACD, the risk of CRC is higher than in the general population. This probably represents misdiagnosis of CRC as acute diverticulitis. Follow-up colonoscopy should be recommended to all patients admitted with acute diverticulitis.},
}
@article {pmid32248599,
year = {2020},
author = {Peltrini, R and Pontecorvi, E and Silvestri, V and Bartolini, C and D'Ambra, M and Bracale, U and Corcione, F},
title = {Laparoscopic sigmoid colectomy with preservation of the inferior mesenteric artery for diverticular disease - a video vignette.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22},
number = {9},
pages = {1205-1206},
doi = {10.1111/codi.15053},
pmid = {32248599},
issn = {1463-1318},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Humans ; *Laparoscopy ; Mesenteric Artery, Inferior/surgery ; },
}
@article {pmid32218442,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {20},
pmid = {32218442},
issn = {2056-676X},
support = {R01 DK101495/DK/NIDDK NIH HHS/United States ; R01 DK103915/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/therapeutic use ; Biomarkers/analysis ; Diagnostic Imaging/methods ; Dietary Fiber/therapeutic use ; Diverticulosis, Colonic/*complications/epidemiology/*physiopathology ; Gastrointestinal Microbiome/physiology ; Gastroparesis/etiology/physiopathology ; Humans ; Probiotics/therapeutic use ; },
abstract = {Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.},
}
@article {pmid32218436,
year = {2020},
author = {},
title = {Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {21},
doi = {10.1038/s41572-020-0162-4},
pmid = {32218436},
issn = {2056-676X},
}
@article {pmid32217637,
year = {2020},
author = {Sidhu, M and Tate, DJ and Bourke, MJ},
title = {Transmucosal diverticular myotomy for the treatment of oesophageal diverticula associated with spastic motility disorders.},
journal = {Gut},
volume = {69},
number = {9},
pages = {1552-1554},
doi = {10.1136/gutjnl-2019-320481},
pmid = {32217637},
issn = {1468-3288},
mesh = {*Diverticulum, Esophageal/diagnosis/physiopathology/surgery ; *Esophageal Motility Disorders/diagnosis/etiology/physiopathology ; Esophagoscopy/*methods ; Esophagus/diagnostic imaging/surgery ; Female ; Humans ; Male ; Manometry/methods ; Middle Aged ; Myotomy/*methods ; Radiography/methods ; Symptom Assessment/methods ; Treatment Outcome ; },
abstract = {Thoracic oesophageal diverticula are often associated with spastic motility disorders. Despite correction of the underlying motility disorder, in a subgroup of patients, symptoms persist, primarily regurgitation. Surgical diverticulectomy is then proposed; however, as the approach is thoracoscopic or via thoracotomy, it is associated with significant morbidity and cost. Descriptions of endoscopic techniques for the treatment of symptomatic midoesophageal diverticula are few. We propose the novel technique of diverticular myotomy (DM) to treat this disorder. In this case series, we describe two patients who successfully underwent DM with no adverse outcomes and excellent clinical results at 24-month follow-up.},
}
@article {pmid32212421,
year = {2021},
author = {Grass, F and Hübner, M and Crippa, J and Lovely, JK and Huebner, M and Larson, DW},
title = {Temporal patterns of hospital readmissions according to disease category for patients after elective colorectal surgery.},
journal = {Journal of evaluation in clinical practice},
volume = {27},
number = {2},
pages = {218-222},
doi = {10.1111/jep.13387},
pmid = {32212421},
issn = {1365-2753},
mesh = {Adult ; *Colorectal Surgery ; Humans ; Length of Stay ; *Patient Readmission ; Postoperative Complications/epidemiology ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {RATIONALE: The aim of this study was to identify temporal readmission patterns according to baseline disease categories to provide opportunities for targeted interventions.
METHODS: Retrospective analysis of consecutive adult (≥18 years) patients who underwent elective colorectal resections (2011-2017) at Mayo Clinic Rochester, MN. A prospective administrative database including patient demographics, procedure characteristics, discharge information and specifics on 30-day readmissions (to index facility) including timing and reasons was utilized. The ICD-9 codes were regrouped into the main pathologies Cancer, Crohn's disease (CD)/chronic ulcerative colitis (CUC), and diverticular disease.
RESULTS: In total, 521 (7.2%) out of 7245 patients undergoing inpatient colorectal surgery were readmitted. In all increments of time from discharge (0-2 days: 31.3% of all readmissions, 3-7 days: 32.4% of all readmissions, 8-14 days: 18% of all readmissions, and 15-30 days: 18.3% of all readmissions), reasons for readmission differed significantly (all P < 0.001). Across all disease categories, early readmissions (within 2 days of discharge) were most likely due to ileus/obstruction (53.4% of early readmissions), whereas with 42.5%, infection was the most common cause for late readmissions (>7 days). Patients with home discharge were more likely to be readmitted earlier within the 30-day observation period (P = 0.099), whereas patients with a longer length of index hospital stay (>7 days) were readmitted later (P = 0.080).
CONCLUSIONS: Reasons for readmission appear to be universal across different disease categories. Targeted educational and collaborative measures may help to mitigate the burden of hospital readmissions to index facilities.},
}
@article {pmid32209628,
year = {2020},
author = {Sohn, M and Agha, A and Iesalnieks, I and Bremer, S and Trum, S and Di Cerbo, F and Nerlich, A and Lotz, N and Klieser, E and Hochrein, A and Schredl, P and Kalcheva, D and Emmanuel, K and Presl, J},
title = {PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease: the PREDIC-DIV study protocol of a prospective multicentric transnational observational study.},
journal = {BMJ open},
volume = {10},
number = {3},
pages = {e034385},
pmid = {32209628},
issn = {2044-6055},
mesh = {Colon, Sigmoid/*surgery ; Diverticular Diseases/*surgery ; *Elective Surgical Procedures ; Humans ; *Laparoscopy ; Multicenter Studies as Topic ; Observational Studies as Topic ; Prospective Studies ; *Quality of Life ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists regarding the effect of different therapeutic strategies on the health-related quality of life (HrQoL). Therefore, the PREDIC-DIV (PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease) study aims to assess predictors of a change in HrQoL in patients after elective sigmoidectomy for diverticular disease.
METHODS AND ANALYSIS: A prospective multicentre transnational observational study was started in November 2017. Patients undergoing elective sigmoid resection for diverticular disease were included. Primary outcome includes HrQoL 6 months postoperatively, staged by the Gastrointestinal Quality of Life Index (GIQLI). Secondary outcomes include HrQoL 6 months after sigmoidectomy, assessed using the Short Form 36 Questionnaire and a custom-made Visual Analogue Scale-based inventory; HrQoL after 12 and 24 months; postoperative morbidity; mortality; influence of surgical technique (conventional laparoscopic multiport operation vs robotic approach); histological grading of inflammation and morphological characteristics of the bowel wall in the resected specimen; postoperative functional changes (faecal incontinence, faecal urge, completeness of emptying, urinary incontinence, sexual function); disease-specific healthcare costs; and changes in economic productivity, measured by the iMTA Productivity Cost Questionnaire. The total follow-up will be 2 years.
ETHICS AND DISSEMINATION: The protocol was approved by the medical ethical committee of the Bavarian Medical Council (report identification number: 2017-177). The study was conducted in accordance with the Declaration of Helsinki. The findings of this study will be submitted to a peer-reviewed journal (BMJ Open, Annals of Surgery, British Journal of Surgery, Diseases of the Colon and the Rectum). Abstracts will be submitted to relevant national and international conferences.
TRIAL REGISTRATION NUMBER: The study is registered with the ClinicalTrials.gov register as NCT03527706; Pre-results.},
}
@article {pmid32202966,
year = {2020},
author = {Sigurdardottir, J and Chabok, A and Thorisson, A and Smedh, K and Nikberg, M},
title = {Elective surgery should be considered after successful conservative treatment of recurrent diverticular abscesses.},
journal = {Scandinavian journal of gastroenterology},
volume = {55},
number = {4},
pages = {454-459},
doi = {10.1080/00365521.2020.1740940},
pmid = {32202966},
issn = {1502-7708},
mesh = {Abdominal Abscess/etiology/*therapy ; Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/methods ; Conservative Treatment/adverse effects/methods ; Diverticular Diseases/*complications/pathology/therapy ; Drainage/adverse effects/methods ; Elective Surgical Procedures/adverse effects/methods ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Sweden ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {Purpose: The purpose of this study was to evaluate the disease pattern and treatment of diverticular abscesses.Methods: Patients treated for diverticulitis (K57) in Västmanland, Sweden were identified for this retrospective population-based study between January 2010 and December 2014. Patients with diverticular abscesses were included. The clinical and radiological data were extracted, and the computed tomography scans were reevaluated.Results: Of the 75 patients (45 women) with a median age of 62 years (range: 23-88 years), abscesses were localized pericolic in 42 patients (59%) and in the pelvis in 33 patients (41%). The median abscess size was 4.8 cm (range: 1.1-11.0 cm). Six patients (8%) required urgent surgical intervention during the index admission. The median follow-up time was 58 months (range: 0-95 months). During follow-up, 40 patients (58%) had disease recurrence and 35 of these patients (88%) presented with complicated diverticulitis. The median time until re-admission was 2 months (range: 3 days-94 months). Patients with pelvic abscesses developed fistulas more frequently, 3 versus 11 patients (p = .003). Twenty-three percent of patients with pericolic abscesses required surgery compared with 40% of patients with pelvic abscesses (p = .09). No patients had a recurrence of abscesses after a colonic resection.Conclusion: The majority of patients with diverticular abscesses had recurrences with repeated admissions regardless of abscess location. An unexpectedly high proportion of patients required surgical intervention during the follow-up period. A liberal approach regarding elective surgery for patients with recurrent diverticulitis abscesses who tolerate surgery seems justified.},
}
@article {pmid32161080,
year = {2020},
author = {Loraine, A},
title = {Bowel preparation agent inducing profound shock precolonoscopy.},
journal = {BMJ case reports},
volume = {13},
number = {3},
pages = {},
doi = {10.1136/bcr-2019-233406},
pmid = {32161080},
issn = {1757-790X},
mesh = {Aged ; Cathartics/*adverse effects ; Citrates/*adverse effects ; Colonoscopy/methods ; Fatal Outcome ; Female ; Humans ; Organometallic Compounds/*adverse effects ; Picolines/*adverse effects ; Preoperative Care/*adverse effects/methods ; Risk Factors ; Shock, Septic/*chemically induced ; },
abstract = {A 73-year-old woman was admitted to the intensive care unit following vomiting and diarrhoea onset after completing oral bowel preparation prior to colonoscopy to investigate haematochezia. She had a history of severe chronic obstructive pulmonary disease, Crohn's disease, diverticular disease, hypertension and dyslipidaemia. She was resuscitated with intravenous fluids, antibiotics and required epinephrine, norepinephrine and vasopressin infusions. She improved over her 4-day intensive care admission and was discharged to the general medical ward, but ultimately died 19 days after presentation.},
}
@article {pmid32155626,
year = {2020},
author = {Hu, H and Wang, M and Zhu, L and Zhou, P},
title = {Endoscopic Transversal Incision and Longitudinal Septostomy (TILS): An Updated Technique for Treating Esophageal Diverticulum.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {38},
number = {6},
pages = {550-554},
doi = {10.1159/000507077},
pmid = {32155626},
issn = {1421-9875},
mesh = {Diverticulum, Esophageal/diagnostic imaging/*surgery ; *Esophagoscopy ; Esophagus/diagnostic imaging/surgery ; Female ; Humans ; Zenker Diverticulum/diagnostic imaging/surgery ; },
abstract = {An esophageal diverticulum is a protruding pouch in a weak portion of the esophageal lining. Previously, our team had reported an endoscopic tunneling technique (submucosal tunneling endoscopic septum division) for diverticulum treatment. However, it does not perform well for the diverticulum located in the upper esophagus, where most diverticula are located. Herein, we report a new endoscopic technique, called endoscopic transversal incision and longitudinal septostomy (TILS). TILS provides both larger operational spaces and complete septostomy and can be performed on most types of diverticula, including Zenker's diverticulum.},
}
@article {pmid32117653,
year = {2020},
author = {Ajmal, HB and Majid, Z and Tahir, F and Sagheer, S},
title = {Axial Torsion and Gangrene: An Unusual Complication of Meckel's Diverticulum.},
journal = {Cureus},
volume = {12},
number = {1},
pages = {e6702},
pmid = {32117653},
issn = {2168-8184},
abstract = {Meckel's diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre's hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded. We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.},
}
@article {pmid32115815,
year = {2021},
author = {Willington, AJ and Cosgrove, S and Davison, P and Cunliffe, RN},
title = {Prevalence and characteristics of post-colonoscopy colorectal cancers in a New Zealand regional centre: a 10-year analysis.},
journal = {Internal medicine journal},
volume = {51},
number = {2},
pages = {249-253},
doi = {10.1111/imj.14811},
pmid = {32115815},
issn = {1445-5994},
mesh = {*Colonic Polyps/diagnostic imaging/epidemiology ; Colonoscopy ; *Colorectal Neoplasms/diagnosis/epidemiology ; Female ; Humans ; New Zealand/epidemiology ; Prevalence ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Post-colonoscopy colorectal cancers (PCCRC) are cancers that appear following a colonoscopy in which no cancer is diagnosed. The occurrence of PCCRC is thought to be multifactorial, reflecting both endoscopy quality and potential differences in tumour biology between detected colorectal cancers and PCCRC.
AIM: To identify the prevalence and characteristics of PCCRC in a New Zealand regional centre over a 10-year period.
METHOD: All cases of colorectal cancer (n = 1055) in the Bay of Plenty region between 1 February 2009 and 1 February 2019 were cross-referenced with endoscopy coding records to identify patients who had undergone colonoscopy within the preceding 6-60 months in which cancer was not identified.
RESULTS: A total of 46 patients were identified to have PCCRC, giving a prevalence of 4.4%. The majority of these patients were older (80% aged 65 years or over) and female (67%). The mean interval between index colonoscopy and diagnosis of PCCRC was 3.03 years. Most (80%) patients had existent pathology (diverticular disease or colonic polyps) at index colonoscopy, and a significant proportion (43%) developed cancer in the same colonic segment. PCCRC were evenly distributed between the left (50%) and right (50%) colon. The majority of patients (63%) had early-stage cancer.
CONCLUSIONS: The prevalence of PCCRC in a New Zealand cohort is consistent with other international reports. Most patients with PCCRC are older, female and have early-stage disease. Of interest, a high proportion of patients developed cancer within a colonic segment with existent pathology, suggesting either missed lesions or incomplete polyp resection.},
}
@article {pmid32100206,
year = {2020},
author = {Stroie, FA and Hasan, OM and Houlihan, MD and McArdle, BJ and Hollowell, CMP and Blumetti, J and Vidal, PP and Psutka, SP},
title = {Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae.},
journal = {International urology and nephrology},
volume = {52},
number = {7},
pages = {1203-1208},
doi = {10.1007/s11255-020-02409-x},
pmid = {32100206},
issn = {1573-2584},
mesh = {*Cystography ; *Cystoscopy ; Female ; Humans ; Intestinal Fistula/*diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Bladder Fistula/*diagnosis/surgery ; },
abstract = {PURPOSE: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF.
METHODS: With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging.
RESULTS: The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT.
CONCLUSIONS: In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.},
}
@article {pmid32077444,
year = {2020},
author = {Tursi, A and Elisei, W},
title = {Diet in colonic diverticulosis: is it useful?.},
journal = {Polish archives of internal medicine},
volume = {130},
number = {3},
pages = {232-239},
doi = {10.20452/pamw.15199},
pmid = {32077444},
issn = {1897-9483},
mesh = {*Diet ; Dietary Fiber ; Diverticulosis, Colonic/diet therapy/etiology/*prevention & control ; Humans ; Red Meat ; },
abstract = {Diverticulosis of the colon is the most common anatomic alteration of the human colon. Diet may be important in the management of diverticular disease (DD). It is known that high‑fiber diet does not prevent diverticulosis, and there are conflicting data on the prevention and treatment of DD and acute diverticulitis. No association has been reported between nut, corn, or popcorn consumption and the development of diverticulosis, DD, and acute diverticulitis. However, there seems to be a mild association between high alcohol intake and diverticulosis, whereas alcohol dependence seems to be related to a lower risk of in‑hospital mortality due to acute diverticulitis. Higher consumption of red meat was associated with a mild increase in the risk of acute diverticulitis, especially when consumed as unprocessed red meat (defined as consumption of "beef or lamb as main dish," "pork as main dish," "hamburger," and "beef, pork or lamb as a sandwich or mixed dish"). On the other hand, higher consumption of poultry (white meat) was not associated with the risk of acute diverticulitis. Finally, higher fish intake was associated with a reduced risk of diverticulitis in an age‑adjusted model but not after adjustment for other potential confounders.},
}
@article {pmid32072285,
year = {2021},
author = {Ng, ZQ and Wijesuriya, R and Misur, P and Tan, JH and Moe, KS and Theophilus, M},
title = {The role of quantitative radiological measures of visceral adiposity in diverticulitis.},
journal = {Surgical endoscopy},
volume = {35},
number = {2},
pages = {636-643},
pmid = {32072285},
issn = {1432-2218},
mesh = {Adiposity ; Aged ; Diverticulitis/*diagnostic imaging/*etiology/surgery ; Female ; Humans ; Intra-Abdominal Fat/*diagnostic imaging ; Male ; Middle Aged ; Multivariate Analysis ; Obesity, Abdominal/complications/*diagnostic imaging ; Retrospective Studies ; Subcutaneous Fat/diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Diverticular disease has been linked to obesity. Recent studies have assessed the role of visceral adiposity with diverticulitis and its complications. The aim of this study was to evaluate the association of quantitative radiological measures of visceral adiposity in patients with diverticulitis with vital signs, biochemistry results, uncomplicated versus complicated diverticulitis and its interventions.
METHODS: A retrospective analysis of all patients with diverticulitis admitted from November 2015 to April 2018 at a single institution was performed. Data collected included demographics, vital signs, biochemistry results, CT scan findings and management outcomes. The patients were divided into uncomplicated (U) and complicated diverticulitis (C) groups. Visceral fat area (VFA), subcutaneous fat area (SFA) and VFA/SFA ratio (V/S) were measured at L4/L5 level by the radiologist. Statistical analysis was performed to evaluate the association of VFA, SFA, V/S with the parameters in both U and C groups.
RESULTS: 352 patients were included in this study (U:C = 265:87). There was no significant difference in vital signs and biochemistry results in both groups. There was no significant difference in VFA, SFA, V/S ratios in both groups. In patients with V/S ratio > 0.4, they were 5.06 times more likely to undergo emergency intervention (95% CI 1.10-23.45) (p = 0.03). On multivariate analysis, a heart rate > 100 (OR 2.9, 95% CI 1.2-6.7), CRP > 50 (OR 3.4, 95% CI 1.9-6.0), WCC < 4 or > 12 (OR 2.1, 95% CI 1.2-3.6) and V/S ratio > 0.4 (OR 2.8, 95% CI 1.5-5.4) were predictive of complicated diverticulitis.
CONCLUSION: The quantitative radiological measurement of visceral adiposity is useful in prognostication in patients presenting with diverticulitis.},
}
@article {pmid32064030,
year = {2020},
author = {Fejleh, MP and Tabibian, JH},
title = {Colonoscopic management of diverticular disease.},
journal = {World journal of gastrointestinal endoscopy},
volume = {12},
number = {2},
pages = {53-59},
pmid = {32064030},
issn = {1948-5190},
abstract = {Diverticula are the most common incidental finding during routine colonoscopy, and their prevalence increases with patient age. The term "diverticular disease" encompasses the range of clinical manifestations and complications that can occur with colonic diverticula, including diverticular bleeding, diverticulitis-associated strictures, and acute diverticulitis. Colonoscopy is a vital tool in the diagnosis and management of diverticular disease and can be useful in a variety of regards. In this editorial, we concisely delineate the current approach to and practices in colonoscopic management of diverticular disease. In particular, we discuss treatment options for diverticular bleeding, propose consideration of colonic stenting as a bridge to surgery in patients with diverticulitis-associated strictures, and the need for diagnostic colonoscopy following an episode of acute diverticulitis in order to rule out underlying conditions such as colonic malignancy or inflammatory bowel disease. In addition, we offer practical tips for performing safe and successful colonoscopy in patients with dense diverticulosis coli.},
}
@article {pmid32054240,
year = {2021},
author = {De Robles, MS and Young, CJ},
title = {Triple-Staple Technique Effectively Reduces Operating Time for Rectal Anastomosis.},
journal = {Annals of coloproctology},
volume = {37},
number = {1},
pages = {16-20},
pmid = {32054240},
issn = {2287-9714},
abstract = {PURPOSE: Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed.
METHODS: One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA).
RESULTS: The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection.
CONCLUSION: The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.},
}
@article {pmid32053333,
year = {2020},
author = {Hawks, MK and Svarverud, JE},
title = {Acute Lower Gastrointestinal Bleeding: Evaluation and Management.},
journal = {American family physician},
volume = {101},
number = {4},
pages = {206-212},
pmid = {32053333},
issn = {1532-0650},
mesh = {Acute Disease ; Colonoscopy ; Computed Tomography Angiography ; Digestive System Surgical Procedures ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/*therapy ; Humans ; },
abstract = {Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purposes once they are hemodynamically stable and have completed adequate bowel preparation. Early colonoscopy has not demonstrated improved patient-oriented outcomes. Hemodynamic stabilization using normal saline or balanced crystalloids improves mortality in critically ill patients. For persistently unstable patients or those who cannot tolerate bowel preparation, abdominal computed tomographic angiography should be considered for localization of a bleeding source. Technetium Tc 99m-labeled red blood cell scintigraphy should not be routinely used in the evaluation of lower gastrointestinal bleeding. Surgical intervention should be considered only for patients with uncontrolled severe bleeding or multiple ineffective nonsurgical treatment attempts. Percutaneous catheter embolization should be considered for patients who are poor surgical candidates. Treatment is based on the identified source of bleeding.},
}
@article {pmid32025621,
year = {2020},
author = {Del Marmol, O and Coulier, B and Pierard, F},
title = {Intravesical Protrusion of a Pedunculated Colonic Polyp through a Sigmoido-Vesical Fistula Caused by Diverticulitis.},
journal = {Journal of the Belgian Society of Radiology},
volume = {104},
number = {1},
pages = {5},
pmid = {32025621},
issn = {2514-8281},
abstract = {Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer.},
}
@article {pmid32015353,
year = {2020},
author = {Reichert, MC and Kupcinskas, J and Schulz, A and Schramm, C and Weber, SN and Krawczyk, M and Jüngst, C and Casper, M and Grünhage, F and Appenrodt, B and Zimmer, V and Tamelis, A and Lukosiene, JI and Pauziene, N and Kiudelis, G and Jonaitis, L and Goeser, T and Malinowski, M and Glanemann, M and Kupcinskas, L and Lammert, F},
title = {Common variation in FAM155A is associated with diverticulitis but not diverticulosis.},
journal = {Scientific reports},
volume = {10},
number = {1},
pages = {1658},
pmid = {32015353},
issn = {2045-2322},
mesh = {Acetylcholinesterase/genetics ; Aged ; Cohort Studies ; Collagen/genetics ; Diverticulitis, Colonic/*genetics ; Diverticulosis, Colonic/*genetics ; Female ; GTPase-Activating Proteins/genetics ; Genetic Association Studies ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Germany ; Humans ; Lithuania ; Male ; Membrane Proteins/*genetics ; Middle Aged ; Muscle Proteins/genetics ; Polymorphism, Single Nucleotide ; Risk Factors ; },
abstract = {Colonic diverticulosis is a very common condition. Many patients develop diverticulitis or other complications of diverticular disease. Recent genome-wide association studies (GWAS) consistently identified three major genetic susceptibility factors for both conditions, but did not discriminate diverticulititis and diverticulosis in particular due the limitations of registry-based approaches. Here, we aimed to confirm the role of the identified variants for diverticulosis and diverticulitis, respectively, within a well-phenotyped cohort of patients who underwent colonoscopy. Risk variants rs4662344 in Rho GTPase-activating protein 15 (ARHGAP15), rs7609897 in collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) and rs67153654 in family with sequence similarity 155 A (FAM155A) were genotyped in 1,332 patients. Diverticulosis was assessed by colonoscopy, and diverticulitis by imaging, clinical symptoms and inflammatory markers. Risk of diverticulosis and diverticulitis was analyzed in regression models adjusted for cofactors. Overall, the variant in FAM155A was associated with diverticulitis, but not diverticulosis, when controlling for age, BMI, alcohol consumption, and smoking status (ORadjusted 0.49 [95% CI 0.27-0.89], p = 0.002). Our results contribute to the assessment specific genetic variants identified in GWAS in the predisposition to the development of diverticulitis in patients with diverticulosis.},
}
@article {pmid32011498,
year = {2020},
author = {Tseng, YJ and Lai, CY and Wang, YC and Chen, WK and Kao, CH and Chen, CH},
title = {Possible increased risk of colonic diverticular disease from alcohol intoxication or abuse.},
journal = {Medicine},
volume = {99},
number = {3},
pages = {e18840},
pmid = {32011498},
issn = {1536-5964},
mesh = {Adult ; Aged ; Alcoholic Intoxication/*complications ; Alcoholism/*complications ; Comorbidity ; Diverticulosis, Colonic/epidemiology/*etiology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Sex Factors ; Taiwan/epidemiology ; },
abstract = {Alcohol consumption has been suggested as a potential risk factor for diverticular diseases. This study investigated the association between alcohol intoxication or abuse and colonic diverticular disease (CDD).Using the National Health Insurance Research Database of Taiwan from January 1, 2000, to December 31, 2008, 51, 866 subjects newly diagnosed with alcohol intoxication were enrolled in this study as the alcohol intoxication cohort. The control (nonalcohol intoxication) cohort was frequency-matched 1:4 by age, sex and index year. Data were analyzed using a Cox proportional hazards model.The overall incidence of CDD (per 10,000 person-years) for the alcohol intoxication and control cohorts was 16.4 and 3.46, respectively. Compared with patients in the control cohort (95% confidence interval [CI] = 2.76-3.74), those with alcohol intoxication exhibited a 3.21-fold risk of CDD; the risk was particularly higher in male patients (adjusted hazard ratio [aHR] = 3.19, 95% CI = 2.72-3.74) and in those aged <45 years (aHR = 4.95, 95% CI = 3.91-6.27). The alcohol intoxication still had higher risk of CDD than nonalcohol intoxication, regardless of subjects without comorbidity (aHR = 3.38, 95% CI = 2.77-4.11) or with (aHR = 2.85, 95% CI = 2.25-3.61).There was a significant relationship between alcohol intoxication or abuse and CDD.},
}
@article {pmid32011402,
year = {2020},
author = {Early, D and Larue, S and Weinstock, L and Kushnir, V and Gyawali, P and Sullivan, S and Thyssen, E and Hollander, T and Elsner, J and Vyhmeister, R and Bhat, T and Gaddam, S},
title = {Impact of Tilt-Down Positioning Compared With Left Lateral Positioning on Ease of Colonoscope Insertion During Colonoscopy.},
journal = {Journal of clinical gastroenterology},
volume = {54},
number = {6},
pages = {558-560},
doi = {10.1097/MCG.0000000000001318},
pmid = {32011402},
issn = {1539-2031},
mesh = {Boston ; Cecum ; *Colonoscopes ; *Colonoscopy ; Female ; Humans ; Middle Aged ; Patient Positioning ; },
abstract = {GOALS: The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy.
BACKGROUND: Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus.
STUDY: Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint.
RESULTS: A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events.
CONCLUSION: TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.},
}
@article {pmid31993993,
year = {2020},
author = {Pellino, G and Podda, M and Wheeler, J and Davies, J and Di Saverio, S},
title = {Laparoscopy and resection with primary anastomosis for perforated diverticulitis: challenging old dogmas.},
journal = {Updates in surgery},
volume = {72},
number = {1},
pages = {21-28},
pmid = {31993993},
issn = {2038-3312},
mesh = {Anastomosis, Surgical/*methods ; Colon, Sigmoid/surgery ; Digestive System Surgical Procedures/*methods ; Diverticulitis/*surgery ; Humans ; Intestinal Perforation/*surgery ; Laparoscopy/*methods ; Prognosis ; },
abstract = {Diverticulitis is a common disease in western countries, and its incidence is likely expected to increase over years. The burden of diverticular disease on health systems and resources utilization cannot be underestimated, given the high prevalence of diverticulosis and the rate of patients requiring hospitalization and/or surgery. Minimally invasive colorectal surgery can guarantee several benefits over traditional open surgery, even more prominently in the emergency settings. However, there is moderate to low agreement regarding the use of a minimally invasive approach in patients with perforated diverticular disease (Hinchey III/IV), as well as primary anastomosis is still feared too risky versus end colostomy. Over the last years, evidence has been growing that laparoscopy can reduce the magnitude of surgical injury, and last but not least, cause less adhesions and/or incisional hernias, and lead to easier subsequent surgeries. The recently published results from the DIVA arm of the Ladies trial showed that 12-month stoma-free survival was significantly better for patients randomized to primary anastomosis compared with patients who received Hartmann's procedure, without differences in short-term morbidity and mortality after index resection. Moreover, several recent studies showed that laparoscopic sigmoidectomy in the treatment of Hinchey III-IV diverticulitis is feasible in haemodynamically stable patients. Taken together, these findings suggest that laparoscopic sigmoidectomy is at least feasible and safe in this challenging subgroup of patients. However, patient selection and additional factors, including surgeon expertise and hospital resources, are crucial and need careful consideration.},
}
@article {pmid31930230,
year = {2019},
author = {Kupcinskas, J and Strate, LL and Bassotti, G and Torti, G and Herszènyi, L and Malfertheiner, P and Cassieri, C and Walker, MM and Tursi, A},
title = {Pathogenesis of Diverticulosis and Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {7-10},
doi = {10.15403/jgld-551},
pmid = {31930230},
issn = {1842-1121},
mesh = {Colon/innervation ; Diverticular Diseases/*etiology/genetics/physiopathology ; Diverticulum/etiology/genetics/physiopathology ; Gastrointestinal Motility/physiology ; Genetic Predisposition to Disease ; Humans ; Life Style ; Obesity/complications ; Sensation/physiology ; Sensation Disorders/etiology ; Smoking/adverse effects ; },
abstract = {In this session different problems regarding the pathogenesis of diverticular disease were considered, including "Genetics", "Neuromuscular function abnormalities", "Patterns of mucosa inflammation", and "Impact of lifestyle". The patients affected by diverticular disease have clear genetic pattern, that might predispose to the occurrence of the disease as well as to its complications. Neuromuscular abnormalities may be recognized already at the stage of diverticulosis, and inflammation may explain symptoms occurrence in symptomatic uncomplicated diverticular disease (SUDD) or symptoms persistence after an episode of acute diverticulitis. Finally, lifestyle might also have an impact on symptoms' occurrence. Specifically smoking, but also obesity seem to play an important role, while the role of low-fiber diet and constipation is now under debate.},
}
@article {pmid31930229,
year = {2019},
author = {Milosavljeviĉ, T and Brandimarte, G and Stollman, N and Barbara, G and Lahat, A and Scarpignato, C and Lanas, A and Papa, V and Tursi, A and Nardone, G},
title = {Course of the Diverticular Disease: What is changing?.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {11-16},
doi = {10.15403/jgld-552},
pmid = {31930229},
issn = {1842-1121},
mesh = {Acute Disease ; Colonoscopy ; Diagnosis, Differential ; Disease Progression ; Diverticular Diseases/*diagnosis ; Diverticulitis/etiology/prevention & control ; Humans ; Irritable Bowel Syndrome/diagnosis ; Risk Factors ; Secondary Prevention/methods ; },
abstract = {In this session several critical issues in diverticular disease were considered, including "It is Symptomatic Diverticular Disease or Irritable Bowel Syndrome?", "What do determine evolution to diverticulitis, bowel habits alteration or inflammation?", and "Prevention of acute diverticulitis: Is it at all possible?". The first talking compared symptoms and laboratory findings between Symptomatic Uncomplicated Diverticular Disease (SUDD) and Irritable Bowel Syndrome (IBS). Although both disease share some symptoms, and although IBS can occur in patients having diverticulosis, SUDD and IBS can be differentiate using a combination of symptoms and laboratory tools. The second talking debated what are the most important risk factors for the evolution towards acute diverticulitis. Current data seem to exclude a significant role of bowel habits alteration, while inflammation seems to have a stronger role, especially in causing acute diverticulitis recurrence. The third talking analyzed about the acute diverticulitis prevention. Primary prevention seem to be little better when using mesalazine, while no definite conclusion can be drawn about the use of fiber and rifaximin. About the secondary prevention, no drugs can be currently advised due to lacking of definite results. At the same time, surgery should be advised on case-by-case basis.},
}
@article {pmid31930228,
year = {2019},
author = {Štimac, D and Nardone, G and Mazzari, A and Crucitti, A and Maconi, G and Elisei, W and Violi, A and Tursi, A and Di Mario, F},
title = {What's New in Diagnosing Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {17-22},
doi = {10.15403/jgld-553},
pmid = {31930228},
issn = {1842-1121},
mesh = {Acute Disease ; Biomarkers/metabolism ; Colonoscopy ; Diagnosis, Differential ; Diverticular Diseases/*diagnosis/therapy ; Diverticulitis/diagnostic imaging ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {In this session different issues for the diagnosis of diverticular disease (DD) were considered including "Biomarkers", "Computer tomography", "Ultrasonography in detecting acute diverticulitis", "Endoscopy" and "The DICA classification: a new predictive tool in managing diverticular disease". Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.},
}
@article {pmid31930227,
year = {2019},
author = {Brandimarte, G and Bafutto, M and Kruis, W and Scarpignato, C and Mearin, F and Barbara, G and Štimac, D and Vranić, L and Cassieri, C and Lecca, PG and D'Avino, A and Malfertheiner, P},
title = {Hot Topics in Medical Treatment of Diverticular Disease: Evidence Pro and Cons.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {23-29},
doi = {10.15403/jgld-554},
pmid = {31930227},
issn = {1842-1121},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticular Diseases/complications/*drug therapy/microbiology ; Evidence-Based Medicine/methods ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome ; Humans ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Symptomatic Uncomplicated Diverticular Disease (SUDD) is the most common clinical form of Diverticular Disease (DD). The therapy should be aimed at reducing both the intensity and frequency of symptoms as well as preventing complications. The pharmacological treatments include fibers, not absorbable antibiotics (for example rifaximin), anti-inflammatory drugs (for example 5-amino-salycilic acid) and probiotics, alone or in combination with other drugs. Although some of these treatments seem to be effective in treating SUDD, but their efficacy in preventing complications of the disease is still uncertain. It has been hypothesized that microbial imbalance associated with bacterial overgrowth of the colon, may be the key to the development of diverticular disease (DD). Therefore, drugs that can manipulate gut microbiota such as probiotics or rifaximine are considered as a potential key therapy. Rifaximine is able to modulate the intestinal ecosystem, restoring eubiosis. Traditionally, DD of the colon is thought to be related to low grade of inflammation. By analogy with other inflammatory bowel diseases mesalazine has been studied also in DD. There are several evidences that may support the use of mesalazine in the SUDD. Unfortunately, mesalazine cannot be used to prevent diverticulitis because of the paucity of high-quality studies. Currently, mesalazine has a limited place for the management of SUDD. In SUDD probiotics have been proven as an effective therapy in reducing abdominal symptoms, but unfortunately there has been limited number of relevant studies regarding efficacy of this therapy.},
}
@article {pmid31930226,
year = {2019},
author = {Binda, GA and Papa, A and Persiani, R and Escalante, R and De Oliveira, EC and Crucitti, A and Mazzari, A and Biondi, A and Papagrigoriadis, S},
title = {Hot Topics in Surgical Management of Acute Diverticulitiss.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {29-34},
doi = {10.15403/jgld-555},
pmid = {31930226},
issn = {1842-1121},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Colectomy/adverse effects/methods ; Digestive System Surgical Procedures/*methods ; Diverticulitis/drug therapy/*surgery ; Humans ; Laparoscopy/adverse effects/methods ; Peritoneal Lavage/methods ; },
abstract = {In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.},
}
@article {pmid31930225,
year = {2019},
author = {Stollman, N and Picchio, M and Biondo, S and Lahat, A and Dumitrascu, DL and Regula, J and Walker, MM},
title = {Critical Issues on Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {35-38},
doi = {10.15403/jgld-557},
pmid = {31930225},
issn = {1842-1121},
mesh = {Ambulatory Care ; Colitis/etiology ; Colorectal Neoplasms/etiology ; Delivery of Health Care/organization & administration ; Diverticular Diseases/complications/*diagnosis/*therapy ; Diverticulitis/complications ; Diverticulosis, Colonic/etiology ; Humans ; Risk Factors ; },
abstract = {In this session diverse critical issues in diverticular disease were considered, including "In or outpatient management of uncomplicated diverticulitis?", "Segmental colitis associated with diverticulosis: what is it?"and "Diverticular inflammation is a risk factor for colorectal cancer?". The conclusions drawn are outlined in the statements but in summary, outpatient management is safe in selected patients, as long as correct diagnosis and stage are assured, and this can allow a cost effective treatment. Non-antibiotic management is also safe but should be confined as an outpatient treatment in carefully selected patients. Segmental colitis associated with diverticulosis (SCAD) is a defined pathological entity (only diagnosed on biopsy) characterized by an inflammatory bowel disease-like pathology, occurring principally in the sigmoid colon, with rectal and right colon sparing. The pathogenesis is unclear but may include a genetic predisposition, microbiome alteration and ischaemia. Treatment can last months, and depends on severity, options include antibiotics, 5 ASA and probiotics for mild cases. Severe disease needs systemic steroids or even anti TNFα treatment. Whether diverticular inflammation is a risk factor for colorectal cancer was debated and the conclusion that within the first eighteen months of diagnosis of diverticular disease associations with cancer are found, likely due to similar symptoms and misclassification of disease. After that time, diverticular disease does not increase the risk of colorectal cancer. Therefore, this is recommended to exclude cancer with imaging and colonoscopy after healing of the first episode of diverticulitis.},
}
@article {pmid31930224,
year = {2019},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Lanas, A and Scarpignato, C and Bafutto, M and Barbara, G and Bassotti, G and Binda, GA and Biondi, A and Biondo, S and Cassieri, C and Crucitti, A and Dumitrascu, DL and Elisei, W and Escalante, R and Herszènyi, L and Kruis, W and Kupcinskas, J and Lahat, A and Lecca, PG and Maconi, G and Malfertheiner, P and Mazzari, A and Mearìn, F and Milosavljeviċ, T and Nardone, G and Chavez De Oliveira, E and Papa, A and Papagrigoriadis, S and Pera, M and Persiani, R and Picchio, M and Regula, J and Štimac, D and Stollman, N and Strate, LL and Walker, MM and , },
title = {The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {39-44},
doi = {10.15403/jgld-558},
pmid = {31930224},
issn = {1842-1121},
mesh = {Colonic Diseases/*diagnosis ; Colonoscopy/standards ; Community Health Services/standards ; Diverticular Diseases/*diagnosis ; Diverticulosis, Colonic/diagnosis ; Humans ; Observer Variation ; Reproducibility of Results ; *Severity of Illness Index ; Video Recording ; },
abstract = {BACKGROUND AND AIMS: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting.
METHODS: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement.
RESULTS: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications.
CONCLUSIONS: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.},
}
@article {pmid31930223,
year = {2019},
author = {Tursi, A and Cassieri, C and Colucci, R and Elisei, W and Picchio, M and Brandimarte, G},
title = {Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {45-48},
doi = {10.15403/jgld-559},
pmid = {31930223},
issn = {1842-1121},
mesh = {Aged ; Budesonide/administration & dosage/*therapeutic use ; Colonic Diseases/*drug therapy/metabolism ; Diverticular Diseases/*drug therapy/metabolism ; Drug Administration Schedule ; Drug Therapy, Combination ; Feces/chemistry ; Female ; Follow-Up Studies ; Gastrointestinal Agents/administration & dosage/*therapeutic use ; Glucocorticoids/administration & dosage/*therapeutic use ; Humans ; Leukocyte L1 Antigen Complex/*metabolism ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIM: Although rifaximin and mesalazine seem to be effective in treating the majority of people suffering from diverticular disease (DD), some patients still experience symptoms following those treatments. The aim of this study was to assess the efficacy of budesonide MMXTM in managing symptoms and raised fecal calprotectin (FC) in patients with endoscopic diagnosis of DD and not responding to standard treatments.
METHODS: We performed a post-hoc analysis of the patients enrolled in the DICA prospective study. All patients were at the first diagnosis of DD, scored according to DICA classification. We assessed abdominal pain, meteorism, constipation and diarrhea (scored from 0 to 10) and FC expression at baseline and after six months. Patients were treated with budesonide MMXTM for 4 weeks (9 mg/day for 2 weeks, followed by 9 mg every other day for further 2 weeks), followed by mesalazine 2.4 grams/day for further 5 months.
RESULTS: We studied 24 patients (18 females and 6 males, median age 64, inter quartile range (IQR): 57.5- 73.5), previously treated with mesalazine and/or rifaximin (equally subdivided between DICA 2 and DICA 3). At 6-month follow-up, a significant reduction of all symptoms assessed was observed (abdominal pain and meteorism: p<0.001; constipation: p=0.007; diarrhea: p=0.009). Median (IQR) FC level was 244.5 (171.5- 322.0) μg/g at baseline and 51.0 (IQR: 35.5-61.5) μg/g (p< 0.001) after 6 months. No side effects were recorded.
CONCLUSIONS: Treatment with budesonide MMXTM seems to be effective in obtaining symptoms' control and dropping of FC in patients with DD and not responding to standard treatments.},
}
@article {pmid31930222,
year = {2019},
author = {D'Amico, F and Fiorini, G and Tursi, A and Saracino, IM and Pavoni, M and Danese, S and Vaira, D},
title = {Efficacy of a New Nutraceutical Formulation in Patients with Symptomatic Uncomplicated Diverticular Disease (SUDD): a Prospective Observational Study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {49-52},
doi = {10.15403/jgld-560},
pmid = {31930222},
issn = {1842-1121},
mesh = {Abdominal Pain/etiology/therapy ; Adult ; Aged ; Aged, 80 and over ; *Dietary Supplements/adverse effects ; Diverticulitis, Colonic/prevention & control ; Diverticulosis, Colonic/complications/pathology/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Remission Induction ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIM: Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain, bloating and altered bowel habits (constipation or diarrhea) attributed to diverticula in the absence of macroscopic mucosal alterations. There is no consensus about management of these patients. DIVER-100®, an association of natural active ingredients may be effective in the treatment of patients with SUDD. The aim was to evaluate the efficacy and safety of DIVER-100® in patients with SUDD.
METHODS: We conducted a prospective observational study to evaluate the efficacy of DIVER-100® in consecutive patients with SUDD, confirmed by radiology or endoscopy. All patients were treated with DIVER-100® 2 capsules/day 10 days per month, for 3 months. The primary endpoint was the clinical remission rate, defined as the reduction of abdominal pain and bloating, improvement of bowel habits and prevention of acute diverticulitis (AD). The secondary endpoint was the rate of adverse events.
RESULTS: One hundred and one patients were consecutively enrolled at the Internal Medicine and Gastroenterology Unit, Sant'Orsola Hospital, Bologna, Italy. DIVER-100® was effective in inducing remission of symptoms in 12 patients (11.9%) at 3 months and in 10 patients (9.9%) at 6 months. DIVER-100® significantly reduced abdominal pain and bloating in 45.5% and 57.4% of patients respectively (p <0.001) after 3 months. No episodes of AD and no adverse events related to DIVER--100® were recorded at month 6 in the study population.
CONCLUSIONS: DIVER-100® is a safe and effective nutraceutical compound in obtaining remission and symptom relief in SUDD patients. Further randomized, placebo-controlled clinical trials are needed to confirm these preliminary data.},
}
@article {pmid31930221,
year = {2019},
author = {Giorgetti, G and Fabiocchi, F and Brandimarte, G and Tursi, A},
title = {Acute Diverticulitis Is at Significant Risk of Malnutrition: an Analysis of Hospitalized Patients in a Medicine Department.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {53-56},
doi = {10.15403/jgld-561},
pmid = {31930221},
issn = {1842-1121},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Feasibility Studies ; Female ; Hospitalization ; Humans ; Length of Stay/statistics & numerical data ; Male ; Malnutrition/diagnosis/*etiology ; Mass Screening/methods ; Middle Aged ; Nutrition Assessment ; Nutritional Status ; Nutritional Support/methods ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND AND AIM: The Nutritional Risk Security (NRS2002) System is recommended for hospitalized patients in order to assess their nutritional status. However, studies assessing large-scale systematic screening policies are lacking. The aim of this study was to assess the feasibility of implementing a screening strategy concerning all admissions for diverticular disease (DD) of the colon in the Department of Medicine of a Tertiary Hospital.
METHODS: All patients suffering from acute diverticulitis (AD) and admitted to the Medicine Department from January 1st to 31 December 2017, were pre-screened by NRS2002 System by the nursing staff of the Nutritional team at the day of the admission. If the pre-screening was positive, the patients were referred to a supplementary assessment performed by a dietician.
RESULTS: The global number of admissions in the observational period was 4,667 and 133 patients suffered from AD. A positive pre-screening test was recorded in 97 (72.9%) patients: a NRS2002 score > 3, describing a severe impaired nutritional status was found in 61 patients (62.9%). All 97 patients with a NRS2002 positive screening received initial nutritional support by oral supplements (17 patients, 17.52%) or enteral nutrition (22 patients, 22.68%) or total parenteral nutrition (58 patients, 59.8%). The mean length of hospital stay for all 133 patients was 6,9 days. However, the length of hospital stay was significantly longer for patients with a positive NRS2002, with a mean of 18 days (p= 0.01) Conclusions: A large number of hospitalized patients due to AD are at nutritional risk and have a significantly longer hospital stay.},
}
@article {pmid31930220,
year = {2019},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Lanas, A and Scarpignato, C and Bafutto, M and Barbara, G and Bassotti, G and Binda, GA and Biondi, A and Biondo, S and Cambiè, G and Cassieri, C and Crucitti, A and Dumitrascu, DL and Elisei, W and Escalante, R and Herszènyi, L and Kruis, W and Kupcinskas, J and Lahat, A and Lecca, PG and Maconi, G and Malfertheiner, P and Mazzari, A and Mearìn, F and Milosavljeviċ, T and Nardone, G and Chavez De Oliveira, E and Papa, A and Papagrigoriadis, S and Pera, M and Persiani, R and Picchio, M and Regula, J and Štimac, D and Stollman, N and Strate, LL and Violi, A and Walker, MM},
title = {International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {57-66},
doi = {10.15403/jgld-562},
pmid = {31930220},
issn = {1842-1121},
mesh = {Congresses as Topic ; Diverticular Diseases/diagnosis/etiology/*therapy ; Diverticulum/diagnosis/etiology/therapy ; Evidence-Based Medicine/methods ; Humans ; },
abstract = {The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.},
}
@article {pmid31920561,
year = {2019},
author = {Barrenschee, M and Cossais, F and Böttner, M and Egberts, JH and Becker, T and Wedel, T},
title = {Impaired Expression of Neuregulin 1 and Nicotinic Acetylcholine Receptor β4 Subunit in Diverticular Disease.},
journal = {Frontiers in cellular neuroscience},
volume = {13},
number = {},
pages = {563},
pmid = {31920561},
issn = {1662-5102},
abstract = {Neuregulin 1 (NRG1) regulates the expression of the nicotinic acetylcholine receptor (nAChR) and is suggested to promote the survival and maintenance of the enteric nervous system (ENS), since deficiency of its corresponding receptor complex ErbB2/ErbB3 leads to postnatal colonic aganglionosis. As diverticular disease (DD) is associated with intestinal hypoganglionosis, the NRG1-ErbB2/ErbB3 system and the nAChR were studied in patients with DD and controls. Samples of tunica muscularis of the sigmoid colon from patients with DD (n = 8) and controls (n = 11) were assessed for mRNA expression of NRG1, ErbB2, and ErbB3 and the nAChR subunits α3, α5, α7, β2, and β4. Site-specific gene expression levels of the NRG1-ErbB2/3 system were determined in myenteric ganglia harvested by laser microdissection (LMD). Localization studies were performed by immunohistochemistry for the NRG1-ErbB2/3 system and nAChR subunit β4. Rat enteric nerve cell cultures were stimulated with NRG1 or glial-cell line derived neurotrophic factor (GDNF) for 6 days and mRNA expression of the aforementioned nAchR was measured. NRG1, ErbB3, and nAChR subunit β4 expression was significantly down-regulated in both the tunica muscularis and myenteric ganglia of patients with DD compared to controls, whereas mRNA expression of ErbB3 and nAChR subunits β2, α3, α5, and α7 remained unaltered. NRG1, ErbB3, and nAChR subunit β4 immunoreactive signals were reduced in neuronal somata and the neuropil of myenteric ganglia from patients with DD compared to control. nAChR subunit β4 exhibited also weaker immunoreactive signals in the tunica muscularis of patients with DD. NRG1 treatment but not GDNF treatment of enteric nerve cell cultures significantly enhanced mRNA expression of nAchR β4. The down-regulation of NRG1 and ErbB3 in myenteric ganglia of patients with DD supports the hypothesis that intestinal hypoganglionosis observed in DD may be attributed to a lack of neurotrophic factors. Regulation of nAChR subunit β4 by NRG1 and decreased nAChR β4 in patients with DD provide evidence that a lack of NRG1 may affect the composition of enteric neurotransmitter receptor subunits thus contributing to the intestinal motility disorders previously reported in DD.},
}
@article {pmid31914931,
year = {2020},
author = {Moysidis, M and Paramythiotis, D and Karakatsanis, A and Amanatidou, E and Psoma, E and Mavropoulou, X and Michalopoulos, A},
title = {The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases.},
journal = {BMC gastroenterology},
volume = {20},
number = {1},
pages = {5},
pmid = {31914931},
issn = {1471-230X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Conservative Treatment/methods ; Diagnosis, Differential ; Digestive System Surgical Procedures/methods ; Diverticulum/complications/*diagnosis/therapy ; Duodenal Diseases/*diagnosis/etiology/therapy ; Duodenum/*surgery ; Female ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy.
CASE PRESENTATION: We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home.
CONCLUSIONS: Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.},
}
@article {pmid31908222,
year = {2019},
author = {Studniarek, A and Kochar, K and Warner, C and Eftaiha, S and Naffouj, S and Borsuk, DJ and Mellgren, A and Park, JJ and Cintron, J and Harrison, J},
title = {Findings on Colonoscopy after Diverticulitis: A Multicenter Review.},
journal = {The American surgeon},
volume = {85},
number = {12},
pages = {1381-1385},
pmid = {31908222},
issn = {1555-9823},
mesh = {Adenocarcinoma/diagnosis/epidemiology ; Adenoma/diagnosis/epidemiology ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/*diagnosis/epidemiology ; *Colonoscopy/statistics & numerical data ; Diverticulitis/*therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult ; },
abstract = {Diverticular disease is a common problem where patients with diverticulosis have a 1-4 per cent risk of acute diverticulitis. Current guidelines recommend a colonoscopy after.the resolution of acute diverticulitis. The aim of this study was to evaluate the yield of significant findings on colonoscopy after an episode of diverticulitis. This is a retrospective analysis of patients who underwent colonoscopy after an episode of diverticulitis between November 2005 and August 2017 at three major teaching hospitals. Advanced adenomas were defined as adenomas ≥1 cm, serrated adenomas, and tubulovillous or villous adenomas. A total of 584 patients (298 males; 51%) underwent colonoscopy for a history of diverticulitis after resolution of acute symptoms. Colonoscopy was complete in 488 patients (84%). Among these 488 patients, 446 had diverticular disease, 31 had advanced adenomas, and four had adenocarcinomas. Colonoscopies were incomplete in 96 patients (16%). Forty-six of those patients underwent surgery. The overall incidence of advanced adenomas and adenocarcinomas was 32 (5.4%) and nine (1.5%), respectively. In our study, the prevalence of advanced adenomas and adenocarcinomas was relatively high compared with the average risk individuals. Our findings support that patients after an episode of diverticulitis should continue to get a colonoscopy.},
}
@article {pmid31907763,
year = {2021},
author = {Kearney, MB and Williams, JM and Ebell, MH},
title = {Colon Cancer and Diverticular Disease Association: a Case-Control Study.},
journal = {Journal of gastrointestinal cancer},
volume = {52},
number = {1},
pages = {120-124},
pmid = {31907763},
issn = {1941-6636},
mesh = {Aged ; Case-Control Studies ; Colon/diagnostic imaging/pathology/surgery ; Colonic Neoplasms/diagnosis/*epidemiology ; Colonic Polyps/diagnosis/*epidemiology/surgery ; Colonoscopy ; Diverticulum, Colon/diagnosis/*epidemiology ; *Exercise ; Female ; Humans ; Incidence ; Intestinal Mucosa/diagnostic imaging/pathology/surgery ; Male ; Middle Aged ; Protective Factors ; Retrospective Studies ; Risk Assessment/statistics & numerical data ; Risk Factors ; },
abstract = {PURPOSE: To determine if there is an association between diverticular disease and colon cancer diagnoses with a secondary outcome of assessing other known risk factors for colon cancer. Colon cancer and diverticular disease have many shared symptoms and risk factors; the association between the two has been debated for many years.
METHODS: 36 cases of colon cancer and 144 age- and sex-matched controls were identified from records at an outpatient endoscopy center in Georgia. These cases and controls then were subject to a retrospective chart review to obtain any known risk factor data points for both diverticular disease and colon cancer. A traditional conditional logistic regression and a stepwise conditional logistic regression model were used to analyze the data using significant data points (P < 0.05).
RESULTS: The final stepwise model found that systolic blood pressure (aOR = 1.027, 95% CI = 1.001 to 1.053), history of polyps (aOR = 0.106, 95% CI = 0.029 to 0.387), exercise (aOR = 0.311, 95% CI = 0.029 to 0.387), and history of diverticular disease (aOR = 0.269, 95% CI = 0.091 to 0.795) were protective factors significantly associated with colon cancer.
CONCLUSIONS: Presence and history of the removal of colorectal polyps, presence or history of diverticular disease, and exercise pose as protective factors against development of colon cancer.},
}
@article {pmid31892800,
year = {2020},
author = {Díaz, JJT and Asenjo, BA and Soriano, MR and Fernández, CJ and Aurusa, JOS and Rentería, JPBH},
title = {Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer.},
journal = {Annals of gastroenterology},
volume = {33},
number = {1},
pages = {68-72},
pmid = {31892800},
issn = {1108-7471},
abstract = {Background: Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients.
Method: This was a retrospective cohort study that included patients with AD between July 2016 and December 2017.
Results: One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively).
Conclusions: Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.},
}
@article {pmid31890199,
year = {2020},
author = {Gorgoraptis, S and Xenaki, S and Athanasakis, E and Daskalaki, A and Lasithiotakis, K and Chrysou, E and Chrysos, E},
title = {A case of solitary rectal diverticulum presenting with a large retrorectal abscess.},
journal = {Annals of medicine and surgery (2012)},
volume = {49},
number = {},
pages = {57-60},
pmid = {31890199},
issn = {2049-0801},
abstract = {Colonic diverticular disease is a common condition, affecting 50% of the population aged above 80. In contrast, rectal diverticular disease is a rare condition with very few cases reported, while symptomatic rectal diverticular disease is even rarer. We present a case of a symptomatic large rectal diverticulum presenting with a retrorectal abscess. A 49-year-old Caucasian female was brought to the emergency department complaining of abdominal pain and weakness in the lower limbs. She was found to have obstructive uropathy and unilateral sciatic neuropathy. She rapidly developed acute abdomen and emergency laparotomy revealed a giant purulent rectal diverticulum. The patient underwent exploratory laparotomy and a loop colostomy was made to decompress the colon.},
}
@article {pmid31885846,
year = {2020},
author = {Sugimoto, H and Fujikawa, A and Kishida, A},
title = {A rare complication of the duodenal diverticulum.},
journal = {Frontline gastroenterology},
volume = {11},
number = {1},
pages = {81-82},
pmid = {31885846},
issn = {2041-4137},
abstract = {Introduction: An 80-year-old woman presented to the emergency department with severe right-sided abdominal pain that had started after her last meal. Physical examination revealed fever (38.6°C) and rebound tenderness in the right upper quadrant of the abdomen. The laboratory studies showed a leucocyte count of 11.3×109/L (normal, 3.7-8.0×109/L) and a C-reactive protein level of 2.34 mg/dL (normal, <0.03 mg/dL). There were no other significant findings. A CT scan of the abdomen with contrast revealed retroperitoneal air around a duodenal diverticulum (figures 1 and 2).Figure 1Computed tomography scan of the abdomen with contrast (coronal section). A diverticulum in the second portion of the duodenum (arrow) and retroperitoneal air (asterisk) are shown.Figure 2Computed tomography scan of the abdomen with contrast (axial section). The area with retroperitoneal air (asterisk) is marked.
Question: What is the most likely diagnosis and the cause underlying the condition?},
}
@article {pmid31844513,
year = {2019},
author = {Albeeshi, MZ and Alwanyan, AA and Salim, AA and Albabtain, IT},
title = {Appendiceal diverticulitis presenting as acute appendicitis diagnosed postoperatively.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {12},
pages = {rjz332},
pmid = {31844513},
issn = {2042-8812},
abstract = {Appendiceal diverticular disease is a rare entity. We report a case of appendiceal diverticulitis mimicking acute appendicitis and diagnosed postoperatively on histopathology. A 28-year-old female presented with a 2-day history of shifting periumbilical pain associated with nausea and anorexia. A computed tomography scan of the abdomen demonstrated acute appendicitis. She was taken to laparoscopic appendectomy. Histopathology showed appendiceal diverticulitis, and perforation of an inflamed diverticulum with periappendicitis. Diverticulosis of the appendix is classified as congenital and acquired. Diagnosis can be made preoperatively by imaging. In this case, diverticulosis was not radiologically evident, and was interpreted as acute appendicitis. Gross appearance of the resected appendix was not suggestive of diverticulitis. Other cases reported that the gross specimen had evidence of diverticular disease. Surgeons should be aware that inflamed appendixes may harbor different pathologies warranting further management.},
}
@article {pmid31828890,
year = {2020},
author = {Siddiqui, J and Young, CJ},
title = {Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients.},
journal = {ANZ journal of surgery},
volume = {90},
number = {1-2},
pages = {113-118},
doi = {10.1111/ans.15578},
pmid = {31828890},
issn = {1445-2197},
mesh = {Aged ; Colonic Diseases/pathology/*surgery ; Conversion to Open Surgery/*statistics & numerical data ; Female ; *Hand-Assisted Laparoscopy ; Humans ; Male ; Middle Aged ; New South Wales ; Prospective Studies ; Rectal Diseases/pathology/*surgery ; },
abstract = {BACKGROUND: We report outcomes on 324 consecutive cases of hand-assisted laparoscopic surgery (HALS) in colorectal patients over 13 years performed by a single surgeon.
METHODS: A prospectively maintained database was used to identify all patients undergoing HALS colorectal procedures for benign or malignant indications from September 2004 to February 2018, at two major tertiary centres in Sydney, Australia.
RESULTS: Median age was 64 years, 51% were female and median body mass index was 26. Colorectal cancer (55%), diverticular disease (13%) and polyp related conditions (13%) were common indications. Anterior resection (65%) and right hemicolectomy (18%) were most commonly performed. Median operative time was 244 min (190-300) and 75% of Gelport incisions were Pfannenstiel. Sixty-three percent of colorectal cancer patients had a T3 or T4 cancer. Median tumour size was 35 mm (25-45). Seven percent required conversion to open and 4% a re-operation in the early post-operative period. Thirty-six percent had a post-operative complication, and 11% were major complications. Follow-up extended to 12.8 years and there were 33 late deaths. Being in a high dependency unit or intensive care unit was significant for late mortality (odds ratio 2.8, 95% confidence interval 1.06-7.78, P = 0.037). Three percent developed an incisional hernia and 6% had small bowel obstruction at long-term follow-up.
CONCLUSION: HALS is an effective technique for both benign and malignant colorectal indications with the added advantage of tactile feedback and a lower rate of conversion to open.},
}
@article {pmid31825345,
year = {2019},
author = {Groshilin, VS and Martynov, DV and Tsygankov, PV and Shvetsov, VK and Lukash, YV},
title = {[Prospects for stimulation in early rehabilitation of patients and restoration of bowel function after proctological operations].},
journal = {Khirurgiia},
volume = {},
number = {12},
pages = {66-73},
doi = {10.17116/hirurgia201912166},
pmid = {31825345},
issn = {0023-1207},
mesh = {Clinical Protocols ; Constipation/etiology/therapy ; Defecation/*physiology ; Galactans/*administration & dosage ; Gastrointestinal Agents/*administration & dosage ; Humans ; Intestines/*physiopathology/surgery ; Lactoferrin/*administration & dosage ; Laxatives/administration & dosage ; Proctectomy/adverse effects/*rehabilitation ; Prospective Studies ; Quality of Life ; Time Factors ; Treatment Outcome ; },
abstract = {RELEVANCE: The leveling of postoperative pain, early activation of patients are the leading components of the fast-track program, providing fast recovery with good quality of life, minimizing postoperative problems. In colorectal surgery, the most important factor determining the early recovery of patients is the normalization of bowel function, the restoration of defecation rhythm.
AIM: To assess the possibility of using dietary fiber (arabinogalactan) in combination with lactoferrin (the drug Fibraxin, Alfa Sigma) in the complex postoperative therapy of proctologic patients, as well as to determine the effectiveness of their influence on the dynamics of rehabilitation.
MATERIAL AND METHODS: A non-randomized cohort comparative prospective study was conducted in two clinical groups of 100 patients operated on for proctological pathology. In the first (control) group, after the operation, venotonics were prescribed for 2-3 weeks, as well as topical preparations - for 2.5 weeks. In the second (main) group, this treatment is supplemented with the use of Fibraxin, at a dosage of 6g 1 time per day, the observation period is 4 weeks. A comparative analysis of the rates of relief of postoperative defecation disorders, as well as the effect of the drug on the dynamics of the relief of leading postoperative complaints, has been carried out.
RESULTS: In the main group, the best results were obtained for the main parameters analyzed, early normalization of the frequency and rhythm of bowel movements was achieved, with adequate relief of complaints of pain during bowel movements and after it. Intolerance to the drug and pathological reactions associated with its use was not. The positive effect of Fibraxin in patients with concomitant diseases of the colon, including colitis, irritable bowel syndrome, diverticular disease and chronic colonic stasis, was noted.
CONCLUSION: The use of the drug Fibraxin at a dose of 6g per day allows a significant influence on the course of the postoperative period in proctological patients. The inclusion of Fibraxin in the scheme of rehabilitation treatment allows to stabilize the immediate results of treatment and reliably improve long-term, due to the correction of rectal dysfunction, elimination of dysbiosis, normalization of motility, as well as potentiation of reparative and restorative processes.},
}
@article {pmid31820191,
year = {2020},
author = {Jolivet, M and Trilling, B and Sage, PY and Boussat, B and Girard, E and Faucheron, JL},
title = {Prospective evaluation of functional outcomes after laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease in consecutive male patients.},
journal = {Techniques in coloproctology},
volume = {24},
number = {1},
pages = {33-40},
pmid = {31820191},
issn = {1128-045X},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Laparoscopy ; Male ; Mesenteric Artery, Inferior/surgery ; Middle Aged ; Pilot Projects ; Prospective Studies ; Quality of Life ; Treatment Outcome ; },
abstract = {BACKGROUND: To date, there has been no consensus concerning the vascular approach during sigmoid colectomy for diverticular disease. The aim of this study was to determine the functional impact of elective laparoscopic sigmoidectomy performed with high ligation of the inferior mesenteric artery for diverticulitis in consecutive male patients.
METHODS: Twenty-five consecutive patients of median age 53 years were enrolled in a prospective single-centre pilot study at a tertiary teaching hospital. Main outcome measures were functional results. Patients were asked to complete standardized, validated questionnaires to evaluate preoperative and 6 months postoperative bowel symptomatology (Jorge-Wexner Incontinence Score and KESS score), urinary function (IPSS), and sexual function (IIEF). Secondary outcomes were surgical data, morbidity, and quality of life (SF-36).
RESULTS: There were no significant differences between preoperative and 6 months postoperative total scores for bowel symptomatology, urinary function, and sexual function. There were no perioperative deaths. The morbidity rate was 12% including three minor and no major events. Quality of life demonstrated statistically better general health (p < 0.01) and better medical status over the prior 4 weeks at 6 months after surgery, compared to baseline. This single-centre prospective study has a limited number of patients, relatively short follow-up time, and includes only male patients.
CONCLUSION: Laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease does not induce functional disorders at 6 months after surgery. The benefit of the operation for quality of life is even greater for general health and medical status.},
}
@article {pmid31810518,
year = {2020},
author = {Bastawrous, AL and Shih, IF and Li, Y and Cleary, RK},
title = {Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study.},
journal = {American journal of surgery},
volume = {220},
number = {2},
pages = {421-427},
doi = {10.1016/j.amjsurg.2019.11.030},
pmid = {31810518},
issn = {1879-1883},
mesh = {Adolescent ; Adult ; Aged ; Analgesics, Opioid/*therapeutic use ; Digestive System Surgical Procedures/methods ; Diverticular Diseases/*surgery ; Drug Utilization/*statistics & numerical data ; Female ; Hospitalization ; Humans ; Laparoscopy ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures ; Young Adult ; },
abstract = {BACKGROUND: Patients undergoing gastrointestinal surgery are at high risk for postoperative opioid use.
METHODS: We evaluated inpatient opioid use among patients undergoing sigmoidectomy for diverticular disease from the Premier Hospital Database and compared across surgical approaches using propensity score-matching analysis.
RESULTS: After the day of surgery, minimally invasive (MIS) patients were administered significantly lower doses of parenteral opioids (median daily morphine milligram equivalents [MME]: 33.3 versus 48.3, p < 0.001). Within MIS, significantly less parenteral opioids were used by the robotic-assisted (RS) than the laparoscopic (LS) group (median daily MME: 30.0 versus 36.8, p = 0.012). MIS patients were more likely than open to start oral opioids on the day of surgery (MIS vs. OS: 8.7% vs. 6.6%, p < 0.001; RS vs. LS: 12.6% vs. 10.2%, p = 0.048).
CONCLUSION: Minimally invasive sigmoidectomy for diverticular disease was associated with less postoperative parenteral opioid use and starting oral opioids sooner after surgery compared to the open approach.},
}
@article {pmid31804268,
year = {2020},
author = {Shah, N},
title = {Expert Commentary on Complicated Diverticulitis.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {1},
pages = {29},
doi = {10.1097/DCR.0000000000001553},
pmid = {31804268},
issn = {1530-0358},
mesh = {Abscess ; *Diverticular Diseases ; *Diverticulitis ; Humans ; *Peritonitis ; },
abstract = {Complicated diverticulitis encompasses a variety of clinical scenariors as outlined in the well-written and succinct review by Drs Mendez and Garcia-Henriquez. These range from acute presentations, such as abscesses and free perforations with peritonitis, to more chronic, insidious sequelae such as fistulas and strictures.The contemporary surgical management of diverticular disease has evolved considerably with better appreciation of the pathophysiology and natural history. Just as in uncomplicated diverticulitis, there has been a significant shift toward a less aggressive surgical strategy in complicated diverticulitis, aided further with improved diagnostic and interventional radiology.I would like to add a few salient points for each listed complication.},
}
@article {pmid31801775,
year = {2019},
author = {Tursi, A and Marinelli, A and Laera, F and Penna, A},
title = {Complicated diverticulitis mimicking colonic carcinoma: combined approach with endoscopy and budesonide.},
journal = {BMJ case reports},
volume = {12},
number = {12},
pages = {},
pmid = {31801775},
issn = {1757-790X},
mesh = {Anti-Inflammatory Agents/*administration & dosage ; Budesonide/*administration & dosage ; Colonic Neoplasms/*diagnosis ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/drug therapy ; Drug Administration Schedule ; Humans ; Male ; Middle Aged ; },
abstract = {Complicated diverticulitis is an uncommon endoscopic finding. We report an unusual case of complicated diverticulitis in a 53-year-old man suffering from chronic constipation, abdominal pain and a recent episode of subocclusion. He underwent to colonoscopy that showed left-sided diverticulosis and a 3 cm irregular mass in the sigmoid. During biopsy sampling due to the suspect of colonic carcinoma, pus and bleeding came out from the lesion. After lavage, a large diverticulum with visible vessel at the bottom was found, which was clipped with stopping bleeding. After a short course of in-hospital treatment, at discharging the patient was treated with budesonide MMX9 mg/day for 8 weeks. At that time, colonoscopy did not show sign of diverticular inflammation, and inflammatory indexes were normal. This case demonstrates that the use of a topical steroid, combined with an endoscopic approach, may easily resolve an unusual endoscopic complication in patients suffering from complicated diverticular disease.},
}
@article {pmid31744067,
year = {2019},
author = {Cirocchi, R and Popivanov, G and Corsi, A and Amato, A and Nascimbeni, R and Cuomo, R and Annibale, B and Konaktchieva, M and Binda, GA},
title = {The Trends of Complicated Acute Colonic Diverticulitis-A Systematic Review of the National Administrative Databases.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {55},
number = {11},
pages = {},
pmid = {31744067},
issn = {1648-9144},
mesh = {Abscess/*classification/complications/epidemiology ; Diverticulitis, Colonic/epidemiology/*physiopathology ; Humans ; Registries ; },
abstract = {Background and Objectives: The diverticular disease includes a broad spectrum of different "clinical situations" from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diverticulitis through a comparative analysis of the hospitalizations based on the national administrative databases. Materials and Methods: A review of the international and national administrative databases concerning admissions for complicated AD was performed. Results: Ten studies met the inclusion criteria and were included in the analysis. No definition of acute complicated diverticulitis was reported in any study. Complicated AD accounted for approximately 42% and 79% of the hospitalizations. The reported rates of abscess varied between 1% and 10% from all admissions for AD and 5-29% of the cases with complicated AD. An increasing temporal trend was found in one study-from 6% to 10%. The rates of diffuse peritonitis ranged from 1.6% to 10.2% of all hospitalizations and 11% and 47% of the complicated cases and were stable in the time. Conclusions: The available data precluded definitive conclusions because of the significant discrepancy between the included studies. The leading cause was the presence of heterogeneity due to coding inaccuracies in all databases, absence of ICD codes to distinguish the different type of complications, and the lack of coding data about some general conditions such as sepsis, shock, malnutrition, steroid therapy, diabetes, pulmonary, and heart failure.},
}
@article {pmid31722875,
year = {2019},
author = {Burr, NE and Derbyshire, E and Taylor, J and Whalley, S and Subramanian, V and Finan, PJ and Rutter, MD and Valori, R and Morris, EJA},
title = {Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study.},
journal = {BMJ (Clinical research ed.)},
volume = {367},
number = {},
pages = {l6090},
pmid = {31722875},
issn = {1756-1833},
support = {MR/L01629X/1/MRC_/Medical Research Council/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Aged ; Colonoscopy/*methods ; *Colorectal Neoplasms/diagnosis/epidemiology ; *Early Detection of Cancer/methods/standards/statistics & numerical data ; England/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Quality Improvement/organization & administration ; Risk Factors ; State Medicine/standards ; },
abstract = {OBJECTIVES: To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.
DESIGN: Population based cohort study.
SETTING: National Health Service in England between 2005 and 2013.
POPULATION: All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).
MAIN OUTCOME MEASURES: National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.
RESULTS: The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.
CONCLUSIONS: Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.},
}
@article {pmid31712072,
year = {2020},
author = {Ma, W and Jovani, M and Nguyen, LH and Tabung, FK and Song, M and Liu, PH and Cao, Y and Tam, I and Wu, K and Giovannucci, EL and Strate, LL and Chan, AT},
title = {Association Between Inflammatory Diets, Circulating Markers of Inflammation, and Risk of Diverticulitis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {10},
pages = {2279-2286.e3},
pmid = {31712072},
issn = {1542-7714},
support = {K24 DK098311/DK/NIDDK NIH HHS/United States ; R00 CA207736/CA/NCI NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; U01 CA167552/CA/NCI NIH HHS/United States ; },
mesh = {Case-Control Studies ; *Diet ; *Diverticulitis/epidemiology ; Follow-Up Studies ; Humans ; Inflammation/epidemiology ; Male ; Prospective Studies ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: Lifestyle and dietary risk factors for diverticulitis also have been associated with chronic inflammation. We performed a prospective study of associations among the inflammatory potential of diets, circulating markers of inflammation, and the incidence of diverticulitis.
METHODS: We followed 46,418 men, initially free of diverticulitis, from 1986 through 2014 in the Health Professionals Follow-Up Study. We collected data on empiric dietary inflammatory pattern scores, which indicate the inflammatory potential of diets, and determined their association with the risk of incident diverticulitis using Cox proportional hazards regression. We used blood samples provided by 18,225 participants from 1993 through 1995 to conduct a nested case-control study; we used conditional logistic regression to evaluate prediagnostic plasma levels of markers of inflammation, including C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor-receptor superfamily member 1B, in 310 diverticulitis cases and 310 matched diverticulitis-free individuals (controls).
RESULTS: We documented 1110 cases of incident diverticulitis over 992,589 person-years of follow-up. Compared with participants in the lowest quintile of empiric dietary inflammatory pattern scores, men in the highest quintile had a multivariable-adjusted hazard ratio for diverticulitis of 1.31 (95% CI, 1.07-1.60; Ptrend = .01). The association did not differ significantly by strata of body mass index or vigorous activity (P for interaction > .05 for each). In the nested case-control study, plasma levels of CRP and IL6 were associated with risk of diverticulitis. When we compared extreme quintiles, the multivariable-adjusted relative risk for diverticulitis was 1.85 for CRP (95% CI, 1.04-3.30) and 2.04 for IL6 (95% CI, 1.09-3.84).
CONCLUSIONS: In a large prospective cohort of men, we found that the inflammatory potential of diet and prediagnostic plasma levels of markers of inflammation were associated with incident diverticulitis.},
}
@article {pmid31708198,
year = {2020},
author = {Weber, KT and Chung, PJ and La Gamma, N and Procaccino, JA and Alfonso, AE and Coppa, G and Sugiyama, G},
title = {Effect of Body Mass Index on Outcomes After Surgery for Perforated Diverticulitis.},
journal = {The Journal of surgical research},
volume = {247},
number = {},
pages = {220-226},
doi = {10.1016/j.jss.2019.10.020},
pmid = {31708198},
issn = {1095-8673},
mesh = {Adult ; Aged ; Body Mass Index ; Colostomy/*adverse effects ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/mortality/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Obesity, Morbid/complications/*epidemiology ; Perioperative Period/mortality ; Postoperative Complications/*epidemiology/etiology ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Sepsis/etiology/mortality/*surgery ; Treatment Outcome ; United States/epidemiology ; },
abstract = {BACKGROUND: Despite the increased adoption of minimally invasive techniques in colorectal surgery, an open resection with ostomy creation remains an accepted operation for perforated diverticulitis. In the United States, there is an increase in the rates of both morbid obesity and diverticular disease. Therefore, we wanted to explore whether outcomes for morbidly obese patients with diverticulitis are worse than nonmorbidly obese patients after open colectomy for diverticulitis.
MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2015, we identified adults with emergent admission for diverticulitis (International Classification of Diseases, Ninth Revision, code 562.11) with evidence of preoperative sepsis and intraoperative contaminated/dirty wound classification, in which a resection with ostomy (Current Procedural Terminology codes 44141, 44143, or 44144) was performed. We excluded cases with age >90 y, ventilator dependence, evidence of disseminated cancer and missing sex, race, body mass index, functional status, American Society of Anesthesiologists class, length of stay (LOS), or operative time data. Morbid obesity was defined as body mass index >35 kg/m2. Risk variables of interest included age, sex, race, medical comorbidities, requirement for preoperative transfusion, preoperative sepsis, and operative time. Outcomes of interest included LOS, 30-d postoperative complications, and mortality. Univariate and propensity scores with postmatching analyses were performed.
RESULTS: A total of 2019 patients met inclusion and exclusion criteria, of which 413 (20.5%) were morbidly obese. Morbidly obese patients tended to be younger (mean 57.2 versus 62.6 y) and female (54.5% versus 45.5%). Morbidly obese patients also had higher rates of insulin-dependent diabetes (8.0% versus 4.2%), hypertension (60.1% versus 51.3%), renal failure (3.4% versus 1.5%), and higher American Society of Anesthesiologists class (class 4: 23.5% versus 19.6% and class 5: 1.45% versus 0.87%). Morbidly obese patient had no increase in 30-d mortality or LOS, but they had higher rates of superficial wound infection (9.0% versus 5.8%; P = 0.0259), deep wound infection (4.4% versus 1.9%; P = 0.0073), acute renal failure (4.8% versus 2.4%; P = 0.0189), postoperative septic shock (17.7% versus 12.1%; P = 0.0040), and return to the operating room (11.1% versus 6.4%; P = 0.0015). We identified 397 morbidly obese patients well matched by propensity score to 397 nonmorbidly obese patients. Conditional logistic regression showed no difference in LOS (median 12.9 versus 12.4 d; P = 0.4648) and no increased risk of 30-d mortality (P = 0.947), but morbid obesity was an independent predictor for return to the operating room (adjusted odds ratio: 27.09 [95% confidence interval: 2.68-274.20]; P = 0.005).
CONCLUSIONS: This analysis of a large national clinical database demonstrates that morbidly obese patients presenting with perforated diverticulitis undergoing a Hartmann's procedure do not have increased mortality or LOS compared with nonobese patients. After adjusting for the effects of morbid obesity, morbidly obese patients had increased risk of return to operating room. Despite literature describing the many perioperative risks of obesity, our analysis showed only increased reoperation for obese patients with diverticulitis.},
}
@article {pmid31706437,
year = {2019},
author = {Eberhardt, F and Crichton, M and Dahl, C and Nucera, R and Jenkins, J and Marx, W and Marshall, S},
title = {Role of dietary fibre in older adults with asymptomatic (AS) or symptomatic uncomplicated diverticular disease (SUDD): Systematic review and meta-analysis.},
journal = {Maturitas},
volume = {130},
number = {},
pages = {57-67},
doi = {10.1016/j.maturitas.2019.10.006},
pmid = {31706437},
issn = {1873-4111},
mesh = {Aged ; Asymptomatic Diseases ; Dietary Fiber/*administration & dosage ; Diverticular Diseases/*drug therapy/epidemiology/physiopathology ; Gastrointestinal Transit ; Humans ; Middle Aged ; Probiotics/therapeutic use ; },
abstract = {Dietary fibre and probiotics may play a role in the management of diverticular disease. This systematic review synthesises the evidence on the effects of dietary fibre modifications, with or without the use of probiotics, on the incidence in older adults of asymptomatic (AS) or symptomatic uncomplicated diverticular disease (SUDD), as well as on gastrointestinal function and symptoms. Five electronic databases were searched for studies through to December 2018. The body of evidence was appraised using the Cochrane Risk of Bias tool and GRADE. Nine studies were included, with mean sample ages ranging from 57 to 70 years, and three meta-analyses were performed. Only one study, with high risk of bias, measured the effect of dietary fibre on the incidence of diverticulitis. Dietary fibre supplementation improved stool weight (MD: 42 g/day, P < 0.00001; GRADE level of evidence: low), but had no significant effect on gastrointestinal symptoms (SMD: -0.13, P = 0.16; GRADE level of evidence: low) or stool transit time (MD: -3.70, P = 0.32 GRADE level of evidence: low). There was "very low" confidence for the body of evidence supporting symbiotics for AS or SUDD. A high dietary fibre intake, in line with dietary guidelines, may improve gastrointestinal function and is recommended in patients with AS or SUDD. Dietary fibre supplementation should be considered on an individualised basis to improve bowel function, while any recommendation on symbiotic supplements requires further well-designed research. Future studies should also measure the impact on the incidence of diverticulitis.},
}
@article {pmid31700230,
year = {2019},
author = {Zullo, A and Gatta, L and Vassallo, R and Francesco, V and Manta, R and Monica, F and Fiorini, G and Vaira, D},
title = {Paradigm shift: the Copernican revolution in diverticular disease.},
journal = {Annals of gastroenterology},
volume = {32},
number = {6},
pages = {541-553},
pmid = {31700230},
issn = {1108-7471},
abstract = {Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.},
}
@article {pmid31697162,
year = {2020},
author = {Yang, D and Pearson, D and Smith, D},
title = {A rare case of a diverticular perforation associated with colo-urachal fistula presenting as anaphylaxis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {3},
pages = {e51-e53},
pmid = {31697162},
issn = {1478-7083},
mesh = {Anaphylaxis/*etiology ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Edema/*etiology ; *Face ; Fistula/*complications ; Humans ; Intestinal Fistula/*complications ; Intestinal Perforation/diagnostic imaging/*etiology ; Male ; Middle Aged ; *Urachus ; },
abstract = {Diverticular disease is a common clinical condition among Western populations, which increases with age. It can present in a variety of manners and has myriad of potential disease complications. We present a rare case of an adult patient with an extraperitoneal complications of a diverticular perforation presenting with facial swelling due to a colo-urachal fistula associated with a patent urachal remnant. Perforation should be considered in patients presenting with surgical emphysema with background of diverticular disease.},
}
@article {pmid31686198,
year = {2019},
author = {Çakar, E and Bayrak, S and Çolak, Ş and Dal, F and Gürbulak, B and Bektaş, H and Yarıkkaya, E and Ferlengez, AG},
title = {Clinical characteristics of appendiceal diverticular disease.},
journal = {International journal of colorectal disease},
volume = {34},
number = {12},
pages = {2035-2041},
pmid = {31686198},
issn = {1432-1262},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendiceal Neoplasms/diagnostic imaging/epidemiology/*pathology/surgery ; Appendicitis/diagnostic imaging/epidemiology/*pathology/surgery ; Appendix/diagnostic imaging/*pathology/surgery ; Child ; Diagnosis, Differential ; Diverticular Diseases/diagnostic imaging/epidemiology/*pathology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Precancerous Conditions/diagnostic imaging/epidemiology/*pathology/surgery ; Predictive Value of Tests ; Prevalence ; Retrospective Studies ; Turkey/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Appendiceal diverticular disease (ADD) is a rare pathology which is associated with an increased mortality risk due to rapid perforation and high rates of neoplasm. In our study, we aimed to evaluate the clinical and histopathological characteristics of ADD with differences from acute appendicitis (AA) diagnosis and to determine the association with neoformative processes.
METHODS: The 4279 patients who underwent appendectomy were evaluated retrospectively. ADD patients histopathologically classified into four groups. Patients' demographic characteristics, imaging and preoperative laboratory findings, additionally postoperative histopathology results were compared between groups.
RESULTS: The prevalence of ADD was 2.29% (n = 98). In addition, the male/female ratio was 2.37 in ADD patients who were found to be significantly older than those with AA patients. Type III was the most frequently (62.2%) identified sub-group of ADD. The incidence of neoplasms, plastrone, and Littre's hernia was found statistically higher in ADD group than AA group. Mucinous adenomas (10.2%) was the most common neoplasm while the carcinoid tumor (1%) and precancerous serrated adenomas (4.1%) were also reported.
CONCLUSIONS: As a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or ıntraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.},
}
@article {pmid31663792,
year = {2019},
author = {Abdalla, AO and Narala, SB and Abdallah, MA and Doshi, R and Gullapalli, N},
title = {The outcomes of Clostridioides difficile infection in patients with diverticular disease: a nationwide analysis.},
journal = {Scandinavian journal of gastroenterology},
volume = {54},
number = {11},
pages = {1353-1356},
doi = {10.1080/00365521.2019.1683223},
pmid = {31663792},
issn = {1502-7708},
mesh = {Aged ; Aged, 80 and over ; Bacterial Infections/*complications/epidemiology ; *Clostridiales ; Databases, Factual ; Diverticular Diseases/epidemiology/*microbiology ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; United States ; },
abstract = {Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections. It contributes to significant morbidity and mortality among hospitalized patients in the United States. Prior studies suggest worse outcomes of CDI in patients with diverticulitis and increased risk for recurrent CDI. We conducted this study to evaluate the outcomes of CDI in patients with diverticular disease from a nationwide data sample (2012-2015).Methods: The National Inpatient Sample (NIS) database between January 2012 and September 2015 was queried for CDI admissions using the International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 008.45, 562.11, 562.10, 562.12, and 562.13 for diagnoses of CDI and diverticular disease.Results: The study included 1,327,595 patients who were admitted between 2012 and 2105 for CDI. Out of all of the patients, 84,170 (6.34%) had a concurrent diagnosis of diverticular disease. After adjusting for confounding variables, the in-hospital mortality was lower [odd ratio (OR): 0.48, 95% CI: 0.44-0.52, p < .001] for patients with diverticular disease. The length of stay (LOS) was longer [10.5 versus 9.3 days, p < .001] and mean cost of hospitalization was significantly higher in patients without a history of diverticular disease.Discussion: In a nationwide population study, admissions with CDI, patients with a concurrent diagnosis of diverticular disease had lower in-hospital mortality. The observed results are different from prior studies and might be attributed to a higher burden of normal flora in those patients and increased use of antibiotic stewardship program across many hospitals nationwide.},
}
@article {pmid31661949,
year = {2020},
author = {Bong, J and Kang, HW and Cho, H and Nam, JH and Jang, DK and Kim, JH and Lee, JK and Lim, YJ and Koh, MS and Lee, JH},
title = {Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study.},
journal = {Intestinal research},
volume = {18},
number = {1},
pages = {121-129},
pmid = {31661949},
issn = {1598-9100},
support = {//Dongguk University/ ; },
abstract = {BACKGROUND/AIMS: Dietary fiber intake is considered a protective factor for diverticular disease such as diverticulitis. However, evidence for an inverse connection between dietary fiber consumption and asymptomatic colonic diverticulosis is lacking. Specifically, few studies have investigated this subject in Asians with different presentations of diverticulosis. Therefore, we assessed the protective effects of a vegetarian diet for asymptomatic colonic diverticulosis in Buddhist monks who are obligatory vegetarians for spiritual reasons compared with the general population.
METHODS: A retrospective, cross-sectional, case-control study was conducted in age- and sex-matched Buddhist monks and the general population who underwent colonoscopy for screening at a Korean health promotion center from August 2005 to June 2018. We compared the prevalence of asymptomatic diverticulosis between the 2 groups using a self-administered questionnaire.
RESULTS: In this study, a total of 1,316 individuals were included (Buddhist monks of 658 and general population of 658) with a mean age of 52.6±9.5 years. The prevalence of asymptomatic diverticulosis in Buddhist monks was lower compared with the general population (6.7% [44/658] vs. 10.8% [71/658], P=0.008). Buddhist monks had a higher rate of high body mass index (BMI) and metabolic syndrome. By a multivariate regression analysis model, a nonvegetarian diet (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.21-2.72, P=0.004), old age (OR, 4.53; 95% CI, 1.36-15.12; P=0.014), male sex (OR, 1.91; 95% CI, 1.28-2.85; P=0.002), and a high BMI (OR, 1.50; 95% CI, 1.01-2.23; P=0.047) were independent predictors of asymptomatic diverticulosis. Moreover, a nonvegetarian diet was associated with both right-sided and left-sided diverticulosis.
CONCLUSIONS: A nonvegetarian diet may increase a risk of asymptomatic colonic diverticulosis in Asians.},
}
@article {pmid31658807,
year = {2021},
author = {Roh, S},
title = {Foregut Diverticula.},
journal = {Korean journal of family medicine},
volume = {42},
number = {3},
pages = {191-196},
pmid = {31658807},
issn = {2005-6443},
abstract = {Diverticular disease can present anywhere along the gastrointestinal (GI) tract. It can result from various pathologies such as abnormal contraction within the GI tract or inflammation causing scar tissue and the resulting forces surrounding the GI tract. Its clinical presentation can vary from asymptomatic to severe symptoms, with significant decrease in quality of life. The treatment for various diverticula along the GI tract can also vary, depending on the severity of symptoms. This article describes diverticular disease occurring within the foregut, with emphasis on pathophysiology, clinical presentation, and treatment.},
}
@article {pmid31650125,
year = {2019},
author = {Kuan, V and Denaxas, S and Gonzalez-Izquierdo, A and Direk, K and Bhatti, O and Husain, S and Sutaria, S and Hingorani, M and Nitsch, D and Parisinos, CA and Lumbers, RT and Mathur, R and Sofat, R and Casas, JP and Wong, ICK and Hemingway, H and Hingorani, AD},
title = {A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service.},
journal = {The Lancet. Digital health},
volume = {1},
number = {2},
pages = {e63-e77},
pmid = {31650125},
issn = {2589-7500},
support = {/DH_/Department of Health/United Kingdom ; MR/K006584/1/MRC_/Medical Research Council/United Kingdom ; 201375/Z/16/Z/WT_/Wellcome Trust/United Kingdom ; /ARC_/Arthritis Research UK/United Kingdom ; //Wellcome Trust/United Kingdom ; RG/10/12/28456//British Heart Foundation/United Kingdom ; /CSO_/Chief Scientist Office/United Kingdom ; 206274/Z/17/Z/WT_/Wellcome Trust/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; 110284/Z/15/Z/WT_/Wellcome Trust/United Kingdom ; },
mesh = {Adolescent ; Adult ; *Age of Onset ; Aged ; Aged, 80 and over ; Algorithms ; Child ; Databases, Factual ; Electronic Health Records ; England/epidemiology ; Female ; *Forecasting ; *Health Status ; Humans ; Male ; *Mental Disorders/diagnosis ; Middle Aged ; Population Surveillance/methods ; State Medicine ; Young Adult ; },
abstract = {Background: To effectively prevent, detect, and treat health conditions that affect people during their lifecourse, health-care professionals and researchers need to know which sections of the population are susceptible to which health conditions and at which ages. Hence, we aimed to map the course of human health by identifying the 50 most common health conditions in each decade of life and estimating the median age at first diagnosis.
Methods: We developed phenotyping algorithms and codelists for physical and mental health conditions that involve intensive use of health-care resources. Individuals older than 1 year were included in the study if their primary-care and hospital-admission records met research standards set by the Clinical Practice Research Datalink and they had been registered in a general practice in England contributing up-to-standard data for at least 1 year during the study period. We used linked records of individuals from the CALIBER platform to calculate the sex-standardised cumulative incidence for these conditions by 10-year age groups between April 1, 2010, and March 31, 2015. We also derived the median age at diagnosis and prevalence estimates stratified by age, sex, and ethnicity (black, white, south Asian) over the study period from the primary-care and secondary-care records of patients.
Findings: We developed case definitions for 308 disease phenotypes. We used records of 2 784 138 patients for the calculation of cumulative incidence and of 3 872 451 patients for the calculation of period prevalence and median age at diagnosis of these conditions. Conditions that first gained prominence at key stages of life were: atopic conditions and infections that led to hospital admission in children (<10 years); acne and menstrual disorders in the teenage years (10-19 years); mental health conditions, obesity, and migraine in individuals aged 20-29 years; soft-tissue disorders and gastro-oesophageal reflux disease in individuals aged 30-39 years; dyslipidaemia, hypertension, and erectile dysfunction in individuals aged 40-59 years; cancer, osteoarthritis, benign prostatic hyperplasia, cataract, diverticular disease, type 2 diabetes, and deafness in individuals aged 60-79 years; and atrial fibrillation, dementia, acute and chronic kidney disease, heart failure, ischaemic heart disease, anaemia, and osteoporosis in individuals aged 80 years or older. Black or south-Asian individuals were diagnosed earlier than white individuals for 258 (84%) of the 308 conditions. Bone fractures and atopic conditions were recorded earlier in male individuals, whereas female individuals were diagnosed at younger ages with nutritional anaemias, tubulointerstitial nephritis, and urinary disorders.
Interpretation: We have produced the first chronological map of human health with cumulative-incidence and period-prevalence estimates for multiple morbidities in parallel from birth to advanced age. This can guide clinicians, policy makers, and researchers on how to formulate differential diagnoses, allocate resources, and target research priorities on the basis of the knowledge of who gets which diseases when. We have published our phenotyping algorithms on the CALIBER open-access Portal which will facilitate future research by providing a curated list of reusable case definitions.
Funding: Wellcome Trust, National Institute for Health Research, Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Department of Health and Social Care (England), Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Social Care and Health Research, and The Alan Turing Institute.},
}
@article {pmid31646852,
year = {2019},
author = {Di Pierro, F and Bertuccioli, A and Pane, M and Ivaldi, L},
title = {Effects of rifaximin-resistant Bifidobacterium longum W11 in subjects with symptomatic uncomplicated diverticular disease treated with rifaximin.},
journal = {Minerva gastroenterologica e dietologica},
volume = {65},
number = {4},
pages = {259-264},
doi = {10.23736/S1121-421X.19.02622-9},
pmid = {31646852},
issn = {1827-1642},
mesh = {Aged ; Anti-Bacterial Agents/*pharmacology/*therapeutic use ; Bifidobacterium longum/*drug effects ; Combined Modality Therapy ; Diverticular Diseases/*therapy ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Probiotics/*therapeutic use ; Retrospective Studies ; Rifaximin/*pharmacology/*therapeutic use ; Treatment Outcome ; },
abstract = {BACKGROUND: In medical practice, the use of rifaximin and a probiotic is quite common in patients with a diagnosis of symptomatic uncomplicated diverticular disease (SUDD), with the latter being administered at the end of the rifaximin cycle. The opportunity of having a probiotic strain (Bifidobacterium longum W11) described as being resistant to rifaximin has prompted us to use it routinely in subjects with SUDD, administering it concomitantly with rifaximin.
METHODS: Retrospectively, we have analyzed whether our approach conferred a real clinical advantage to patients. The results seem to confirm the logic of our approach.
RESULTS: Patients treated with rifaximin concomitantly receiving strain W11 demonstrated better clinical outcomes than subjects treated with rifaximin followed by strain W11. Moreover, we have observed that the concomitant use of a rifaximin-resistant probiotic has improved the stool consistency of most patients. Finally, the adherence to the given therapy was very different, being very high in subjects undergoing concomitant use of the W11 strain and rifaximin, and being low in the other group. This is probably because of the different duration of therapy (7 days versus 14 days) and due to the fact that after 7 days of rifaximin treatment, patients felt better and decided not to proceed with the probiotic administration.
CONCLUSIONS: Despite the many biases that our retrospective analysis presents, we believe that a probiotic strain demonstrating a strong non-transferable resistance to a particular antibiotic should be used along with that specific antibiotic, at least in cases of SUDD diagnosis.},
}
@article {pmid31634580,
year = {2020},
author = {Peery, AF and Keku, TO and Galanko, JA and Sandler, RS},
title = {Sex and Race Disparities in Diverticulosis Prevalence.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {9},
pages = {1980-1986},
pmid = {31634580},
issn = {1542-7714},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; P30 ES010126/ES/NIEHS NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; *Colonoscopy ; *Diverticulum ; Ethnicity ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Risk Factors ; United States/epidemiology ; },
abstract = {BACKGROUND & AIMS: The prevalence of diverticulosis differs with demographic features of patients, but evidence is limited. Well-defined demographic studies are necessary to understand diverticulosis biology. We estimated the prevalence of diverticulosis among patients of different ages, sexes, and races and ethnicities and calculated odds ratios.
DESIGN: Using data from an endoscopic database, we identified 271,181 colonoscopy procedures performed from 2000 through 2012 at 107 sites in the United States. Our analysis included individuals 40 years and older who underwent colonoscopy examination for average-risk screening. The outcome was any reported diverticulosis on colonoscopy. Multivariate analyses were performed using logistic regression to estimate odds ratios (ORs) and 95% CI values, adjusting for confounding variables.
RESULTS: The prevalence of diverticulosis increased with age in men and women of all races and ethnicities. Women 40-49 years old had significantly lower odds of any diverticulosis (OR, 0.71; 95% CI, 0.63-0.80) compared with men 40-49 years old, after adjustment. The strength of this association decreased with age. Compared with non-Hispanic white individuals, non-Hispanic black individuals (OR, 0.80; 95% CI, 0.77-0.83) and Asian/Pacific Islanders (OR, 0.38; 95% CI, 0.35-0.41) had lower odds of any diverticulosis. However, non-Hispanic black individuals (OR, 1.53, 95% CI, 1.44-1.62) had increased odds of any proximal diverticulosis, whereas Asian/Pacific Islanders (OR, 3.12; 95% CI, 2.67-3.66) had increased odds of only proximal diverticulosis.
CONCLUSIONS: In an analysis of data from 271,181 colonoscopy procedures, diverticulosis was less prevalent in women compared with men in the same age groups, indicating that sex hormones might affect pathogenesis. Differences in the odds of diverticulosis by race and ethnicity indicate a genetic contribution to risk.},
}
@article {pmid31620490,
year = {2019},
author = {Chan, AP and Mulatinho, M and Iskander, P and Lee, H and Martinez-Agosto, JA and Yeh, J},
title = {Maternal Uniparental Disomy 14 (UPD14) Identified by Clinical Exome Sequencing in an Adolescent with Diverticulosis.},
journal = {ACG case reports journal},
volume = {6},
number = {3},
pages = {1-3},
pmid = {31620490},
issn = {2326-3253},
abstract = {Pediatric diverticular disease is extremely rare, with most cases associated with connective tissue disorders. We report an adolescent boy with syndromic features who presented with acute complicated sigmoid diverticulitis. Clinical exome sequencing analysis detected a 6.5-Mb region of homozygosity on chromosome 14, consistent with partial maternal uniparental disomy. Analysis of this region did not identify rare homozygous variants but included several imprinted genes that were candidates for the observed phenotypes. The pediatric clinical presentation of diverticulosis in this patient has not been previously described in maternal uniparental disomy of chromosome 14 and adds to the phenotypic spectrum of the syndrome.},
}
@article {pmid31604485,
year = {2020},
author = {Sapci, I and Hameed, I and Ceylan, A and Oktem, A and Rencuzogullari, A and Hull, TL and Liska, D and Delaney, CP and Gorgun, E},
title = {Predictors of ileus following colorectal resections.},
journal = {American journal of surgery},
volume = {219},
number = {3},
pages = {527-529},
doi = {10.1016/j.amjsurg.2019.10.002},
pmid = {31604485},
issn = {1879-1883},
mesh = {Age Factors ; Colonic Diseases/*surgery ; Female ; Humans ; Ileus/*etiology ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/*etiology ; Rectal Diseases/*surgery ; Risk Factors ; Sex Factors ; },
abstract = {BACKGROUND: Ileus following colorectal surgery is a significant burden for healthcare and can be challenging to manage. This study aims to evaluate risk factors for postoperative ileus in patients undergoing colorectal surgery.
METHODS: Patients who underwent colorectal resections for any diagnosis were identified from our institutional database between 2009 and 2014. Patient demographics, pre-operative comorbidities, and operation-related variables were compared in patients with and without ileus within 30 days after surgery.
RESULTS: A total of 5369 patients were identified with a mean age of 53 years. 892 patients (16.6%) developed postoperative ileus. Males were twice as likely (p < 0.001) and patients with anastomosis were 1.4 times more likely to develop ileus compared to those without (p < 0.001). Laparoscopic surgery and younger age were associated with lower ileus risk. Patients with colorectal cancer, Crohn's disease, and ulcerative colitis diagnoses were all more likely to develop postoperative ileus compared to patients with diverticular disease.
CONCLUSIONS: Evaluation of factors such as male gender, older age, anastomosis formation, diagnosis of cancer and inflammatory bowel disease, can help facilitate earlier diagnosis of postoperative ileus and may require consideration of prophylactic therapy.},
}
@article {pmid31559365,
year = {2019},
author = {Tomizawa, K and Toda, S and Tate, T and Hanaoka, Y and Moriyama, J and Matoba, S and Kuroyanagi, H},
title = {Laparoscopic surgery for colovesical fistula associated with sigmoid colon diverticulitis: a review of 39 cases.},
journal = {Journal of the anus, rectum and colon},
volume = {3},
number = {1},
pages = {36-42},
pmid = {31559365},
issn = {2432-3853},
abstract = {OBJECTIVES: Colonic diverticular disease is widespread in Western countries and its associated with aging. In Japan, diverticulitis and colovesical fistula are also occurring more frequently. Colonic resection for diverticula-related fistulas is frequently technically demanding because of associated acute or chronic inflammation. We evaluated the safety and efficacy of a standardized laparoscopic procedure.
METHODS: Data from 39 consecutive patients who had undergone laparoscopic surgery for colovesical fistula between October 2006 and August 2017 were retrospectively reviewed.
RESULTS: The patients' median age was 60 years and comprised 35 men and four women. Sigmoidectomy was performed in 33 patients, Hartmann's procedure in four, and anterior resection in two. The median operative time was 203 minutes and estimated blood loss 15 mL. There were no intraoperative complications or conversion to open surgery. No patients required bladder repair; three had minor postoperative complications, and none had recurrent diverticulitis or fistula at a mean follow-up of 5.1 years.
CONCLUSIONS: The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.},
}
@article {pmid31523330,
year = {2019},
author = {Kamal, MU and Baiomi, A and Balar, B},
title = {Acute Diverticulitis: A Rare Cause of Abdominal Pain.},
journal = {Gastroenterology research},
volume = {12},
number = {4},
pages = {203-207},
pmid = {31523330},
issn = {1918-2805},
abstract = {There is an increasing incidence of diverticulosis and diverticulitis in the younger populations; and its occurrence in very young individual is concerning. Here we report a rare and interesting case of a 20-year-old man who presented with 3-day history of epigastric abdominal pain associated with diarrhea and nausea. His abdominal examination revealed mild tenderness in the right lower abdominal quadrant. Computed tomography (CT) scan of abdomen with intravenous contrast revealed scattered diverticula throughout the colon with focal thickening, pericolonic infiltrative changes suggestive of acute diverticulitis in the distal ascending colon. He was treated with intravenous hydration and antibiotics and discharged when his clinical status improved. He underwent colonoscopy 1 month later which showed pan diverticulosis. This case illustrates the importance of considering acute diverticulitis in the differential diagnosis of right lower quadrant pain when evaluating a young patient.},
}
@article {pmid31517330,
year = {2019},
author = {Ticinesi, A and Nouvenne, A and Corrente, V and Tana, C and Di Mario, F and Meschi, T},
title = {Diverticular Disease: a Gut Microbiota Perspective.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {3},
pages = {327-337},
doi = {10.15403/jgld-277},
pmid = {31517330},
issn = {1842-1121},
mesh = {Animals ; Bacteria/genetics/*growth & development ; Diverticulitis/epidemiology/*microbiology/therapy ; Diverticulum/epidemiology/*microbiology/therapy ; Dysbiosis ; Feces/microbiology ; *Gastrointestinal Microbiome ; Host-Pathogen Interactions ; Humans ; Intestinal Mucosa/*microbiology ; Risk Factors ; },
abstract = {Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal and extraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation. However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorly investigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associated microbiota composition and functionality across different stages of diverticular disease. We also explore the influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possible relevance of these associations for the pathogenesis of diverticula. We overview the current treatments of diverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty and the need for future studies. Although no conclusive remarks on the relationship between microbiota and diverticular disease can be made, preliminary data suggest that abdominal symptoms are associated with reduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, and overgrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the early stages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiome in the pathogenesis of diverticular disease and its progression towards more severe forms.},
}
@article {pmid31492987,
year = {2019},
author = {Sohn, M and Agha, A and Roussos, D and Bloss, F and Hochrein, A and Gundling, F and Iesalnieks, I},
title = {Disease phenotype rather than treatment strategy impacts the long-term quality of life in patients with diverticular disease.},
journal = {International journal of colorectal disease},
volume = {34},
number = {10},
pages = {1749-1756},
pmid = {31492987},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticular Diseases/complications/*pathology/*therapy ; Female ; Hospitalization ; Humans ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Phenotype ; Propensity Score ; *Quality of Life ; Surveys and Questionnaires ; Time Factors ; },
abstract = {PURPOSE: To identify the impact of the severity of diverticular disease on long-term quality of life.
METHODS: Consecutive patients, hospitalized between October 2009 and November 2015 due to uncomplicated (UD) and complicated diverticulitis (CD) of the left colon, were analyzed. Patients undergoing emergent surgery for perforated disease were excluded. Primary endpoint was health-related quality of life (HrQol), measured by the Short Form 36 questionnaire (SF-36). Physical (PCS) and mental (MCS) compository scores were calculated from SF-36 subscales. To overcome bias, one-to-one propensity score matching and multivariable logistic regression analysis were performed.
RESULTS: Two hundred eighty of the overall 392 patients (Male 138, Female 142; mean age 60.5 years, range 27-91) answered the SF-36 questionnaire. The median follow-up period was 37.8 months (range 15-85). After propensity score matching, each group consisted of 51 patients. Results of the SF-36 questionnaires showed a statistically significant difference, favoring patients with CD in 5 of 8 domains. Also, PCS (56.3 vs. 52.9, p = 0.13) and MCS (53.3 vs. 46.7, p = 0.005) were higher in patients treated for CD. By a multivariate analysis, complicated disease was independently associated with a better scoring on 6 out of 8 SF-36 subscales and on MCS. Treatment strategy (surgery or conservative) did not have any impact on SF-36 subscales, MCS, or PCS on multivariate analysis.
CONCLUSION: In contrast to complicated disease, the uncomplicated diverticular disease is associated with an impaired long-term quality of life especially in domains composing mental health scores independently of chosen treatment strategy.
STUDY REGISTRATION: The study is registered with the Research Registry at June 19, 2019. Research registry UIN: researchregistry4959 .},
}
@article {pmid31481638,
year = {2019},
author = {Banasiewicz, T and Paszkowski, J and Borejsza-Wysocki, M and Bobkiewicz, A and Pietrzak, A and Szczepkowski, M and Francuzik, W},
title = {Efficacy of combined prophylactic therapy (rifaximine alpha + prebiotic arabinogalactan with lactofferin) on GUT function in patients with diagnosed symptomatic uncomplicated diverticular disease.},
journal = {Polski przeglad chirurgiczny},
volume = {91},
number = {4},
pages = {1-8},
doi = {10.5604/01.3001.0013.4115},
pmid = {31481638},
issn = {2299-2847},
mesh = {Abdominal Pain/*drug therapy/etiology ; Adult ; Child ; Combined Modality Therapy ; *Dietary Supplements ; Diverticular Diseases/*drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome ; Humans ; Intestine, Small/metabolism ; Male ; Middle Aged ; Mucoproteins/*therapeutic use ; Plant Proteins/therapeutic use ; Rifaximin/*therapeutic use ; },
abstract = {.},
}
@article {pmid31474787,
year = {2019},
author = {Mari, A and Baker, FA and Mahamid, M and Yacoob, A and Sbeit, W and Khoury, T},
title = {Clinical utility of fecal calprotectin: potential applications beyond inflammatory bowel disease for the primary care physician.},
journal = {Annals of gastroenterology},
volume = {32},
number = {5},
pages = {425-430},
pmid = {31474787},
issn = {1108-7471},
abstract = {Fecal calprotectin (FC) is an inflammatory marker released mainly from gastrointestinal granulocytes measured in stool samples. FC is noninvasive, economical, simple, and acceptable for patients. Levels of FC have proven reliable for intestinal inflammation, with good clinical sensitivity, and are useful in screening and monitoring inflammatory bowel disease (IBD), as well as in the differential diagnosis between IBD and irritable bowel syndrome (IBS). Given its advantages, FC represents an attractive biomarker that could be utilized in various gastrointestinal (GI) diseases apart from IBD, and is currently being studied extensively by many research groups with significant amounts of data emerging. In this current review we aim to provide an outline of the utility of FC in distinguishing between IBS and IBD, as well as an up-to-date summary of the available clinical experience concerning FC in various common conditions of the GI tract commonly encountered by gastroenterology practitioners, such as IBS, microscopic colitis, acute gastroenteritis, Clostridium difficile infection, colorectal cancer, diverticular disease, coeliac disease, and other GI conditions.},
}
@article {pmid31439460,
year = {2020},
author = {La Torre, M and Mingoli, A and Brachini, G and Lanciotti, S and Casciani, E and Speranza, A and Mastroiacovo, I and Frezza, B and Cirillo, B and Costa, G and Sapienza, P},
title = {Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis.},
journal = {Asian journal of surgery},
volume = {43},
number = {3},
pages = {476-481},
doi = {10.1016/j.asjsur.2019.07.016},
pmid = {31439460},
issn = {0219-3108},
mesh = {Acute Disease ; Aged ; Digestive System Surgical Procedures ; Diverticulitis, Colonic/classification/*diagnostic imaging/*pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; *Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND/OBJECTIVE: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD).
METHODS: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes.
RESULTS: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI = 0.850-0.960) for observers A and B, while the concordance between radiological and surgical findings was weak (kappa values = 0.213 and 0,248, respectively and 95% CI = 0.106 to 0.319 and 95% CI = 0.142 to 0.355, respectively). When overall morbidity, mortality and the need of a terminal colostomy were considered as main endpoints no concordance was observed between surgical and radiological findings and the CDD (P=NS).
CONCLUSIONS: The need for a more accurate classification of ACD, able to better stage this emergency, and to provide surgeons with reliable information for the best treatment is advocated.},
}
@article {pmid31433257,
year = {2019},
author = {Beltzer, C and Knoerzer, L and Bachmann, R and Axt, S and Dippel, H and Schmidt, R},
title = {Robotic Versus Laparoscopic Sigmoid Resection for Diverticular Disease: A Single-Center Experience of 106 Cases.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {11},
pages = {1451-1455},
doi = {10.1089/lap.2019.0451},
pmid = {31433257},
issn = {1557-9034},
mesh = {Aged ; Anastomotic Leak/etiology ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/surgery ; Conversion to Open Surgery ; Diverticulitis, Colonic/*surgery ; Enterostomy ; Female ; Humans ; Ileus/etiology ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; Operative Time ; Pain, Postoperative/drug therapy/etiology ; Reoperation ; Retrospective Studies ; *Robotic Surgical Procedures/adverse effects ; },
abstract = {Background: Laparoscopic sigmoid resection is the surgical standard for the treatment of diverticulitis. Robotic sigmoid resection with the da Vinci Xi® platform may offer advantages over the laparoscopic approach. Materials and Methods: One hundred and six patients with uncomplicated, complicated, or recurrent diverticular disease underwent robotic (n = 60) or laparoscopic (n = 46) sigmoid resection at our institution between 2013 and 2018. Patient demographics and characteristics, perioperative measures, and complications were retrospectively analyzed. Results: There were no statistically significant differences between the robotic and laparoscopic group with regard to operative time (130 versus 118 minutes; P = .23), anastomotic leakage (6.7% versus 6.5%; P = 1.0), need for stoma (6.7% versus 4.3%; P = 1.0), conversion rate (1.7% versus 0%; P = .36), reoperation (8.3% versus 15.2%; P = .27), overall complications according to the Clavien-Dindo classification (30.0% versus 30.4%; P = .8), mortality (1.7% versus 0%; P = 1.0), and need for intravenous analgesics (3.0 versus 2.1 days; P = .21). The duration of postoperative ileus was significantly shorter in the robotic group (2.2 versus 2.8 days; P = .01). Conclusion: Robotic sigmoid resection for uncomplicated, complicated, or recurrent diverticular disease is a safe and feasible procedure. However, robotic sigmoid resection for diverticulitis is not associated with relevant clinical benefits for patients compared to laparoscopic resection except for a slightly shorter duration of postoperative ileus.},
}
@article {pmid31411846,
year = {2019},
author = {Williamson, B},
title = {Lower Gastrointestinal Conditions: Diverticular Disease.},
journal = {FP essentials},
volume = {483},
number = {},
pages = {25-29},
pmid = {31411846},
issn = {2159-3000},
mesh = {Anti-Bacterial Agents ; Colonoscopy ; *Colorectal Neoplasms ; *Diverticulitis ; Humans ; Prevalence ; },
abstract = {Diverticular disease is a spectrum of conditions related to diverticulosis and includes symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, diverticular bleeding, and diverticulitis. The spectrum of pathology contributes significantly to gastrointestinal comorbidities and increases in prevalence with age. Diverticulosis is associated with low dietary fiber intake, obesity, an inactive lifestyle, and family history. Patients with diverticulitis typically present with left lower quadrant pain and an elevated white blood cell count or C-reactive protein level. The diagnosis is made by clinical examination with or without imaging. Management of diverticulitis includes intravenous fluids and antibiotics, although recent studies have shown that the latter may be avoided in select patients with uncomplicated diverticulitis. The need for hospitalization is determined by patient presentation and complications identified on imaging. Surgery is indicated in patients with frank perforation, unsuccessful conservative management of an abscess, or lack of improvement with conservative therapy. Elective interval colectomy should be considered on an individual basis. Colonoscopy should be performed 4 to 8 weeks after resolution of diverticulitis to exclude colorectal cancer. For secondary prevention, a high-fiber diet and vigorous physical activity are recommended.},
}
@article {pmid31411366,
year = {2019},
author = {De Simone, V and van Baarle, L and Matteoli, G},
title = {Neurite outgrowth in symptomatic uncomplicated diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {31},
number = {9},
pages = {e13680},
doi = {10.1111/nmo.13680},
pmid = {31411366},
issn = {1365-2982},
mesh = {Diverticular Diseases/*diagnosis/metabolism/*physiopathology ; Humans ; Neuronal Outgrowth/*physiology ; Neuropeptides/metabolism ; },
abstract = {Diverticulosis is the presence of small, bulging pouches in the lining of the intestinal colonic mucosal and submucosal layers. This condition is usually asymptomatic. The few patients (25%) that do develop abdominal symptoms are diagnosed with symptomatic uncomplicated diverticular disease (SUDD). Up to now it is not clear which pathophysiological events trigger the transition from asymptomatic diverticulosis to SUDD. However, data from Barbaro and colleagues published in the current issue of Neurogastroenterology and Motility showed extensive axonal sprouting and increased macrophage infiltration in SUDD compared to asymptomatic diverticulosis patients. Thereby they provide more evidence suggesting that enteric neuro-plasticity, whether or not affected by infiltrating macrophages, may underlie the development of symptoms in diverticulosis.},
}
@article {pmid33028724,
year = {2019},
author = {Khuat, D and Julkowska, A and Chamarczuk, F and Flont, A and Horbacka, K},
title = {Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation - case report.},
journal = {Polski przeglad chirurgiczny},
volume = {92},
number = {5},
pages = {1-5},
doi = {10.5604/01.3001.0013.3425},
pmid = {33028724},
issn = {2299-2847},
mesh = {Abdominal Pain/etiology ; Aged ; Chest Pain/*etiology ; Colonoscopy/*adverse effects ; Female ; Humans ; Intestinal Perforation/*complications/surgery ; Mediastinal Emphysema/*etiology/*surgery ; Pneumothorax/etiology ; Treatment Outcome ; },
abstract = {INTRODUCTION: Chest pain is one of the most common symptoms with which patients report to the doctor. The reason for this is the fear of the sick, who often equate this symptom with dangerous diseases such as heart attack. The primary source of pain does not always have to be located within the chest. Colon perforation is a rare but possible complication of colonoscopy, which may result in free gas entering the mediastinum which is accompanied by chest pain.
CASE REPORT: We present the case of a 78-year-old woman who reported to the hospital emergency department with chest pain, shortness of breath and abdominal pain. On the basis of imaging examinations, perforation of sigmoid affected by diverticulosis, complicated by pneumomediastinum and retroperitoneal emphysema, was suspected. The aforementioned ailments were caused by iatrogenic perforation of the sigmoid during diagnostic colonoscopy performed on an outpatient basis a few hours before reporting to the hospital. The patient was urgently qualified for laparotomy. Intraoperatively, perforation was confirmed at the rectosigmoid junction, which was the cause of retroperitoneal and pneumomediastinum with rightsided emphysema of the lateral neck region. No fluid or intestinal contents were found in the abdomen. The sigmoid colon and upper rectum were resected via double-stapled anastomosis performed between the descending colon and rectum. The patient was discharged home in good condition on the 7th postoperative day.
CONCLUSIONS: Colonoscopy is a diagnostic and therapeutic procedure that is considered relatively safe, but also carries complications such as bleeding or perforation of the large intestine. Diverticular disease is a common condition which most often affects the sigmoid colon. In areas of the weakest resistance, diverticulum formation occurs as a result of increased intra-abdominal pressure, which is an additional risk factor for perforation during colonoscopy. It is important to remember the possible different clinical presentation of gastrointestinal perforation, which may also manifest as chest pain. With early detection and surgical treatment, life-threatening complications associated with the development of pneumothorax can be avoided.},
}
@article {pmid31396759,
year = {2019},
author = {Broad, JB and Wu, Z and Xie, S and Bissett, IP and Connolly, MJ},
title = {Diverticular disease epidemiology: acute hospitalisations are growing fastest in young men.},
journal = {Techniques in coloproctology},
volume = {23},
number = {8},
pages = {713-721},
pmid = {31396759},
issn = {1128-045X},
support = {3709593//Faculty of Medical and Health Sciences, University of Auckland/ ; },
mesh = {Acute Disease/epidemiology ; Adult ; *Age Factors ; Aged ; Aged, 80 and over ; Diverticular Diseases/*epidemiology ; Diverticulitis/*epidemiology ; Female ; Hospitalization/*trends ; Humans ; Incidence ; Male ; Middle Aged ; New Zealand/epidemiology ; Prevalence ; *Sex Factors ; },
abstract = {BACKGROUND: Older age has long been linked to risk of diverticulitis, but the epidemiology is seldom described for a national population. The aim of this study was to investigate age- and gender differences in incidence, temporal trends, lifetime risk and prevalence related to acute diverticulitis hospitalisations in New Zealand.
METHODS: Records of all hospitalisations with diverticulitis the primary diagnosis were obtained from the Ministry of Health for the period 2000-2015. The first acute diverticulitis admission recorded for an individual was taken as an incident event; all others were classified as recurrent. Trends in age- and sex-specific and age-standardised incidence rates are described, and lifetime risk and prevalence estimated.
RESULTS: Over the 16 years from 2000 to 2015, 37,234 acute hospitalisations for diverticulitis were recorded in 28,329 people aged 30 + years (median = 66 years). Rates of incident hospitalisations rose with age, from 5/10,000 person-years at age 50-54 years to 19/10,000py by age 80-84 years. Rates for women were lower than men before age 55 years, but higher thereafter. Age-standardised rates rose 0.2/10,000py annually, but approximately doubled among men aged < 50 years. Lifetime risk was estimated at over 5%, with the prevalence pool rising to over 1.5% of the population aged 30+ in 2030.
CONCLUSIONS: Rapid increases in diverticulitis admissions among young men since 2000 correspond with increases reported elsewhere but remain unexplained; notably young women follow similar trends 5-10 years later. Increasing incidence, combined with population ageing, adds urgency to explain diverticular formation, to understand factors that trigger or provoke their inflammation/infection, and to clarify treatment and (self-)management pathways.},
}
@article {pmid31378319,
year = {2019},
author = {Raña-Garibay, R and Salgado-Nesme, N and Carmona-Sánchez, R and Remes-Troche, JM and Aguilera-Carrera, J and Alonso-Sánchez, L and Arnaud-Carreño, C and Charúa-Guindic, L and Coss-Adame, E and de la Torre-Bravo, A and Espinosa-Medina, D and Esquivel-Ayanegui, F and Jacobo-Karam, JS and Roesch-Dietlen, F and López-Colombo, A and Muñoz-Torres, JI and Noble-Lugo, A and Rojas-Mendoza, F and Suazo-Barahona, J and Stoopen-Rometti, M and Torres-Flores, E and Vallejo-Soto, M and Vergara-Fernández, O},
title = {Erratum to: The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon".},
journal = {Revista de gastroenterologia de Mexico (English)},
volume = {84},
number = {3},
pages = {423-424},
doi = {10.1016/j.rgmx.2019.07.001},
pmid = {31378319},
issn = {2255-534X},
}
@article {pmid31375994,
year = {2020},
author = {Bianchini, M and Palmeri, M and Stefanini, G and Furbetta, N and Di Franco, G},
title = {The role of robotic-assisted surgery for the treatment of diverticular disease.},
journal = {Journal of robotic surgery},
volume = {14},
number = {1},
pages = {239-240},
pmid = {31375994},
issn = {1863-2491},
mesh = {Colectomy ; *Diverticular Diseases ; *Diverticulitis ; Humans ; *Laparoscopy ; Postoperative Complications ; Propensity Score ; *Robotic Surgical Procedures ; },
}
@article {pmid31373562,
year = {2019},
author = {Cwaliński, J and Hermann, J and Banasiewicz, T and Paszlowski, J},
title = {Atypical and Life-threatening Crohn's Disease Following Colectomy: A Case Report.},
journal = {Wound management & prevention},
volume = {65},
number = {7},
pages = {36-40},
pmid = {31373562},
issn = {2640-5245},
mesh = {Colectomy/*adverse effects/methods ; Crohn Disease/*complications ; Female ; Humans ; Intestinal Fistula/etiology/physiopathology ; Middle Aged ; Surgical Wound Infection/etiology/physiopathology ; },
abstract = {Although Crohn's Disease (CD) usually occurs between the second and third decade of life, it also may develop in older adults. Treating elderly patients may be challenging due to other comorbidities, including diverticular disease or intestinal ischemia.
PURPOSE: The purpose of this case study was to describe successful treatment of atypical and life-threatening CD due to enterocutaneous fistulas with short-bowel syndrome and multiorgan failure after partial colectomy.
CASE REPORT: After an urgent colectomy for an inflammatory colon tumor, a 64-year-old woman with a history of CD and multiple comorbidities developed acute small bowel ischemia. Following an extended bowel resection, she developed a severe surgical site infection, entero- and gastrocutaneous fistulas, multiorgan failure, and short bowel syndrome. Her care included intensive medical and nutritional treatment as well as negative pressure wound therapy (NPWT) using continuous negative pressure of -80 mm Hg. She not only survived, but she also achieved complete wound closure and restoration of digestive tract continuity and metabolic control. She was discharged with a central venous catheter on total parenteral nutrition.
CONCLUSION: In this case study, a good outcome was observed using intensive medical treatment, nutritional therapy, and conservative surgical treatment that included NPWT for a patient with CD and major comorbidities who developed postoperative complications.},
}
@article {pmid31359166,
year = {2019},
author = {Pulzato, I and Boero, E and Shaipi, E and Cardinale, L},
title = {"Sigmoid diverticulitis mimicking cholecystitis" a clinical challenge.},
journal = {The ultrasound journal},
volume = {11},
number = {1},
pages = {14},
pmid = {31359166},
issn = {2524-8987},
abstract = {Diverticular disease is a common disorder and its incidence increases with ageing. Pathophysiology is multifactorial. Lifestyle, including smoking, alcohol intake, decreased dietary fibres and lack of physical activity, plays a predominant role. Genetics seems also to contribute specifically for right-sided diverticular disease (RSD). The majority of the patients with diverticular disease are asymptomatic. Diverticulitis is the inflammation of the diverticula usually presenting with abdominal pain associated to nausea, vomiting, rectal bleeding, diarrhoea and fever. When the inflammation process affects the diverticula in the ascending colon, the condition represents a clinical challenge as it can be easily misdiagnosed with other acute abdominal emergencies. We reported a case of a 70-year-old female who presented to our Emergency Department (ED) with right upper quadrant pain and an initial clinical suspicion of cholecystitis. Ultrasound (US) and Computed Tomography (CT) demonstrated an anatomical variation of the sigmoid colon diverticulitis. This clinical report demonstrates that ultrasound plays a relevant part as first-step approach to the acute abdominal conditions and its accuracy increases together with other diagnostic tools such as Computer Tomography.},
}
@article {pmid31351939,
year = {2020},
author = {Camilleri, M and Sandler, RS and Peery, AF},
title = {Etiopathogenetic Mechanisms in Diverticular Disease of the Colon.},
journal = {Cellular and molecular gastroenterology and hepatology},
volume = {9},
number = {1},
pages = {15-32},
pmid = {31351939},
issn = {2352-345X},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK115950/DK/NIDDK NIH HHS/United States ; },
mesh = {Colon/physiopathology ; Diverticulitis, Colonic/epidemiology/*genetics/physiopathology ; *Genetic Predisposition to Disease ; Genome-Wide Association Study ; Humans ; Molecular Epidemiology ; Polymorphism, Single Nucleotide ; },
abstract = {This article reviews epidemiological evidence of heritability and putative mechanisms in diverticular disease, with greatest attention to 3 recent studies of genetic associations with diverticular disease based on genome-wide or whole-genome sequencing studies in large patient cohorts. We provide an analysis of the biological plausibility of the significant associations with gene variants reported and highlight the relevance of ANO1, CPI-17 (aka PPP1R14A), COLQ6, COL6A1, CALCB or CALCA, COL6A1, ARHGAP15, and S100A10 to colonic neuromuscular function and tissue properties that may result in altered compliance and predispose to the development of diverticular disease. Such studies also identify candidate genes for future studies.},
}
@article {pmid31346801,
year = {2019},
author = {Rezapour, M and Stollman, N},
title = {Diverticular Disease in the Elderly.},
journal = {Current gastroenterology reports},
volume = {21},
number = {9},
pages = {46},
pmid = {31346801},
issn = {1534-312X},
mesh = {*Diverticular Diseases/diagnosis/etiology/therapy ; Humans ; },
abstract = {PURPOSE OF REVIEW: While few diseases are limited solely to the elderly, diverticular disease is clearly more prevalent with increasing age and therefore the aim of this review is to focus on the clinical implications of diverticular disease in the elderly.
RECENT FINDINGS: Diverticulitis in the elderly is best managed with an individualized treatment approach including considerations for selective antibiotic usage even in uncomplicated disease. Furthermore, due to the increased prevalence of ischemic colitis in the elderly and the similarities in presentation with diverticular hemorrhage, there needs to be a high index of suspicion and appropriate evaluation for ischemic colitis in patients with hematochezia, particularly if they have abdominal pain. The elderly are a vulnerable population where the index of suspicion for complications of diverticular disease should be high.},
}
@article {pmid31346485,
year = {2019},
author = {Zeidan, Z and Lwin, Z and Iswariah, H and Manawwar, S and Karunairajah, A and Chandrasegaram, MD},
title = {Unusual Presentation of a Sigmoid Mass with Chicken Bone Impaction in the Setting of Metastatic Lung Cancer.},
journal = {Case reports in surgery},
volume = {2019},
number = {},
pages = {1016534},
pmid = {31346485},
issn = {2090-6900},
abstract = {Background: Ingestion of foreign bodies can cause various gastrointestinal tract complications including abscess formation, bowel obstruction, fistulae, haemorrhage, and perforation. While these foreign body-related complications can occur in normal bowel, diseased bowel from inflammation, strictures, or malignancy can cause diagnostic difficulties. Endoscopy is useful in visualising the bowel from within, providing views of the mucosa and malignancies arising from here, but its ability in diagnosing extramural malignancies arising beyond or external to the mucosa of the bowel as in the case of metastatic extramural disease can be limited.
Case Summary: We present the case of a 60-year-old female with an impacted chicken bone in the sigmoid colon with formation of a sigmoid mass, on a background of metastatic lung cancer. On initial diagnosis of her lung cancer, there was mild Positron Emission Tomography (PET) avidity in the sigmoid colon which had been evaluated earlier in the year with a colonoscopy with findings of diverticular disease. Subsequent computed tomography (CT) scans demonstrated thickening of the sigmoid colon with a structure consistent with a foreign body distal to this colonic thickening. A repeat PET scan revealed an intensely fluorodeoxyglucose (FDG) avid mass in the sigmoid colon which was thought to be inflammatory. She was admitted for a flexible sigmoidoscopy and removal of the foreign body which was an impacted chicken bone. She had a fall and suffered a fractured hip. During her admission for her hip fracture, she had an exacerbation of her abdominal pain. She developed a large bowel obstruction, requiring laparotomy and Hartmann's procedure to resect the sigmoid mass. Histopathology confirmed metastatic lung cancer to the sigmoid colon.
Conclusion: This unusual presentation highlights the challenges of diagnosing ingested foreign bodies in patients with metastatic disease.},
}
@article {pmid31318769,
year = {2019},
author = {DeLeon, MF and Sapci, I and Akeel, NY and Holubar, SD and Stocchi, L and Hull, TL},
title = {Diverticular Colovaginal Fistulas: What Factors Contribute to Successful Surgical Management?.},
journal = {Diseases of the colon and rectum},
volume = {62},
number = {9},
pages = {1079-1084},
doi = {10.1097/DCR.0000000000001445},
pmid = {31318769},
issn = {1530-0358},
mesh = {Aged ; Colonoscopy/*methods ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/*complications/diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/diagnosis/etiology/*surgery ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Vaginal Fistula/diagnosis/etiology/*surgery ; },
abstract = {BACKGROUND: Diverticular disease is the leading cause of colovaginal fistulas. Surgery is challenging given the inflammatory process that makes dissection difficult. To date, studies are small and include fistula secondary to multiple etiologies.
OBJECTIVE: The objectives of this study were to examine surgical outcomes of diverticular colovaginal fistulas and to identify variables associated with successful closure.
DESIGN: This was a retrospective study of a prospectively maintained clinical database.
SETTINGS: The study was conducted at a single tertiary referral center.
PATIENTS: Women with diverticular colovaginal fistulas, who underwent surgical repair with intent to close the fistula, were included.
INTERVENTIONS: Repair of colovaginal fistula through minimally invasive or open techniques was involved.
MAIN OUTCOME MEASURES: Successful closure of fistula, defined as resolution of symptoms and no stoma, was measured.
RESULTS: Fifty-two patients underwent surgical treatment of diverticular colovaginal fistula, 23 (44%) of whom underwent a minimally invasive approach (conversion rate of 22%). Ostomy construction and omental pedicle flaps were used in 28 (54%) and 38 patients (73%). Surgery was successful in 47 patients (90%). Accounting for secondary operations, ultimate success and failure rates were 49 (94.0%) and 3 (5.7%). There was no difference in postoperative morbidity between the 2 groups (5 patients with Clavien-Dindo III/IV complications in the success group versus 2 patients in the failure group; 10.6% vs 40.0%; p = 0.44). Failure to achieve fistula closure was not associated with perioperative variables, age, BMI, diabetes mellitus, ASA grade, steroid use, previous abdominal surgery or hysterectomy, use of omentoplasty, or ostomy. Patients who failed were more likely to be smokers (60.0% vs 12.8%; p = 0.03).
LIMITATIONS: Limitations include the retrospective design and lack of power.
CONCLUSIONS: Surgery is effective in achieving successful closure of diverticular colovaginal fistula. Smokers should be encouraged to stop before embarking on an elective repair. Although the use of fecal diversion and omental pedicle flaps did not correlate with success, they should be used when clinically appropriate. See Video Abstract at http://links.lww.com/DCR/A983. FÍSTULAS COLOVAGINALES DIVERTICULARES ¿QUÉ FACTORES CONTRIBUYEN AL ÉXITO DEL TRATAMIENTO QUIRÚRGICO?: La enfermedad diverticular es la causa principal de fístulas colovaginales. La cirugía es un reto dado el proceso inflamatorio que dificulta la disección. Hasta la fecha, los estudios son pequeños e incluyen fístulas secundarias a múltiples etiologías.
OBJETIVO: 1) Examinar los resultados quirúrgicos de las fístulas colovaginales diverticulares; 2) Identificar variables asociadas a un cierre exitoso. DISEÑO:: Estudio retrospectivo de una base de datos clínicos prospectivamente mantenida. CONFIGURACIÓN:: Centro de referencia superior.
PACIENTES: Mujeres con fístulas colovaginales diverticulares, que se sometieron a una reparación quirúrgica con la intención de cerrar la fístula.
INTERVENCIONES: Reparación de la fístula colovaginal mediante técnicas mínimamente invasivas o abiertas.
Cierre exitoso de la fístula definida como resolución de los síntomas y sin estoma.
RESULTADOS: Cincuenta y dos pacientes se sometieron a tratamiento quirúrgico de la fístula colovaginal diverticular, 23 (44%) de los cuales se sometieron a un acceso mínimamente invasivo (tasa de conversión del 22%). La construcción de la ostomía y los pedículos omentales se utilizaron en 28 (54%) y 38 pacientes (73%), respectivamente. La cirugía fue exitosa en 47 pacientes (90%). Tomando en cuenta las operaciones secundarias, las tasas finales de éxito y fracaso fueron 49 (94.0%) y 3 (5.7%). No hubo diferencias en la morbilidad postoperatoria entre los dos grupos (5 pacientes con complicaciones de Clavien-Dindo III / IV en el grupo de éxito versus a 2 pacientes en el grupo de fracaso, 10.6% versus a 40.0%; p = 0.44). El fracaso para lograr el cierre de la fístula no se asoció con variables perioperatorios, edad, IMC, diabetes, grado ASA, uso de esteroides, cirugía abdominal previa o histerectomía, uso de omentoplastia u ostomía. Los pacientes que fracasaron eran más propensos a ser fumadores (60.0% versus a 12.8%; p = 0.03).
LIMITACIONES: Las limitaciones incluyen el diseño retrospectivo y la falta de poder.
CONCLUSIONES: La cirugía es efectiva para lograr el cierre exitoso de la fístula colovaginal diverticular. Se debe aconsejar a los fumadores a parar de fumar antes de embarcarse en una reparación electiva. Mientras el uso de desviación fecal y pedículos omentales no se correlacionó con el éxito, deberían utilizarse cuando sea clínicamente apropiado. Consulte el Video del Resumen en http://links.lww.com/DCR/A983.},
}
@article {pmid31316786,
year = {2019},
author = {Cremon, C and Carabotti, M and Cuomo, R and Pace, F and Andreozzi, P and Barbaro, MR and Annibale, B and Barbara, G},
title = {Italian nationwide survey of pharmacologic treatments in diverticular disease: Results from the REMAD registry.},
journal = {United European gastroenterology journal},
volume = {7},
number = {6},
pages = {815-824},
pmid = {31316786},
issn = {2050-6406},
mesh = {Aged ; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use ; Diverticular Diseases/diagnosis/*drug therapy/*epidemiology ; Female ; Health Care Surveys ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Registries ; Risk Factors ; Treatment Outcome ; },
abstract = {Background: Although diverticular disease is a common condition, its effective treatment is challenging in clinical practice.
Objective: The objective of this article is to assess pharmacological management in different clinical settings of diverticular disease and factors associated with treatment using the Italian registry Registro Malattia Diverticolare (REMAD).
Methods: At study enrolment, patients were categorised into subgroups: diverticulosis, symptomatic uncomplicated diverticular disease and previous diverticulitis. We registered demographic, clinical and lifestyle factors, quality of life and the use of treatments for diverticular disease in the last year. Logistic regression analysis assessed the association between clinical factors and treatment consumption.
Results: A total of 500 of the 1206 individuals included had had at least one treatment for diverticular disease in the last year: 23.6% (166/702) of patients with diverticulosis, 55.9% (165/295) of patients with symptomatic diverticular disease, and 80.9% (169/209) of patients with previous diverticulitis (p < 0.001). In multivariate analysis, the following factors were significantly associated with treatment use: female gender, family history of colonic diverticula, organic digestive comorbidity and impaired physical quality of life components.
Conclusion: Individuals with diverticular disease take medications based on the different clinical settings of disease. We identified different features associated with treatment use in the distinct clinical entities of diverticular disease.ClinicalTrial.gov Identifier: NCT03325829.},
}
@article {pmid31314796,
year = {2019},
author = {Broad, JB and Wu, Z and Ng, J and Arroll, B and Connolly, MJ and Jaung, R and Oliver, F and Bissett, IP},
title = {Diverticular disease management in primary care: How do estimates from community-dispensed antibiotics inform provision of care?.},
journal = {PloS one},
volume = {14},
number = {7},
pages = {e0219818},
pmid = {31314796},
issn = {1932-6203},
mesh = {Anti-Bacterial Agents/therapeutic use ; Disease Management ; Diverticular Diseases/diagnosis/*epidemiology/etiology/therapy ; Female ; Humans ; Male ; New Zealand/epidemiology ; Population Surveillance ; *Primary Health Care ; },
abstract = {BACKGROUND: The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed.
AIM: To estimate how often DDI is managed in primary care, using antibiotics dispensing data.
DESIGN AND SETTING: Hospitalisation records of New Zealand residents aged 30+ years during 2007-2016 were individually linked to databases of community-dispensed oral antibiotics.
METHOD: Patients with an index hospital admission 2007-2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007-2016 for these people with ten individually-matched non-DDI residents, taking the case's index date. Multivariable negative binomial models were used to estimate rates of antibiotic use.
RESULTS: From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation.
CONCLUSION: DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.},
}
@article {pmid31297777,
year = {2019},
author = {Destek, S and Gül, VO},
title = {Effectiveness of conservative approach in right colon diverticulitis.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {25},
number = {4},
pages = {396-402},
doi = {10.14744/tjtes.2019.47382},
pmid = {31297777},
issn = {1306-696X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Cecum/surgery ; Colectomy ; *Conservative Treatment ; Diverticulitis, Colonic/classification/diagnostic imaging/surgery/*therapy ; Drainage ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND: Approximately 10%-25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis.
METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated.
RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment.
CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.},
}
@article {pmid31292420,
year = {2019},
author = {Bonavina, L and Arini, A and Ficano, L and Iannuzziello, D and Pasquale, L and Aragona, SE and Ciprandi, G and On Digestive Disorders, ISG},
title = {Abincol® (Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, Lactobacillus delbrueckii LDD01), an oral nutraceutical, pragmatic use in patients with chronic intestinal disorders.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {90},
number = {7-S},
pages = {8-12},
pmid = {31292420},
issn = {2531-6745},
mesh = {Administration, Oral ; Chronic Disease ; Dietary Supplements ; Diverticular Diseases/*therapy ; Female ; Humans ; Inflammatory Bowel Diseases/*therapy ; Irritable Bowel Syndrome/*therapy ; *Lactobacillus ; *Lactobacillus delbrueckii ; *Lactobacillus plantarum ; Male ; Middle Aged ; Probiotics/*therapeutic use ; Self Report ; },
abstract = {Chronic intestinal disorders (CID), including inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease, irritable bowel syndrome (IBS), and diverticular disease (DD), are diseases that relapse episodes. There is evidence that patients with CID have intestinal dysbiosis, so probiotics may counterbalance the impaired microbiota. Therefore, the current survey evaluated the efficacy and safety of Abincol®, an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 millions of living cells), and Lactobacillus delbrueckii LDD01 (200 millions of living cells), in 3,460 outpatients (1,660 males and 1,800 females, mean age 55 years) with chronic intestinal disorders. Patients took 1 stick/daily for 8 weeks. Abincol® significantly diminished the presence and the severity of intestinal symptoms and improved stool form. In conclusion, the current survey suggests that Abincol® may be considered an effective and safe therapeutic option in the management of patients with chronic intestinal disorders.},
}
@article {pmid31286905,
year = {2019},
author = {Dziki, Ł and Włodarczyk, M and Sobolewska-Włodarczyk, A and Mik, M and Trzciński, R and Hill, AG and Dziki, A},
title = {Is suturing of the bladder defect in benign Enterovesical fistula necessary?.},
journal = {BMC surgery},
volume = {19},
number = {1},
pages = {85},
pmid = {31286905},
issn = {1471-2482},
mesh = {Adult ; Aged ; Female ; Humans ; Intestinal Fistula/*etiology ; Male ; Middle Aged ; Retrospective Studies ; Suture Techniques ; Urinary Bladder/*surgery ; Urinary Bladder Fistula/etiology/*surgery ; },
abstract = {BACKGROUND: Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. The aim of the study was to analyze whether closure of the defect in the bladder wall during surgery is always necessary.
METHODS: Fifty-nine patients with benign EVF undergoing surgical treatment were enrolled. A one-stage surgical procedure was performed in all patients. After the separation of the diseased bowel segment, methylene blue was introduced. Through a catheter into the bladder. Only patients with urinary bladder leakage were sutured.
RESULTS: The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 53% of cases. Two-thirds of patients had diverticular disease as the underlying pathology. There was no relationship between suturing of the bladder and perioperative complications. Recurrent EVF was observed in one patient with bladder suturing and in two patients without suture.
CONCLUSIONS: These findings suggest that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. This study is limited by its retrospective design and small numbers and a randomized controlled trial is recommended to answer this question definitively.},
}
@article {pmid31279270,
year = {2019},
author = {Ogilvie, JW and Saunders, RN and Parker, J and Luchtefeld, MA},
title = {Sigmoidectomy for Diverticulitis-A Propensity-Matched Comparison of Minimally Invasive Approaches.},
journal = {The Journal of surgical research},
volume = {243},
number = {},
pages = {434-439},
doi = {10.1016/j.jss.2019.06.018},
pmid = {31279270},
issn = {1095-8673},
mesh = {Aged ; Colectomy/methods/*statistics & numerical data ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*statistics & numerical data ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures/*statistics & numerical data ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication.
METHODS: We identified all elective cases of laparoscopic- and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges.
RESULTS: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P = 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P = 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P = 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P = 0.62 and 3.8 versus 3.3, P = 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P = 0.70). In the robotic arm operating room charges were slightly more ($2835 ± $394 versus $2196 ± $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001).
CONCLUSIONS: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic- and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use.},
}
@article {pmid31266529,
year = {2019},
author = {Pedrazzani, C and Park, SY and Scotton, G and Park, JS and Kim, HJ and Polati, E and Guglielmi, A and Choi, GS},
title = {Analgesic efficacy of preemptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: study protocol for a randomized, multicenter, single-blind, noninferiority trial.},
journal = {Trials},
volume = {20},
number = {1},
pages = {391},
pmid = {31266529},
issn = {1745-6215},
mesh = {Abdominal Muscles/*innervation ; Adult ; Aged ; Anesthetics, Local/*administration & dosage/adverse effects ; Colectomy/adverse effects/*methods ; Colorectal Neoplasms/*surgery ; Diverticular Diseases/*surgery ; Equivalence Trials as Topic ; Female ; Humans ; Italy ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; Multicenter Studies as Topic ; Nerve Block/adverse effects/*methods ; Pain Measurement ; Pain, Postoperative/diagnosis/etiology/*prevention & control ; Republic of Korea ; Ropivacaine/*administration & dosage/adverse effects ; Single-Blind Method ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Transversus abdominis plane (TAP) block and wound infiltration (WI) are common locoregional anesthesia techniques for pain management in patients undergoing colorectal laparoscopic surgery. Comparative data between these two practices are conflicting, and a clear benefit of TAP block over WI is still debated. The main purpose of this study is to determine the efficacy in pain control of WI compared with WI plus laparoscopic TAP block (L-TAP) in cases of laparoscopic colorectal resection. Secondary aims are to evaluate other short-term results directly related to pain management: the need for rescue analgesic drugs, the incidence of postoperative nausea and vomiting, the resumption of gut functions, and the length of hospital stay.
METHODS/DESIGN: This is a prospective, randomized, controlled, two-arm, multicenter, single-blind study evaluating the efficacy of postoperative analgesic management of WI versus WI plus L-TAP in the context of laparoscopic colorectal surgery. Randomization is at the patient level, and participants are randomized 1:1 to receive either WI alone or WI plus L-TAP. Those eligible for inclusion were patients undergoing laparoscopic resection for colorectal tumor or diverticular disease at the Division of General and Hepatobiliary Surgery, Verona University, Verona, Italy, and at the Colorectal Cancer Center, Kyungpook National University, Daegu, Korea. Fifty-four patients are needed in each group to evidence a difference greater than 1 of 10 according to the numeric rating scale for pain assessment to establish that this difference would matter in practice.
DISCUSSION: The demonstration of a noninferiority of WI compared with WI plus L-TAP block would call into question TAP block usefulness in the setting of laparoscopic colorectal surgery.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT03376048 . Prospectively registered on 15 December 2017.},
}
@article {pmid31250368,
year = {2020},
author = {McKenna, NP and Bews, KA and Cima, RR and Crowson, CS and Habermann, EB},
title = {Development of a Risk Score to Predict Anastomotic Leak After Left-Sided Colectomy: Which Patients Warrant Diversion?.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {1},
pages = {132-143},
pmid = {31250368},
issn = {1873-4626},
support = {KL2 TR002379/TR/NCATS NIH HHS/United States ; UL1 TR002377/TR/NCATS NIH HHS/United States ; UL1 TR002319/TR/NCATS NIH HHS/United States ; },
mesh = {Aged ; Anastomotic Leak/*diagnosis/epidemiology/etiology ; Colectomy/*adverse effects/methods/statistics & numerical data ; Colonic Diseases/*surgery ; Elective Surgical Procedures/adverse effects/statistics & numerical data ; Enterostomy ; Female ; *Health Status Indicators ; Humans ; Male ; Middle Aged ; Prognosis ; Quality Improvement/statistics & numerical data ; Risk Assessment/*methods/statistics & numerical data ; Risk Factors ; },
abstract = {BACKGROUND: Anastomotic leak is a feared complication after left-sided colectomy, but its risk can potentially be reduced with the use of a diverting ostomy. However, an ostomy has its own associated negative sequelae; therefore, it is critical to appropriately identify patients to divert. This is difficult in practice since many risk factors for anastomotic leak exist and outside factors bias this decision. We aimed to develop and validate a risk score to predict an individual's risk of anastomotic leak and aid in the decision.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted PUF was queried from 2012 to 2016 for patients undergoing elective left-sided resection for malignancy, benign neoplasm, or diverticular disease. Multivariable logistic regression identified predictors of anastomotic leak in non-diverted patients, and a risk score was developed and validated.
RESULTS: 38,475 patients underwent resection with an overall anastomotic leak rate of 3%. Independent risk factors for anastomotic leak included younger age, male sex, tobacco use, and omission of combined bowel preparation. A risk score incorporating independent predictors demonstrated excellent calibration. There was strong visual correspondence between predicted and observed anastomotic leak rates. 3960 patients underwent resection with diversion, yet over half of these patients had a predicted leak rate of less than 4%.
CONCLUSION: A novel risk score can be used to stratify patients according to anastomotic leak risk after elective left-sided resection. Intraoperative calculation of scores for patients can help guide surgical decision-making in both diverting the highest risk patients and avoiding diversion in low-risk patients.},
}
@article {pmid31236301,
year = {2019},
author = {Riccardi, M and Deters, K and Jabbar, F},
title = {Sigmoid Diverticulitis and Perforation Secondary to Biliary Stent Migration.},
journal = {Case reports in surgery},
volume = {2019},
number = {},
pages = {2549170},
pmid = {31236301},
issn = {2090-6900},
abstract = {Introduction: Biliary stent migration occurs in 5-10% of patients. Generally, this is a benign process and stents pass or are retrieved endoscopically. In rare instances, intestinal perforation has occurred.
Presentation of Case: A 79-year-old female presented with a one-day history of abdominal pain. She had undergone an ERCP four weeks previously for primary choledocholithiasis during which time a sphincterotomy and sphincteroplasty were performed, and stents were placed in the common bile duct. CT scan of the abdomen and pelvis demonstrated a biliary stent that had migrated into the sigmoid colon, appearing to perforate the colon with free air throughout the abdomen. Patient was taken for diagnostic laparoscopy and noted to have biliary stent perforating the sigmoid colon. Procedure was converted to open, and Hartmann's procedure was performed with end colostomy.
Conclusion: Generally, biliary stent migration is a benign process, but in rare instances, intestinal perforation has occurred. Sites of perforation include the duodenum, distal small bowel, and colon. Perforation is more common with an additional pathology present such as hernias or diverticular disease. Migration and perforation also appear more common with straight biliary stents. In patients with known diverticular disease and straight biliary stents, considerations should be made for early stent removal.},
}
@article {pmid31221028,
year = {2019},
author = {Brillantino, A and Andreano, M and Lanza, M and D'Ambrosio, V and Fusco, F and Antropoli, M and Lucia, A and Zito, ES and Forner, A and Ambrosino, F and Monte, G and Cricrì, AM and Robustelli, U and De Masi, A and Calce, R and Ciardiello, G and Renzi, A and Castriconi, M},
title = {Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease.},
journal = {Surgical innovation},
volume = {26},
number = {6},
pages = {656-661},
doi = {10.1177/1553350619857561},
pmid = {31221028},
issn = {1553-3514},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Digestive System Surgical Procedures/adverse effects/methods/statistics & numerical data ; Diverticulitis/*surgery ; Female ; Humans ; Intestinal Perforation/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; *Negative-Pressure Wound Therapy/adverse effects/methods/statistics & numerical data ; Peritonitis/*surgery ; Postoperative Complications ; },
abstract = {Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients' conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann's procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann's procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.},
}
@article {pmid31211706,
year = {2019},
author = {Tursi, A},
title = {Endoscopic Diagnosis of Diverticulosis and Diagnosis of Symptomatic Uncomplicated Diverticular Disease of the Colon: If You Properly Classify, You Properly Make the Diagnosis.},
journal = {The American journal of gastroenterology},
volume = {114},
number = {8},
pages = {1349-1350},
doi = {10.14309/ajg.0000000000000293},
pmid = {31211706},
issn = {1572-0241},
mesh = {Colon ; Colonoscopy ; *Diverticular Diseases ; *Diverticulum ; Humans ; Inflammation ; },
}
@article {pmid31209604,
year = {2020},
author = {Dreifuss, NH and Schlottmann, F and Piatti, JM and Bun, ME and Rotholtz, NA},
title = {Safety and feasibility of laparoscopic sigmoid resection without diversion in perforated diverticulitis.},
journal = {Surgical endoscopy},
volume = {34},
number = {3},
pages = {1336-1342},
pmid = {31209604},
issn = {1432-2218},
mesh = {*Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis/*surgery ; Feasibility Studies ; Humans ; Intestinal Perforation/*surgery ; *Laparoscopy ; Length of Stay/statistics & numerical data ; Postoperative Complications/epidemiology ; Retrospective Studies ; },
abstract = {BACKGROUND: Laparoscopic primary anastomosis (PA) without diversion for diverticulitis has historically been confined to the elective setting. Hartmann's procedure is associated with high morbidity rates that might be reduced with less invasive and one-step approaches. The aim of this study was to analyze the results of laparoscopic PA without diversion in Hinchey III perforated diverticulitis.
METHODS: We performed a retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic sigmoidectomy for diverticular disease during the period 2000-2018. The sample was divided in two groups: elective laparoscopic sigmoid resection for recurrent diverticulitis (G1) and emergent laparoscopic sigmoidectomy for Hinchey III diverticulitis (G2). Demographics, operative variables, and postoperative outcomes were compared between groups.
RESULTS: A total of 415 patients underwent laparoscopic sigmoid resection for diverticular disease. PA without diversion was performed in 351 patients; 278 (79.2%) belonged to G1 (recurrent diverticulitis) and 73 (20.8%) to G2 (perforated diverticulitis). Median age, gender, and BMI score were similar in both groups. Patients with ASA III score were more frequent in G2 (p: 0.02). Conversion rate (G1: 4% vs. G2: 18%, p < 0.001), operative time (G1: 157 min vs. G2: 183 min, p < 0.001), and median length of hospital stay (G1: 3 days vs. G2: 5 days, p < 0.001) were significantly higher in G2. Overall postoperative morbidity (G1: 22.3% vs. G2: 28.7%, p = 0.27) and anastomotic leak rate (G1: 5.7% vs. G2: 5.4%, p = 0.92) were similar between groups. There was no mortality in G1 and one patient (1.3%) died in G2 (p = 0.21).
CONCLUSION: Laparoscopic sigmoid resection without diversion is feasible and safe in patients with perforated diverticulitis. In centers with vast experience in laparoscopic colorectal surgery, patients undergoing this procedure have similar morbidity and mortality to those undergoing elective sigmoidectomy.},
}
@article {pmid31204408,
year = {2019},
author = {Tursi, A},
title = {Current and Evolving Concepts on the Pathogenesis of Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {},
pages = {225-235},
doi = {10.15403/jgld-184},
pmid = {31204408},
issn = {1842-1121},
mesh = {Colon/microbiology/physiopathology ; Diverticular Diseases/*etiology/genetics/immunology/physiopathology ; Enteric Nervous System/physiopathology ; Gastrointestinal Microbiome ; Gastrointestinal Motility/physiology ; Genetic Predisposition to Disease ; Humans ; Risk Factors ; },
abstract = {BACKGROUND AND AIMS: Diverticulosis of the colon is the most common anatomic alteration of the human colon, and it is characterized by the out-pouching of the colonic mucosa and submucosa through the muscular layer. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, and inflammation of diverticula may lead to acute diverticulitis. In the past few years, several studies have investigated the factors predisposing or triggering diverticular disease (DD) occurrence. Moreover, new physiopathological knowledge has been acquired. The aim of this study was to review current knowledge regarding the pathogenesis of DD.
METHODS: A search of PubMed and EMBASE database was performed to identify articles relevant to the pathogenesis of DD.
RESULTS: Several papers have shown that genetic predisposition, environmental factors, and colonic dysmotility are implicated in the pathogenesis of DD. More recent studies have associated specific host immune responses, gut microbiota imbalance and therefore low-grade inflammation as contributors to symptom occurrence in DD and diverticulitis.
CONCLUSIONS: Current and evolving evidence highlighted the role of genetic susceptibility, environment, colonic motility, visceral sensitivity, immune response, and microbiota in the pathogenesis of this disease. Further studies are required to identify potential targets for medical or surgical decision-making.},
}
@article {pmid31188087,
year = {2021},
author = {Liekens, E and Mutijima Nzaramba, E and Geurde, B and Seydel, B and Jourdan, JL},
title = {Giant colonic diverticulum: case report of a rare surgical condition.},
journal = {Acta chirurgica Belgica},
volume = {121},
number = {1},
pages = {42-45},
doi = {10.1080/00015458.2019.1631627},
pmid = {31188087},
issn = {0001-5458},
mesh = {Aged ; Colectomy ; Colon ; Colon, Sigmoid/surgery ; *Diverticulum, Colon/diagnosis/surgery ; Female ; Humans ; Radiography, Abdominal ; },
abstract = {INTRODUCTION: Diverticular disease is a common disorder of the colon with an extremely rare presentation: giant colonic diverticulum (GCD). GCD is defined as a diverticulum measuring 4 cm or larger and affects the sigmoid colon in 90% of the cases.
PATIENTS: We report on a case of a 74-year-old woman with a GCD.
METHODS: We present a case report of a 74-year-old woman with a GCD. A brief review of the literature concerning clinical presentation, diagnosis, differential diagnosis, pathogenesis, histological classification and treatment of GCD will be discussed.
RESULTS: Our patient was treated according to the available information in the literature. The outcome was uneventful.
CONCLUSIONS: GCD is a rare presentation of diverticular disease. Because of the risk of serious complications, a correct diagnosis and treatment is essential. The investigations of choice include a plain abdominal X-ray and an abdominal CT scan. Surgical treatment is the treatment of choice with preferably a colectomy with en-bloc resection of the diverticulum.},
}
@article {pmid31187871,
year = {2020},
author = {Alaburda, P and Lukosiene, JI and Pauza, AG and Rysevaite-Kyguoliene, K and Kupcinskas, J and Saladzinskas, Z and Tamelis, A and Pauziene, N},
title = {Ultrastructural changes of the human enteric nervous system and interstitial cells of Cajal in diverticular disease.},
journal = {Histology and histopathology},
volume = {35},
number = {2},
pages = {147-157},
pmid = {31187871},
issn = {1699-5848},
support = {SEN-06/2015/PRM15/135//The Research Council of Lithuania/ ; },
mesh = {Adult ; Aged ; Diverticular Diseases/*pathology ; Enteric Nervous System/*pathology/*ultrastructure ; Female ; Humans ; Interstitial Cells of Cajal/*pathology/*ultrastructure ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; },
abstract = {BACKGROUND: In spite of numerous advances in understanding diverticular disease, its pathogenesis remains one of the main problems to be solved. We aimed to investigate the ultrastructural changes of the enteric nervous system in unaffected individuals, in asymptomatic patients with diverticulosis and in patients with diverticular disease.
METHODS: Transmission electron microscopy was used to analyse samples of the myenteric, outer submucosal and inner submucosal plexuses from patients without diverticula (n=9), asymptomatic patients with diverticulosis (n=7) and in patients with complicated diverticular disease (n=9). We described the structure of ganglia, interstitial cells of Cajal and enteric nerves, as well as their relationship with each other. The distribution and size of nerve processes were analysed quantitatively.
RESULTS: In complicated diverticular disease, neurons exhibited larger lipofuscin-like inclusions, their membranous organelles had larger cisterns and the nucleus showed deeper indentations. Nerve remodeling occurred in every plexus, characterised by an increased percentage of swollen and fine neurites. Interstitial cells of Cajal had looser contacts with the surrounding cells and showed cytoplasmic depletion and proliferation of the rough endoplasmic reticulum. In asymptomatic patients with diverticulosis, alterations of enteric nerves and ICC were less pronounced.
CONCLUSIONS: In conclusion, the present findings suggest that most ultrastructural changes of the enteric nervous system occur in complicated diverticular disease. The changes are compatible with damage to the enteric nervous system and reactive remodeling of enteric ganglia, nerves and interstitial cells of Cajal. Disrupted architecture of enteric plexuses might explain clinical and pathophysiological changes associated with diverticular disease.},
}
@article {pmid31175421,
year = {2019},
author = {Croghan, SM and Zaborowski, A and Mohan, HM and Mulvin, D and McGuire, BB and Murphy, M and Galvin, DJ and Lennon, G and Quinlan, D and Winter, DC},
title = {The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections.},
journal = {International journal of colorectal disease},
volume = {34},
number = {7},
pages = {1161-1178},
pmid = {31175421},
issn = {1432-1262},
mesh = {Aged ; Catheterization ; Colorectal Neoplasms/economics/*surgery ; Costs and Cost Analysis ; Female ; Humans ; Male ; Middle Aged ; *Stents/economics ; Time Factors ; Treatment Outcome ; Ureter/injuries/*surgery ; },
abstract = {PURPOSE: 'Prophylactic' ureteric stents potentially reduce rates, and facilitate intraoperative recognition, of iatrogenic ureteric injury (IUI) during colorectal resections. A lack of consensus surrounds the risk-benefit equation of this practice, and we aimed to assess the evidence base.
METHODS: A systematic review was performed according to PRISMA guidelines. MEDLINE, Scopus, EMBASE and Cochrane databases were searched using terms 'ureteric/ureteral/JJ/Double J stent' or 'ureteric/ureteral catheter' and 'colorectal/prophylactic/resection/diverticular disease/diverticulitis/iatrogenic injury'. Primary outcomes were rates of ureteric injuries and their intraoperative identification. Secondary outcomes included stent complication rates.
RESULTS: We identified 987 publications; 22 papers met the inclusion criteria. No randomised controlled trials were found. The total number of patients pooled for evaluation was 869,603 (102,370 with ureteric stents/catheters, 767,233 controls). The most frequent indications for prophylactic stents were diverticular disease (45.38%), neoplasia (33.45%) and inflammatory bowel disease (9.37%). Pooled results saw IUI in 1521/102,370 (1.49%) with, and in 1333/767,233 (0.17%) without, prophylactic ureteric stents. Intraoperative recognition of IUIs occurred in 10/16 injuries (62.5%) with prophylactic stents, versus 9/17 (52.94%) without stents (p = 0.579). The most serious complications of prophylactic stent use were ureteric injury (2/1716, 0.12%) and transient ureteric obstruction following stent removal (13/666, 1.95%).
CONCLUSIONS: Placement of prophylactic ureteric stents has a low complication rate. There is insufficient evidence to conclude that stents decrease ureteric injury or increase intraoperative detection of IUIs. Apparently higher rates of IUI in stented patients likely reflect use in higher risk resections. A prospective registry with harmonised data collection points and stratification of intraoperative risk is needed.},
}
@article {pmid31166613,
year = {2019},
author = {Lowes, H and Rowaiye, B and Carr, NJ and Shepherd, NA},
title = {Complicated appendiceal diverticulosis versus low-grade appendiceal mucinous neoplasms: a major diagnostic dilemma.},
journal = {Histopathology},
volume = {75},
number = {4},
pages = {478-485},
doi = {10.1111/his.13931},
pmid = {31166613},
issn = {1365-2559},
mesh = {Adenocarcinoma, Mucinous/*diagnosis/pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendiceal Neoplasms/*diagnosis/pathology ; Appendix/*pathology ; Case-Control Studies ; Diagnosis, Differential ; Diverticulum/*diagnosis/*pathology ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; },
abstract = {AIMS: To research and identify how often complicated diverticular disease of the appendix [appendiceal diverticular disease (ADD)] shows histological mimicry of low-grade appendiceal mucinous neoplasms (LAMNs) and to provide guidance on the useful histopathological features that allow the appropriate diagnosis to be made.
METHODS AND RESULTS: Seventy-four cases of complicated appendiceal diverticular disease were identified from two specialist centres. Of the second opinion/consultation cases, 71% of the ADD cases had been diagnosed by referring pathologists as LAMNs. Salient pathological features were identified and agreed upon to reach the applicable diagnosis. For a diagnosis of complicated diverticulosis, particularly when associated with mucus cysts, the following morphological features were regarded as important: relative retention of the normal mucosal architecture with lamina propria and a maintained crypt architecture, crypts arranged in regular array, epithelial hyperplasia and a lack of nuclear abnormalities extending the length of the crypts. In a formal case-control study undertaken on 30 cases with each diagnosis, ADD and LAMN, loss of lamina propria, a filiform architecture and hypermucinosis were significantly associated with low-grade appendiceal mucinous neoplasms. Mucosal neuromas were significantly associated with diverticular disease of the appendix.
CONCLUSIONS: To our knowledge, this study represents the largest series in the world literature and serves to highlight the important pathological features to distinguish complicated diverticular disease of the appendix from LAMNs, and emphasises the difficulties experienced by diagnostic pathologists in diagnosing complicated appendiceal diverticulosis. This is important, as LAMNs have a significant risk of transcoelomic spread, while complicated appendiceal diverticulosis has no such risk.},
}
@article {pmid31161448,
year = {2020},
author = {Darwich, I and Stephan, D and Klöckner-Lang, M and Scheidt, M and Friedberg, R and Willeke, F},
title = {A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: results and technical aspects.},
journal = {Journal of robotic surgery},
volume = {14},
number = {2},
pages = {297-304},
pmid = {31161448},
issn = {1863-2491},
mesh = {Aged ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/*surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Robotic Surgical Procedures/*methods ; Time Factors ; Treatment Outcome ; },
abstract = {Since the turn of the century, robotic-assisted colorectal surgery has been synonymous with the da Vinci® robotic surgical system. We report in this study our first results in robotic-assisted sigmoid resection for diverticular disease using the Senhance™ Surgical Robotic System, while introducing a standardized roadmap for engaging the robotic arms. 12 patients underwent a sigmoid resection using the Senhance™ Surgical Robotic System. All four arms of the robotic system were engaged during all procedures according to a previously devised roadmap. A 4-trocar technique was used in all patients. Perioperative data, including those regarding technical difficulties, were collected and analyzed. Two procedures were converted into standard laparoscopy. There were no conversions to open surgery. The mean age of the patients was 62.5 years (47-79). One third of the patients were males. The mean BMI was 27 kg/m2 (19-38). The mean operative time, the mean console time and the mean docking time were 219 min (204-305), 149 min (124-205) and 10 min (6-15), respectively. The mean length of stay was 9 days (6-15). There was one major complication (8.3%, Clavien-Dindo IIIb). There were no mortalities. No other complications were observed. No patients were readmitted after discharge. The Senhance™ Surgical Robotic System can be used safely in sigmoid resection for diverticular disease after adequate training and systematic planning of the different steps of the procedure. Further experience is needed to judge the benefit for patient and surgeon, as well as the cost and time effectiveness.},
}
@article {pmid31157135,
year = {2019},
author = {Eastment, JG and Butler, N and Slater, K},
title = {Diverticular Perforation Secondary to a Chicken Bone: Food for Thought.},
journal = {Cureus},
volume = {11},
number = {3},
pages = {e4273},
pmid = {31157135},
issn = {2168-8184},
abstract = {A 56-year-old man presented to the emergency department with a one-day history of lower abdominal pain and fever. Clinical examination revealed generalized peritonitis. A computed tomography (CT) scan identified a linear hyperdensity straddling the site of a perforated sigmoid diverticulum. The patient proceeded to emergency laparotomy, which confirmed feculent peritonitis secondary to chicken bone perforation through the sigmoid colon diverticulum. After removal of the bone, Hartmann's procedure was performed, and the patient subsequently made an excellent recovery.},
}
@article {pmid31123245,
year = {2019},
author = {Saliba, C and Rabah, H and Nicolas, G and Emmanuel, N and Sleiman, A and Hashem, M and Hussein, R and El Masri, A and Abboud, R and Fawaz, M and Haidar Ahmad, H},
title = {Recurrent Asymptomatic Sigmoid Diverticular Perforation in a Patient with Pemphigus Vulgaris on Immunosuppressive Therapy: A Case Report.},
journal = {The American journal of case reports},
volume = {20},
number = {},
pages = {735-738},
pmid = {31123245},
issn = {1941-5923},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Azathioprine/*therapeutic use ; Diverticulum, Colon/diagnosis/*etiology ; Humans ; Immunosuppressive Agents/*therapeutic use ; Intestinal Perforation/diagnosis/*etiology ; Male ; Middle Aged ; Pemphigus/complications/*drug therapy ; Recurrence ; Sigmoid Diseases/diagnosis/*etiology ; },
abstract = {BACKGROUND Perforation of the colon is associated with high mortality and requires early diagnosis. However, the diagnosis of perforation from atypical causes can be a diagnostic challenge. This report is of a rare case of recurrent sigmoid colonic perforation in a patient with diverticular disease who did not present with an acute abdomen but who had pemphigus vulgaris treated with immunosuppressive therapy. CASE REPORT A 57-year-old man with pemphigus vulgaris was treated with steroids, non-steroidal anti-inflammatory drugs (NSAIDS), and azathioprine. He had episodes of abdominal bloating but denied any other symptoms. He was diagnosed with spontaneous sigmoid diverticular perforation without presenting with an acute abdomen. CONCLUSIONS Diverticular perforation can be asymptomatic in patients on immunosuppressive therapy. Therefore, there should be a high index of suspicion for bowel perforation in patients with abdominal symptoms who are treated for skin diseases, such as pemphigus vulgaris, and are on steroids and other immunosuppressive treatments.},
}
@article {pmid31117071,
year = {2020},
author = {Mari, GM and Crippa, J and Borroni, G and Cocozza, E and Roscio, F and Scandroglio, I and Origi, M and Ferrari, G and Forgione, A and Riggio, V and Pugliese, R and Costanzi, ATM and Maggioni, D and , },
title = {Symptomatic Uncomplicated Diverticular Disease and Incidence of Unexpected Abscess during Sigmoidectomy: A Multicenter Prospective Observational Study.},
journal = {Digestive surgery},
volume = {37},
number = {3},
pages = {199-204},
doi = {10.1159/000500084},
pmid = {31117071},
issn = {1421-9883},
mesh = {Abdominal Abscess/diagnosis/*etiology/surgery/therapy ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Chronic Disease ; Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/classification/complications/diagnosis/*therapy ; Elective Surgical Procedures ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Symptom Assessment ; Young Adult ; },
abstract = {BACKGROUND: Symptomatic uncomplicated diverticular disease can affect patients' everyday routine. Considerable efforts have been made to identify clinical features that correlate to the severity of the disease. Unexpected intraoperative abscesses are reported in large retrospective series, showing how uncomplicated symptoms and presentations can underlie a complicated disease. The aim of this study was to investigate the incidence of pericolic or intramural abscess in patients undergoing elective sigmoidectomy for symptomatic uncomplicated diverticular disease and see if chronic symptoms correlate to the presence of an abscess.
METHODS: Between January 2016 and June 2018, we prospectively collected data of patients who were given indication to elective sigmoidectomy for symptomatic uncomplicated diverticular disease. Patients were divided into 3 groups: acute resolving, smoldering, and atypical according to a previously described classification of uncomplicated diverticular disease.
RESULTS: One hundred fifty-eight consecutive patients were enrolled in the study. The median age was 63 years (22- 88), and the mean body mass index was 26 (±7) kg/m2. There were 114 patients in the acute resolving group, 36 in the smoldering group, and 8 in the atypical group. An unexpected abscess was reported in 75 patients (47.5%) during surgery or pathological examination. The incidence of -abscess was greater for patient in the smoldering group (p = 0.0243).
CONCLUSION: Our series of patients affected by symptomatic uncomplicated diverticular disease showed an incidence of unexpected pericolic or intramural abscess of 47.5%. Patients affected by smoldering diverticular disease presented a greater abscess rate.},
}
@article {pmid31105031,
year = {2020},
author = {Aguado, A and García Del Álamo, M},
title = {[Gastrointestinal comorbidity and symptoms associated with depression in patients aged over 60 years].},
journal = {Semergen},
volume = {46},
number = {1},
pages = {27-32},
doi = {10.1016/j.semerg.2019.03.003},
pmid = {31105031},
issn = {1578-8865},
mesh = {Aged ; Aged, 80 and over ; Chronic Disease ; Cross-Sectional Studies ; Depression/*epidemiology ; Female ; Gastrointestinal Diseases/*epidemiology/physiopathology/psychology ; Humans ; Male ; Middle Aged ; Prevalence ; Primary Health Care ; },
abstract = {OBJECTIVE: A study was carried out on the prevalence of gastrointestinal diagnoses and symptoms associated with depression.
MATERIAL AND METHODS: A cross-sectional observational study was conducted in Primary Care in 2017. All patients aged 60 years or more with depression were included from the health care centre (N=2312), and were compared to the total patients that visited the centre from the same age group without depression (N=11049). The variables collected were age, gender and the codes for gastrointestinal symptoms and chronic conditions. These were obtained from the computerised medical files. The prevalence was calculated for both groups, and included the odds ratio (OR) and 95% confidence interval (CI).
RESULTS: More than one-third (38.0%) of patients with depression have chronic gastrointestinal diseases, 64.7% have gastrointestinal symptoms, and 74.7% have either of them. The conditions with strongest associations are: irritable bowel syndrome OR: 2.00 (95% CI: 1.51-2.64), congenital anomaly 1.83 (1.17-2.86), other peptic ulcers 1.75 (1.28-2.40), diverticular disease 1.73 (1.52-1.97), cholecystitis/cholelithiasis 1.59 (1.36-1.86), liver disease 1.55 (1.32-1.82), viral hepatitis 1.50 (1.12-2.02), and oesophageal diseases 1.45 (1.24-1.69). Symptoms with a statistically significant OR were: anorexia 2.81 (1.75-4.50), nausea/vomiting 2.19 (1.79-2.67), constipation 1.96 (1.77-2.18), flatulence 1.78 (1.48-2.14), dysphagia 1,72 (1.30-2.28), abdominal pain 1.69 (1.57-1.82), dyspepsia 1.56 (1.30-1.87), and heartburn 1.55 (1.26-1.92).
CONCLUSIONS: Gastrointestinal comorbidity is very common in patients over 60 years-old with depression. Three-quarters of the patients have chronic gastrointestinal diseases or symptoms. The conditions with strongest associations are irritable bowel syndrome, congenital anomalies, other peptic ulcers, and diverticular disease. The symptoms with strongest associations are anorexia, nausea/vomiting, constipation, flatulence, dysphagia, abdominal pain, dyspepsia, and heartburn.},
}
@article {pmid31094166,
year = {2019},
author = {Parfenov, AI and Krums, LM and Pavlov, MV},
title = {Small intestinal diverticula.},
journal = {Terapevticheskii arkhiv},
volume = {91},
number = {2},
pages = {4-8},
doi = {10.26442/00403660.2019.02.000080},
pmid = {31094166},
issn = {0040-3660},
mesh = {*Diverticulitis ; *Diverticulum ; Gastrointestinal Hemorrhage ; Humans ; *Malabsorption Syndromes ; *Meckel Diverticulum ; },
abstract = {The prevalence of small intestinal diverticula (SID) in the population is 0.5-2.3%, and in most cases they are asymptomatic. In the presence of small intestinal bacterial overgrowth this results in chronic diarrhea and malabsorption. When it is complicated by diverticulitis it causes pain and other symptoms of inflammatory bowel disease. Inflammatory process progression may be accompanied by bleeding, invagination, intestinal obstruction, diverticulum abscess and perforation with peritonitis development. SID include separate nosological forms such as paraphateral diverticulum and Meckel's diverticulum. In diagnosis of SID ray and endoscopic methods are crucial. The basis of small intestine diverticular disease treatment is intestinal antiseptics, antibiotics as well as surgical intervention for severe complications. Two cases are discussed, the first one confirms a possibility of development of severe malabsorption syndrome with chronic diarrhea, and the second one is a complication in a form of severe diverticulitis, abscess with perforation and peritonitis.},
}
@article {pmid31091148,
year = {2019},
author = {Guo, X and Patel, B and Han, L and Al-Dulaimi, H and Van Alstine, WG and Noblet, JN and Chambers, S and Kassab, GS},
title = {Novel swine model of colonic diverticulosis.},
journal = {American journal of physiology. Gastrointestinal and liver physiology},
volume = {317},
number = {1},
pages = {G51-G56},
doi = {10.1152/ajpgi.00408.2018},
pmid = {31091148},
issn = {1522-1547},
mesh = {Animal Feed ; Animal Nutritional Physiological Phenomena ; Animals ; *Collagenases ; Colon/*pathology ; Dietary Fiber/*deficiency ; Disease Models, Animal ; Disease Progression ; Diverticulitis, Colonic/*etiology/pathology ; Female ; Sus scrofa ; Swine ; Time Factors ; },
abstract = {The pathophysiology of colonic diverticulosis has not been completely understood. The development of appropriate animal models is essential to study diverticular disease. To date, no large animal models are available for this disease condition. The objective of this study was to develop a swine model by damaging the colon wall, combined with or without a low-fiber diet to mimic the pathogenesis of diverticulosis. To create a weakness on the colon wall, collagenase was applied in vivo to degrade the collagen in the colon wall. Three groups of Yucatan minipigs were included. Group 1 (n = 12) underwent collagenase injection (CI) with a low-fiber diet for 6 mo, group 2 (n = 8) underwent CI alone with a standard swine diet for 6 mo, and group 3 (n = 12) received a low-fiber diet alone for 6 mo. We found that diverticulosis occurred in 91.7% (11 of 12) of pigs in the CI + diet group and 100% (8 of 8) in CI-alone group. Moreover, around 30-75% of colon CI spots for each pig developed diverticular lesions. Diet alone for 6 mo did not induce diverticulosis. The endoscopic and histological examinations revealed the formation of multiple wide-mouthed diverticular lesions along the descending colon. Our results provide convincing evidence of the high efficacy of the reduced colon wall strength caused by CI in the development of a swine model of diverticulosis. Low-fiber diet consumption for 6 mo had no influence on the generation time or incidence rate of diverticulosis. In this model, digestion of the collagen in the colonic wall is sufficient to cause diverticulosis. NEW & NOTEWORTHY Effective large animal models of diverticulosis are currently lacking for the study of diverticular disease. This study marks the first time that a swine model of diverticulosis was developed by damaging colon wall structure, combined with or without a low-fiber diet. We found that a defect of colon wall could result in colon diverticular lesions within 6 mo in swine. This animal model mimicking the pathological process of diverticulosis is of great clinical value.},
}
@article {pmid31081253,
year = {2020},
author = {Nur, T and Fagan, P and Nugent, T and Kodeda, K},
title = {Giant pneumosalpinx secondary to colonic diverticular disease.},
journal = {ANZ journal of surgery},
volume = {90},
number = {3},
pages = {E61-E62},
doi = {10.1111/ans.15246},
pmid = {31081253},
issn = {1445-2197},
mesh = {Diverticulum, Colon/*complications/*diagnostic imaging/surgery ; Fallopian Tube Diseases/*diagnostic imaging/*etiology/surgery ; Female ; Humans ; Middle Aged ; },
}
@article {pmid31077829,
year = {2020},
author = {Peery, AF and Keil, A and Jicha, K and Galanko, JA and Sandler, RS},
title = {Association of Obesity With Colonic Diverticulosis in Women.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {1},
pages = {107-114.e1},
pmid = {31077829},
issn = {1542-7714},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Anthropometry ; Body Mass Index ; Body Size ; Colonoscopy/methods ; Diverticulosis, Colonic/*diagnosis/etiology ; Female ; Humans ; Male ; Middle Aged ; Obesity/*complications/diagnosis ; Prospective Studies ; Risk Factors ; Sex Factors ; },
abstract = {BACKGROUND & AIMS: Obesity has been associated with an increased risk of colonic diverticulosis. Evidence for this association is limited. We assessed whether anthropometric measures of obesity were associated with colonic diverticulosis.
METHODS: We analyzed data from a prospective study of 623 patients undergoing screening colonoscopies from 2013 through 2015; colonoscopies included examinations for diverticulosis. Body measurements were made the day of the procedure. Multivariate analyses were performed using modified Poisson regression to estimate prevalence ratios (PRs) and 95% CIs while adjusting for confounding variables. All analyses were stratified by sex.
RESULTS: Among men, there was no association between any measure of obesity and diverticulosis. After adjustment, women with an obese body mass index (BMI ≥ 30) had an increased risk of any diverticulosis (PR, 1.48; 95% CI, 1.08-2.04) compared with women with a normal body mass index (BMI 18.5-24.9). The strength of this association was greater for more than 5 diverticula (PR, 2.05; 95% CI, 1.23-3.40). There was no significant association between measures of central obesity and diverticulosis in women. Stratified by sex, colonic diverticulosis was significantly less prevalent in women compared with men before the age of 51 years (29% vs 45%, P = .06). The prevalence of diverticulosis did not differ by sex in older age groups.
CONCLUSIONS: In an analysis of data from 623 patients undergoing screening colonoscopies, we found that obesity (BMI ≥30) significantly increased the risk of colonic diverticulosis in women but not men. Colonic diverticulosis was less prevalent in premenopausal-age women compared with similar-age men. These findings suggest that sex hormones may influence the development of diverticulosis.},
}
@article {pmid31067253,
year = {2019},
author = {Murray, KA and Hoad, CL and Garratt, J and Kaviani, M and Marciani, L and Smith, JK and Siegmund, B and Gowland, PA and Humes, DJ and Spiller, RC},
title = {A pilot study of visceral fat and its association with adipokines, stool calprotectin and symptoms in patients with diverticulosis.},
journal = {PloS one},
volume = {14},
number = {5},
pages = {e0216528},
pmid = {31067253},
issn = {1932-6203},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; BRU 2011-2022/DH_/Department of Health/United Kingdom ; },
mesh = {Adiponectin/*blood ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Body Mass Index ; Diverticulum/epidemiology/metabolism/*pathology ; Feces/*chemistry ; Female ; Humans ; Insulin Resistance ; Intra-Abdominal Fat/*physiopathology ; Leukocyte L1 Antigen Complex/*analysis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pilot Projects ; Young Adult ; },
abstract = {BACKGROUND: Complications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects.
OBJECTIVE: The study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from 2-echo magnetic resonance imaging (MRI) data; B) to use this to determine if visceral fat was associated with bowel symptoms and inflammatory markers in patients with symptomatic and asymptomatic diverticular disease.
DESIGN: An observational study measuring visceral fat using MRI together with serum adiponectin, leptin, stool calprotectin and patient-reported somatisation and bowel habit.
SETTING: Medical and imaging research centres of a university hospital.
PARTICIPANTS: MRI scans were performed on 55 patients after an overnight fast measuring abdominal subcutaneous and visceral adipose tissue volumes together with small bowel water content (SBWC). Blood and stool samples were collected and patients kept a 2 week stool diary and completed a somatisation questionnaire.
MAIN OUTCOME MEASURES: Difference in the volume of visceral fat between symptomatic and asymptomatic patients.
RESULTS: There were no significant differences in visceral (p = 0.98) or subcutaneous adipose (p = 0.60) tissue between symptomatic and asymptomatic patients. However measured fat volumes were associated with serum adipokines. Adiponectin showed an inverse correlation with visceral adipose tissue (VAT) (Spearman ρ = -0.5, p = 0.0003), which correlated negatively with SBWC (ρ = -0.3, p = 0.05). Leptin correlated positively with subcutaneous adipose tissue (ρ = 0.8, p < 0.0001). Overweight patients (BMI > 25 kgm-2) showed a moderate correlation between calprotectin and VAT (ρ = 0.3, p = 0.05). Somatization scores were significantly higher in symptomatic patients (p < 0.0003).
CONCLUSIONS: Increasing visceral fat is associated with lower serum adiponectin and increased faecal calprotectin suggesting a pro-inflammatory effect which may predispose to the development of complications of diverticulosis.},
}
@article {pmid31063252,
year = {2019},
author = {Balla, A and Sosa, V and Licardie, E and Alarcón, I and Morales-Conde, S},
title = {Laparoscopic left hemicolectomy with indocyanine green fluorescence angiography for diverticular disease in a patient with intestinal malrotation - a video vignette.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {8},
pages = {978-979},
doi = {10.1111/codi.14670},
pmid = {31063252},
issn = {1463-1318},
mesh = {Colectomy/*methods ; Coloring Agents ; Digestive System Abnormalities/*complications ; Diverticular Diseases/etiology/*surgery ; Female ; Fluorescein Angiography/*methods ; Humans ; Indocyanine Green ; Intestinal Volvulus/*complications ; Laparoscopy/*methods ; Middle Aged ; },
}
@article {pmid31062152,
year = {2020},
author = {Bastawrous, AL and Landmann, RG and Liu, Y and Liu, E and Cleary, RK},
title = {Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease.},
journal = {Surgical endoscopy},
volume = {34},
number = {2},
pages = {598-609},
pmid = {31062152},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Aged ; Colon, Sigmoid/surgery ; Conversion to Open Surgery/*methods ; Diverticular Diseases/*surgery ; Elective Surgical Procedures/*methods ; Female ; Humans ; Incidence ; Laparoscopy/*methods ; Laparotomy/*methods ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Propensity Score ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/*methods ; United States/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Benefits of minimally invasive surgical approaches to diverticular disease are limited by conversion to open surgery. A comprehensive analysis that includes risk factors for conversion may improve patient outcomes.
METHODS: The US Premier Healthcare Database was used to identify patients undergoing primary elective sigmoidectomy for diverticular disease between 2013 and September 2015. Propensity-score matching was used to compare conversion rates for laparoscopic and robotic-assisted sigmoidectomy. Patient, clinical, hospital, and surgeon characteristics associated with conversion were analyzed using multivariable logistic regression, providing odds ratios for comparative risks. Clinical and economic impacts were assessed comparing surgical outcomes in minimally invasive converted, completed, and open cases.
RESULTS: The study population included 13,240 sigmoidectomy patients (8076 laparoscopic, 1301 robotic-assisted, 3863 open). Analysis of propensity-score-matched patients showed higher conversion rates in laparoscopic (13.6%) versus robotic-assisted (8.3%) surgeries (p < 0.001). Greater risk of conversion was associated with patients who were Black compared with Caucasian, were Medicaid-insured versus Commercially insured, had a Charlson Comorbidity Index ≥ 2 versus 0, were obese, had concomitant colon resection, had peritoneal abscess or fistula, or had lysis of adhesions. Significantly lower risk of conversion was associated with robotic-assisted sigmoidectomy (versus laparoscopic, OR 0.58), hand-assisted surgery, higher surgeon volume, and surgeons who were colorectal specialties. Converted cases had longer operating room time, length of stay, and more postoperative complications compared with minimally invasive completed and open cases. Readmission and blood transfusion rates were higher in converted compared with minimally invasive completed cases, and similar to open surgeries. Differences in inflation-adjusted total ($4971), direct ($2760), and overhead ($2212) costs were significantly higher for converted compared with minimally invasive completed cases.
CONCLUSIONS: Conversion from minimally invasive to open sigmoidectomy for diverticular disease results in additional morbidity and healthcare costs. Consideration of modifiable risk factors for conversion may attenuate adverse associated outcomes.},
}
@article {pmid31061646,
year = {2019},
author = {Plasencia, A and Bahna, H},
title = {Diverting Ostomy: For Whom, When, What, Where, and Why.},
journal = {Clinics in colon and rectal surgery},
volume = {32},
number = {3},
pages = {171-175},
pmid = {31061646},
issn = {1531-0043},
abstract = {Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.},
}
@article {pmid31060664,
year = {2019},
author = {Mari, G and Costanzi, A and Crippa, J and Berardi, V and Santurro, L and Gerosa, M and Maggioni, D},
title = {Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {114},
number = {2},
pages = {295-299},
doi = {10.21614/chirurgia.114.2.295},
pmid = {31060664},
issn = {1221-9118},
mesh = {Adenocarcinoma/surgery ; Aged ; Anastomosis, Surgical/*adverse effects ; Colonoscopy/*methods ; Diverticulum, Colon/surgery ; Endometriosis/surgery ; Epinephrine/administration & dosage ; Female ; Humans ; Laparoscopy ; Male ; Postoperative Hemorrhage/etiology/*therapy ; Proctectomy/*adverse effects/methods ; Rectal Diseases/*surgery ; Rectal Neoplasms/surgery ; Surgical Stapling/*adverse effects ; Therapeutic Irrigation ; Treatment Outcome ; Vasoconstrictor Agents/administration & dosage ; },
abstract = {Bleeding from the stapled line is a rare but potentially lethal complication that requires a proper and immediate management. Treatment for stapled anastomotic hemorrhage may be operative or conservative. We report three cases of anastomotic stapled line bleeding after colorectal surgery successfully treated endos-copically. Laparoscopic High Anterior Resection with a trans anal anastomosis according to Knight-Griffen with circular a stapler was performed for adenocarcinoma, rectal endometriosis and diverticular disease. All three patients had major rectal bleeding within 24 hours from surgery. 1 patients had endoscopy before the end of the surgical procedure. Endoscopic wash out with removal of the clots and infiltration of the bleeding sites along the stapled line with Adrenaline 1 : 10000 (2 ml) was performed achieving a good hemostasis. Early endoscopy is a safe and efficient treatment in colorectal anastomotic bleeding.},
}
@article {pmid31056430,
year = {2019},
author = {Scroggie, DL},
title = {Dubious answers to unimportant questions in the treatment of perforated diverticular disease.},
journal = {The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland},
volume = {17},
number = {5},
pages = {319},
doi = {10.1016/j.surge.2019.03.007},
pmid = {31056430},
issn = {1479-666X},
mesh = {*Diverticular Diseases ; *Diverticulitis ; Humans ; *Laparoscopy ; Therapeutic Irrigation ; },
}
@article {pmid31037341,
year = {2020},
author = {Aune, D and Sen, A and Norat, T and Riboli, E},
title = {Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies.},
journal = {European journal of nutrition},
volume = {59},
number = {2},
pages = {421-432},
pmid = {31037341},
issn = {1436-6215},
mesh = {Dietary Fiber/*administration & dosage ; Diverticular Diseases/*prevention & control ; Humans ; Prospective Studies ; Risk Assessment ; },
abstract = {BACKGROUND: A high intake of dietary fibre has been associated with a reduced risk of diverticular disease in several studies; however, the dose-response relationship between fibre intake and diverticular disease risk has varied, and the available studies have not been summarised in a meta-analysis. We conducted a systematic review and meta-analysis of prospective cohort studies to clarify the association between dietary fibre intake, fibre subtypes, and the risk of diverticular disease.
METHODS: PubMed and Embase databases were searched up to August 9th 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model and nonlinear associations were modelled using fractional polynomial models.
RESULTS: Five prospective cohort studies with 19,282 cases and 865,829 participants were included in the analysis of dietary fibre and diverticular disease risk. The summary RR was 0.74 (95% CI 0.71-0.78, I2 = 0%) per 10 g/day. There was no evidence of a nonlinear association between dietary fibre intake and diverticular disease risk, pnonlinearity = 0.35, and there was a 23%, 41% and 58% reduction in risk for an intake of 20, 30, and 40 g/day, respectively, compared to 7.5 g/day. There was no evidence of publication bias with Egger's test, p = 0.58 and the association persisted in subgroup and sensitivity analyses. The summary RR per 10 g/day was 0.74 (95% CI 0.67-0.81, I2 = 60%, n = 4) for cereal fibre, 0.56 (95% CI 0.37-0.84, I2 = 73%, n = 2) for fruit fibre, and 0.80 (95% CI 0.45-1.44, I2 = 87%, n = 2) for vegetable fibre.
CONCLUSIONS: These results suggest that a high fibre intake may reduce the risk of diverticular disease and individuals consuming 30 g of fibre per day have a 41% reduction in risk compared to persons with a low fibre intake. Further studies are needed on fibre types and risk of diverticular disease and diverticulitis.},
}
@article {pmid31035942,
year = {2019},
author = {Bundgaard-Nielsen, C and Baandrup, UT and Nielsen, LP and Sørensen, S},
title = {The presence of bacteria varies between colorectal adenocarcinomas, precursor lesions and non-malignant tissue.},
journal = {BMC cancer},
volume = {19},
number = {1},
pages = {399},
pmid = {31035942},
issn = {1471-2407},
mesh = {Adult ; Aged ; Aged, 80 and over ; Bacteria/classification/genetics/*growth & development ; Carcinogenesis/genetics ; Colon/*microbiology ; Colorectal Neoplasms/*microbiology/pathology ; Diverticular Diseases/*microbiology/pathology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; RNA, Ribosomal, 16S/genetics ; Rectum/*microbiology ; },
abstract = {BACKGROUND: A causal association has been suggested between certain bacteria and colorectal cancer (CRC). Only a few studies have, however, investigated the presence of these bacteria directly in colon tissue with conflicting results. It is thus uncertain which role they may have in prognosis and carcinogenesis of CRC.
METHODS: Formalin-fixed and paraffin-embedded (FFPE) colorectal tissue samples from patients diagnosed with colorectal cancer (CRC)(tumor and paired normal tissue, n = 99), adenomas (n = 96), or diverticular disease (n = 104) were tested for the presence and bacterial load of Streptococcus gallolyticus (S. gallolyticus), Fusobacterium nucleatum (F. nucleatum), and Bacteroides fragilis (B. fragilis) using quantitative PCR. A subsequent broader search was conducted on a subset of samples using 16S ribosomal RNA gene sequencing. Finally, to evaluate the prognostic value, the bacterial status was compared to patient outcome.
RESULTS: S. gallolyticus was not detected by qPCR in any of the investigated tissue samples and F. nucleatum and B. fragilis were found to be equally distributed in tumors, paired normal tissue, and diverticula, but significantly less present in adenomas compared to both tumors and diverticula. Neither, F. nucleatum nor B. fragilis status affected the five-year prognosis of the patients. The 16S rRNA gene sequencing data revealed that tumors were associated with the Prevotella genus while conversely adenomas and diverticula were associated with Acinetobacter genus.
CONCLUSION: These findings do not support a role of F. nucleatum or B. fragilis during colorectal beginning, while S. gallolyticus was not implicated in the colorectal tissue of a Danish population. A potential role of the bacterial genera Prevotella and Acinetobacter was indicated, and requires further investigations.},
}
@article {pmid31032559,
year = {2019},
author = {Horesh, N and Klein, Y and Gutman, M},
title = {[ACUTE DIVERTICULAR DISEASE - IS IT STILL A "SURGICAL" CONDITION?].},
journal = {Harefuah},
volume = {158},
number = {4},
pages = {253-257},
pmid = {31032559},
issn = {0017-7768},
mesh = {Acute Disease ; *Diverticular Diseases/surgery ; *Diverticulitis/surgery ; Humans ; Israel ; },
abstract = {INTRODUCTION: The therapeutic approach to diverticular disease has changed significantly in recent decades. From a disease treated almost exclusively by surgery, diverticulitis is nowadays treated operatively in specific indications, shifting the majority of patients towards an outpatient based treatment. Significant changes occurred not only in uncomplicated diverticular disease but also in complicated cases, treated in the past with emergency surgery. These changes have been studied relentlessly around the world, and despite the fact that the vast majority of patients presenting with acute diverticular disease are not treated with surgery, it is still considered a surgical condition. In this review article, we set out to examine whether there is still justification to consider acute diverticulitis as a surgical disease and in addition, to examine whether the changes in treatment seen around the world are compatible with the current treatment strategies implemented in Israel.},
}
@article {pmid31022679,
year = {2019},
author = {Goldwag, JL and Lyn, RV and Wilson, LR and Wilson, MZ and Ivatury, SJ},
title = {Effect of Elective Sigmoidectomy for Diverticulitis on Bowel Function Patient-Reported Outcomes.},
journal = {The Journal of surgical research},
volume = {241},
number = {},
pages = {135-140},
doi = {10.1016/j.jss.2019.03.041},
pmid = {31022679},
issn = {1095-8673},
mesh = {Aged ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/physiopathology/surgery ; Diverticulitis, Colonic/physiopathology/*surgery ; Elective Surgical Procedures/adverse effects/*methods ; Female ; Humans ; Ileostomy/adverse effects/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; *Patient Reported Outcome Measures ; Patient Satisfaction/statistics & numerical data ; Postoperative Period ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticular disease is common worldwide. A subset of these patients will choose to undergo elective surgical resection because of symptoms or complicated disease. The aim of this study was to evaluate changes in bowel function after elective sigmoid resection for diverticular disease.
MATERIALS AND METHODS: We retrospectively reviewed patients seen at our institution from May 2015 to July 2018 who underwent elective sigmoid resection for diverticular disease. We used the Colorectal Functional Outcome (COREFO) questionnaire, a validated questionnaire that assesses bowel function in five domains and a global function score (scores 0-100, with higher score indicating worse function). We obtained questionnaire data at baseline, as well as at postoperative follow-up, and a paired t-test was used to compare.
RESULTS: Forty-nine patients met criteria for inclusion in this study. The median time between questionnaire completion was 70 days (interquartile range: 56 to 85). The mean age was 60 ± 12 years, with 57% female patients. Thirty-six (73%) patients underwent sigmoidectomy alone and 13 (27%) underwent sigmoidectomy with fistula repair. Six patients (12%) had a diverting loop ileostomy in addition to sigmoidectomy and underwent a subsequent reversal. Overall, there were no differences in any of the five domains or the total Colorectal Functional Outcome score from baseline to postintervention.
CONCLUSIONS: In our cohort, bowel function did not significantly change in the early postoperative period after elective sigmoid resection for diverticular disease. Surgeons should counsel patients, especially symptomatic ones, that bowel function will likely be no different at time of postoperative follow-up.},
}
@article {pmid31019703,
year = {2019},
author = {Cossais, F and Lange, C and Barrenschee, M and Möding, M and Ebsen, M and Vogel, I and Böttner, M and Wedel, T},
title = {Altered enteric expression of the homeobox transcription factor Phox2b in patients with diverticular disease.},
journal = {United European gastroenterology journal},
volume = {7},
number = {3},
pages = {349-357},
pmid = {31019703},
issn = {2050-6406},
mesh = {Aged ; Colon/metabolism/pathology ; Diverticular Diseases/*metabolism ; Dopaminergic Neurons/metabolism ; Enteric Nervous System/*metabolism/pathology ; Female ; Gene Expression ; Homeodomain Proteins/*genetics/*metabolism ; Humans ; Intestinal Pseudo-Obstruction/metabolism ; Male ; Neuroglia/metabolism ; Proto-Oncogene Proteins c-ret/metabolism ; RNA, Messenger/genetics ; Retrospective Studies ; S100 Calcium Binding Protein beta Subunit/metabolism ; Transcription Factors/*genetics/*metabolism ; Tyrosine 3-Monooxygenase/metabolism ; },
abstract = {Background: Diverticular disease, a major gastrointestinal disorder, is associated with modifications of the enteric nervous system, encompassing alterations of neurochemical coding and of the tyrosine receptor kinase Ret/GDNF pathway. However, molecular factors underlying these changes remain to be determined.
Objectives: We aimed to characterise the expression of Phox2b, an essential regulator of Ret and of neuronal subtype development, in the adult human enteric nervous system, and to evaluate its potential involvement in acute diverticulitis.
Methods: Site-specific gene expression of Phox2b in the adult colon was analysed by quantitative polymerase chain reaction. Colonic specimens of adult controls and patients with diverticulitis were subjected to quantitative polymerase chain reaction for Phox2b and dual-label immunochemistry for Phox2b and the neuronal markers RET and tyrosine hydroxylase or the glial marker S100β.
Results: The results indicate that Phox2b is physiologically expressed in myenteric neuronal and glial subpopulations in the adult enteric nervous system. Messenger RNA expression of Phox2b was increased in patients with diverticulitis and both neuronal, and glial protein expression of Phox2b were altered in these patients.
Conclusions: Alterations of Phox2b expression may contribute to the enteric neuropathy observed in diverticular disease. Future studies are required to characterise the functions of Phox2b in the adult enteric nervous system and to determine its potential as a therapeutic target in gastrointestinal disorders.},
}
@article {pmid31014749,
year = {2019},
author = {Raña-Garibay, R and Salgado-Nesme, N and Carmona-Sánchez, R and Remes-Troche, JM and Aguilera-Carrera, J and Alonso-Sánchez, L and Arnaud-Carreño, C and Charúa-Guindic, L and Coss-Adame, E and de la Torre-Bravo, A and Espinosa-Medina, D and Esquivel-Ayanegui, F and Roesch-Dietlen, F and López-Colombo, A and Muñoz-Torres, JI and Noble-Lugo, A and Rojas-Mendoza, F and Suazo-Barahona, J and Stoopen-Rometti, M and Torres-Flores, E and Vallejo-Soto, M and Vergara-Fernández, O},
title = {The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon.},
journal = {Revista de gastroenterologia de Mexico (English)},
volume = {84},
number = {2},
pages = {220-240},
doi = {10.1016/j.rgmx.2019.01.002},
pmid = {31014749},
issn = {2255-534X},
mesh = {Colonic Diseases/*therapy ; Consensus ; Delphi Technique ; Diverticular Diseases/*therapy ; Diverticulitis/therapy ; Guidelines as Topic ; Humans ; Mexico ; },
abstract = {Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.},
}
@article {pmid31012495,
year = {2019},
author = {Sköldberg, F and Granlund, J and Discacciati, A and Hjern, F and Schmidt, PT and Olén, O},
title = {Incidence and lifetime risk of hospitalization and surgery for diverticular disease.},
journal = {The British journal of surgery},
volume = {106},
number = {7},
pages = {930-939},
doi = {10.1002/bjs.11143},
pmid = {31012495},
issn = {1365-2168},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Diverticulitis, Colonic/*epidemiology/*surgery ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Information Storage and Retrieval ; Male ; Middle Aged ; Registries ; Risk ; Sweden/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Studies on incidence rates of first-time colonic diverticular disease are few, and population-based estimates of lifetime risk are lacking. In this observational study, the incidence, admission rates and lifetime risks of hospitalization and surgery for diverticular disease were investigated.
METHODS: Considering the entire Swedish population as an open cohort, incidence and admission rates, and lifetime risk estimates (considering death as a competing risk) of hospitalization and surgery for diverticular disease were calculated using data from cross-linked national registers and population statistics from 1987 to 2010.
RESULTS: In total, there were 144 107 hospital admissions for diverticular disease in 95 049 individual patients. Of these, 17 599 were admissions with bowel resection or stoma formation in 16 824 patients. The total number of person-years in the population during the study period was 213 949 897. Age-standardized incidence rates were 47·4 (95 per cent c.i. 47·1 to 47·7) for first-time hospitalization with diverticular disease and 8·4 (8·2 to 8·5) per 100 000 person-years for diverticular disease surgery. The corresponding admission rates (including readmissions) were 70·8 (70·4 to 71·2) and 8·7 (8·6 to 8·9) per 100 000 person-years. Following an increase in 1990-1994, rates stabilized. Based on incidence and mortality rates from 2000 to 2010, the estimated remaining lifetime risk of hospitalization from 30 years of age was 3·1 per cent in men and 5·0 per cent in women. The corresponding risk of surgery was 0·5 per cent in men and 0·8 per cent in women.
CONCLUSION: Diverticular disease is a common reason for hospital admission, particularly in women, but rates are stable and the lifetime risk of surgery is low.},
}
@article {pmid31001067,
year = {2019},
author = {Tursi, A and Elisei, W},
title = {Role of Inflammation in the Pathogenesis of Diverticular Disease.},
journal = {Mediators of inflammation},
volume = {2019},
number = {},
pages = {8328490},
pmid = {31001067},
issn = {1466-1861},
mesh = {Animals ; Diverticular Diseases/etiology/*immunology/*metabolism ; Humans ; Inflammation/complications/*immunology/*metabolism ; },
abstract = {Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. We do not know yet what the trigger of this low-grade inflammation occurrence is. However, some preliminary evidence found colonic dysbiosis linked to low-grade inflammation and therefore to symptom occurrence in those patients. The aim of this paper is to summarize current evidences about the role of inflammation in symptom occurrence in symptomatic uncomplicated diverticular disease and in symptom persistence after an episode of acute diverticulitis.},
}
@article {pmid30993858,
year = {2019},
author = {de Groof, EJ and Bruggeman, AE and Buskens, CJ and Tanis, PJ and Bemelman, WA},
title = {Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {9},
pages = {1045-1050},
doi = {10.1111/codi.14652},
pmid = {30993858},
issn = {1463-1318},
mesh = {*Cystography ; *Digestive System Surgical Procedures ; Drainage ; Female ; Humans ; Intestinal Fistula/*diagnostic imaging/*surgery ; Male ; Middle Aged ; Postoperative Complications/*diagnostic imaging/*surgery ; Recurrence ; Retrospective Studies ; Urinary Bladder Fistula/*diagnostic imaging ; },
abstract = {AIM: Patients undergoing resectional surgery for enterovesical fistulas generally have an indwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the role of a cystogram as part of the postoperative follow-up of such surgery, when it should be performed and for how long the bladder should be drained after surgery.
METHOD: A retrospective single-centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary end-point of recurrent urinary fistula.
RESULTS: Between 1994 and 2015, 46 patients (23 male; mean age 55.4 ± 18.3 years) underwent surgery [23 (50%) for diverticular disease, 16 (34.8%) for Crohn's disease, five (10.9%) for malignancy and two (4.3%) for previous radiotherapy]. Closure of the bladder fistula was by simple suture in 21 (46%) patients and with an omental pedicle in 16 (36%). Overall median duration of urinary drainage was 10.5 [interquartile range (IQR): 7.3-14.0] days. A postoperative cystogram was performed in 26 (57%) patients after a median of 10.0 (IQR: 8.0-13.0) days. This demonstrated persistent leakage in three patients, of whom two had undergone surgical closure of the bladder. This group required prolonged drainage (7, 19 and 40 days). One patient who had undergone surgery following radiotherapy for urothelial cancer developed a recurrent malignant fistula at 9 months, even though the postoperative cystogram had been negative.
CONCLUSION: This study suggests that a routine postoperative cystogram after surgery for enterovesical fistula may not be necessary for all patients if the bladder is drained for 1-2 weeks after bowel resection.},
}
@article {pmid30990362,
year = {2019},
author = {Davalos, G and Lan, BY and Diaz, R and Welsh, LK and Roldan, E and Portenier, D and Guerron, AD},
title = {Single-Center Experience with Magnetic Retraction in Colorectal Surgery.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {8},
pages = {1033-1037},
doi = {10.1089/lap.2018.0744},
pmid = {30990362},
issn = {1557-9034},
mesh = {Adenocarcinoma/*surgery ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*instrumentation ; Colon, Sigmoid/*surgery ; Colorectal Neoplasms/*surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/*instrumentation ; *Magnetics ; Male ; Middle Aged ; Postoperative Complications ; Risk ; *Surgical Instruments ; Treatment Outcome ; },
abstract = {Background: Appropriate tissue retraction is essential in laparoscopic surgery, and colorectal operations often require an additional incision and trocar that can disturb visualization and maneuverability. Each incision carries an increased risk for complications as well as increased pain and cosmetic issues. Magnetic devices have been developed for a less invasive retraction. The objective of this study is to report our initial experience using magnet retraction. Methods: Ten consecutive patients who underwent laparoscopic colorectal procedures by a single surgeon using a magnetic retractor (Levita Magnetics® Surgical System, San Mateo, CA) between October 2017 and June 2018 at Duke Regional Hospital in Durham, NC, were included. Results: The cases included four single-port right colectomies, one sigmoidectomy, and five rectopexies. Nine cases were completed laparoscopically, as one right colectomy required conversion due to adhesions and bulky specimen. Indications included adenocarcinoma, diverticular disease, and rectal prolapse. The magnet was successfully used for uterus, colon, or colonic pedicle retraction. No intraoperative or 30-day complications were observed. Conclusion: Magnetic surgical retractors are a safe, dynamic, and incision-less option for surgical field exposure during laparoscopic colorectal surgery. Reduced trocars decrease tissue trauma, enhances maneuverability, and potentially improves outcomes; however, further studies are required.},
}
@article {pmid30976892,
year = {2019},
author = {Schwenk, W},
title = {[Endoscopy, angiography, surgery: diagnostic and therapeutic algorithms for diverticular bleeding].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {90},
number = {8},
pages = {621-630},
pmid = {30976892},
issn = {1433-0385},
mesh = {Algorithms ; *Angiography ; Colectomy ; Colonoscopy ; *Diverticulum/complications ; *Gastrointestinal Hemorrhage/diagnosis/surgery ; Humans ; },
abstract = {Diverticular bleeding is a complication of diverticular disease but in contrast to diverticulitis, publications concerning diverticular bleeding are less common. Diverticular bleeding is the cause of approximately 20-50% of cases of lower gastrointestinal bleeding and in rare cases can be life-threatening. The main symptom of diverticular hemorrhage is painless hematochezia and the German guidelines recommend that further diagnostics of suspected diverticular bleeding should be performed in hospital. Interdisciplinary diagnostic and therapeutic algorithms recommend primary endoscopy in acute as well as chronic recurrent diverticular bleeding. If endoscopy fails to provide an exact localization of the origin of bleeding, angiography or computed tomography (CT) angiography can be performed. The 99mTc erythrocyte scintigraphy should only be performed if endoscopy and angiography are unable to identify the localization of the bleeding source. More than 90% of diverticular hemorrhages stop spontaneously; however, it is general agreed that an active diverticular bleeding detected during colonoscopy should be immediately treated endoscopically. Alternative radiological techniques for hemostasis are rarely needed and attention must be paid to the complications. In the rare case of severe bleeding that cannot otherwise be stopped or if the bleeding vessel cannot be located, laparotomy and total colectomy can be recommended. If the diverticular bleeding has definitely been identified or recurrent bleeding causes chronic anemia, segmental or total colectomy may be undertaken; however, the advantages and disadvantages of both types of surgery have to be thoroughly explained to the patient.},
}
@article {pmid30976578,
year = {2019},
author = {Wetterhall, C and Mariusdottir, E and Hall, C and Jörgren, F and Buchwald, P},
title = {Low Incidence of Pelvic Sepsis after Hartmann's Procedure: Radiation Therapy May Be a Risk Factor.},
journal = {Gastrointestinal tumors},
volume = {5},
number = {3-4},
pages = {77-81},
pmid = {30976578},
issn = {2296-3774},
abstract = {Purpose: Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors.
Methods: All patients who underwent Hartmann's procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.
Results: 172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (p = 0.03) and Hinchey grade III and IV (p = 0.02) in those patients who underwent Hartmann's procedure for diverticular disease.
Conclusion: Hartmann's procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.},
}
@article {pmid30967935,
year = {2019},
author = {Beh, HN and Ongso, YF},
title = {Simultaneous gastric and colonic erosions from gastric band and its tubing in the setting of recurrent intra-abdominal infection.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {4},
pages = {rjz102},
pmid = {30967935},
issn = {2042-8812},
abstract = {Chronic abdominal pain is often a diagnostic dilemma. We present a 59-year-old female with chronic generalized colicky abdominal and altered bowel habits. She was investigated with colonoscopy and CT abdomen. Patient has a history of recurrent diverticulitis and insertion laparoscopic adjustable gastric band. The colonoscopy revealed a tubular foreign body and diverticular disease. The tubular structure was confirmed to be gastric band tubing on CT abdomen, also showing simultaneous gastric and colonic erosions. She denies any gastric band port related infection or previous issues with gastric band. This case suggest that the cause of the erosion is due to recurrent episodes diverticulitis. She underwent wedge resection of large bowel and laparoscopic removal of gastric band. She had uneventful post-operative recovery.},
}
@article {pmid30944680,
year = {2019},
author = {Pietrzak, AM and Dziki, A and Banasiewicz, T and Reguła, J},
title = {Cyclic rifaximin therapy effectively prevents the recurrence of symptoms after exacerbation of symptomatic uncomplicated diverticular disease: a retrospective study.},
journal = {Przeglad gastroenterologiczny},
volume = {14},
number = {1},
pages = {69-78},
pmid = {30944680},
issn = {1895-5770},
abstract = {Introduction: Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.
Aim: To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment.
Material and methods: A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg b.i.d. for 7 days per month. The patients' SUDD history, diagnostic methods, treatment, and results were evaluated.
Results: In total 294 patients were included in this study (67% women, median age: 65 years (26-87)). The mean duration of diverticular disease (DD) was 4.5 years (1-20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; p < 0.0001; sum from 9.37 (max. 18 points) to 1.35; p < 0.0001) and an improvement in individual symptom score.
Conclusions: Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.},
}
@article {pmid30921802,
year = {2020},
author = {Galetin, A and Rink, AD and Vestweber, B and Vestweber, KH and Galetin, T},
title = {Single-Incision Laparoscopic versus Open Sigmoidectomy for Diverticular Disease: A Disease-Stratified Matched-Pair Analysis.},
journal = {Digestive surgery},
volume = {37},
number = {1},
pages = {56-64},
doi = {10.1159/000497449},
pmid = {30921802},
issn = {1421-9883},
mesh = {Aged ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Laparoscopy ; Male ; Matched-Pair Analysis ; Middle Aged ; },
abstract = {BACKGROUND: Single-incision laparoscopic surgery (SILS) is a variant of laparoscopic surgery, especially for diverticular disease (DD), but there are very little data comparing SILS to standard surgical procedures for DD, and most studies on DD surgery do not declare the disease stage. We compared SILS to open sigmoidectomy for DD in a stage-stratified matched-pair analysis to validate the significance of SILS.
METHODS: All patients with SILS or conventional sigmoidectomy for diverticulitis of a single visceral surgery department were subject to a matched-pair analysis stratified by age, sex, body mass index, previous abdominal surgery, and the stage of DD.
RESULTS: Fifty-five pairs were included. In total, 84/110 (76%) had complicated stages of DD. ASA stages were higher in the laparotomy group; the proportion of elective operations was similar (SILS 78%, open: 71%). In the SILS group, length of hospital stay (LoS; 10.2 vs. 16.7 days) and duration of intensive or intermediate care (IMC; 1.8 vs. 3.7 days) were shorter, blood transfusions were reduced (0.1 vs. 0.4 units) and less patients received opioids postoperatively (75 vs. 98%). The day of first defecation, stoma rate, and rates of morbidity and mortality were similar.
CONCLUSIONS: SILS equals open sigmoidectomy regarding complications with advantages regarding pain, LoS, IMC/intensive care unit treatment, and blood transfusion.},
}
@article {pmid30897258,
year = {2019},
author = {Thambi, P and Borowski, DW and Sathasivam, R and Obuobi, RB and Viswanath, YKS and Gill, TS},
title = {Single-incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {7},
pages = {833-840},
doi = {10.1111/codi.14617},
pmid = {30897258},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/surgery ; Colostomy/*methods ; Databases, Factual ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/*epidemiology/etiology ; Proctocolectomy, Restorative/adverse effects/*methods ; Prospective Studies ; Rectum/surgery ; Retrospective Studies ; Surgical Stomas/*statistics & numerical data ; Surgical Wound ; Treatment Outcome ; United Kingdom ; Young Adult ; },
abstract = {AIM: Restoration of bowel continuity after Hartmann's procedure (RoH) can be challenging and associated with considerable morbidity. A technique using single-incision laparoscopic surgery through the stoma site (SIL RoH) has been shown to be feasible and safe. In this study, we compared clinical outcomes of SIL RoH with conventional laparoscopic surgery (CL) and open surgery (OS).
METHODS: This was a retrospective analysis of a prospectively maintained database between 2007 and 2017 in a UK colorectal unit. The access technique was decided by the surgeon on a case by case basis.
RESULTS: A total of 106 patients underwent RoH. It was carried out for diverticular disease (n = 71, 67.6%), cancer (n = 19, 17.9%) and anastomotic leak (n = 4, 3.8%). The remainder (n = 12, 11.3%) were for miscellaneous reasons including trauma. Most RoHs were performed via OS (n = 87, 81.1%). The most common intended approaches for RoH were SIL (n = 56, 52.8%) and OS (n = 34, 32.1%) with fewer starting with CL (n = 16, 15.1%). Conversion to OS took place in five (8.9%) patients with SIL and six (37.5%) with CL (P = 0.005). Postoperative complications occurred in 17 (30.4%) for SIL, seven (43.8%) for CL and 17 (50.0%) for OS (P = 0.162). Median operating time for SIL was 146 min (range 44-389), 211 min (109-320) for CL and 211 min (85-420) for OS (P < 0.001). Median length of stay was 4 days (2-44) for SIL compared to 6 (3-34) for CL and 7 (4-34) for OS (P < 0.001). Discharge on or before day 5 was achieved in 41 (74.5%) patients for SIL compared to six (37.5%) for CL and seven (20.6%) for OS (P < 0.001).
CONCLUSION: Compared to OS and CL, SIL RoH appears to have shorter operating times and hospitalization, with no discernible difference in morbidity; this finding requires further evaluation in a randomized setting.},
}
@article {pmid30891177,
year = {2019},
author = {Wehrmann, F and Hashim, E and Mansoor, S},
title = {Ingested partial denture mimicking perforated diverticular disease.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {3},
pages = {rjz071},
pmid = {30891177},
issn = {2042-8812},
abstract = {Denture ingestion is a rare clinical entity among foreign body ingestions. The caveat is that there is often no recollection of the event and that dentures are radiolucent and as such hard to identify on conventional imaging. To date not all dentures contain radiopaque marker. Here we present the case of a 52-year-old male who was admitted with clinical and radiological signs of perforated diverticular disease. A curvilinear metallic foreign body was picked up on repeat CT imaging at day 3, which was part of an unknowingly swallowed partial denture that became impacted and perforated the sigmoid colon. The patient underwent an uneventful laparoscopic anterior resection and was discharged home a week later. We conclude that all dentures should contain a radiopaque marker in order to avoid failure in radiological detection and thus prevent misdiagnosis and inappropriate treatment.},
}
@article {pmid30884376,
year = {2019},
author = {Almalki, MA and Yaseen, WY and Baatiyyah, M},
title = {Small bowel diverticulum complicated by enterocutaneous fistula and abdominal wall abscess - Case report.},
journal = {International journal of surgery case reports},
volume = {57},
number = {},
pages = {39-41},
pmid = {30884376},
issn = {2210-2612},
abstract = {INTRODUCTION: Small bowel diverticular disease is uncommon, representing 1-2% of general population. The ileum diverticulum is very rare, especially if it is complicated by enterocutaneous fistula with abdominal wall abscess.
PRESENTATION OF THE CASE: Here, we report a case of small bowel diverticulum, ileum diverticulum with enterocutaneous fistula in a 65-year man presented with lower abdominal pain and an irreducible swelling for 5 days.
DISSECTION: Diverticulosis has no exact cause, but theoretically the diverticula result from peristalsis abnormalities, intestinal dyskinesia, or high segmental intraluminal pressures. Complications of small intestinal diverticulum include bleeding, diverticulitis and its complication (e.g. fistula formation, and intra-abdominal abscess) [5].
CONCLUSION: This is considered rare and serious complication of small bowel diverticulum could occur if diagnosis is delayed.},
}
@article {pmid30868321,
year = {2019},
author = {Grass, F and Crippa, J and Mathis, KL and Kelley, SR and Larson, DW},
title = {Feasibility and safety of robotic resection of complicated diverticular disease.},
journal = {Surgical endoscopy},
volume = {33},
number = {12},
pages = {4171-4176},
pmid = {30868321},
issn = {1432-2218},
mesh = {Diverticular Diseases/*surgery ; Feasibility Studies ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/*surgery ; Retrospective Studies ; Robotic Surgical Procedures/*methods ; Treatment Outcome ; },
abstract = {This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014-2018). All procedures were performed within an enhanced recovery pathway (ERP). Demographic, surgical and ERP-related items were compared between patients with simple and complicated diverticular disease according to intra-operative presentation. Postoperative complications and length of stay were compared between the two groups. Out of 150 patients, 78 (52%) presented with complicated and the remaining 72 (48%) with uncomplicated disease. Both groups were comparable regarding demographic baseline characteristics and overall ERP compliance. Surgery for complicated disease was longer (288 ± 96 vs. 258 ± 72 min, p = 0.04) and more contaminated (≥ class 3: 57.7 vs. 23.6%, p < 0.001) with a trend to higher conversion rates (10.3 vs. 2.8%, p = 0.1). While postoperative overall complications tended to occur more often after resections for complicated disease (28.2 vs. 15.3%, p = 0.075), major, surgical and medical complications did not differ between the two groups, and median length of stay was 3 days in both settings (p = 0.19). Robotic resection of diverticular disease was feasible and safe regardless of disease presentation by the time of surgery.},
}
@article {pmid30856681,
year = {2019},
author = {Self, D and Reece, M and Dilernia, S},
title = {Predicting the need for transfer and interventional angiography for patients with acute colonic haemorrhage in a regional setting.},
journal = {ANZ journal of surgery},
volume = {89},
number = {4},
pages = {E109-E112},
doi = {10.1111/ans.15064},
pmid = {30856681},
issn = {1445-2197},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/complications/diagnosis/*therapy ; Computed Tomography Angiography/*methods ; Embolization, Therapeutic/*methods ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/diagnosis/etiology/*therapy ; Humans ; Male ; Mesenteric Arteries/*diagnostic imaging ; Middle Aged ; Patient Transfer/*statistics & numerical data ; Retrospective Studies ; },
abstract = {BACKGROUND: Radiological angioembolization is an important strategy in management of acute colonic bleeding. Due to requirement for specialized interventional radiology, many hospitals rely on transfer for this service. This study aimed to identify patient and clinical factors associated with positive (blush) computed tomography mesenteric angiogram (CTMA) or need for invasive angiography. The secondary aim was to identify a patient population who may forego transfer and be safely managed in a regional centre.
METHODS: All presentations to Central Coast Local Health District with colonic bleeding from June 2013-June 2017 were included. A guideline for transfer of patients with positive CTMA from Central Coast Local Health District to Royal North Shore Hospital had been established prior to the study period. Demographics, medical background, transfusion requirement, presentation details and mortality data were collected on all patients.
RESULTS: Of 2378 patients presenting with colonic bleeding, 71 of 247 patients investigated with CTMA had a blush. Forty-six patients were transferred to Royal North Shore Hospital. Of these, 28 proceeded to interventional angiography with 19 undergoing angioembolization. Acute transfusion ≥5 units (odds ratio 6.78, P < 0.01) was the only significant predictor of needing interventional angiography. There was no association between age, bleeding site (right or left), use of antiplatelet or anticoagulation, diverticular disease or chronic kidney disease and identification of arterial bleeding on interventional angiography. There was no mortality or significant procedure-related morbidity.
CONCLUSION: A patient's medical background demonstrates a lack of correlation to identification of active bleeding on interventional angiography. Patients requiring ≥5 units blood transfusion should be considered for transfer and interventional angiography.},
}
@article {pmid30851168,
year = {2019},
author = {Tursi, A and Brandimarte, G and di Mario, F and Nardone, G and Scarpignato, C and Picchio, M and Elisei, W and , },
title = {The "DICA" endoscopic classification for diverticular disease of the colon shows a significant interobserver agreement among community endoscopists.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {1},
pages = {23-27},
doi = {10.15403/jgld.2014.1121.281.dic},
pmid = {30851168},
issn = {1842-1121},
mesh = {Colon/*pathology ; *Colonoscopy ; Diverticulitis, Colonic/classification/*pathology ; Diverticulosis, Colonic/classification/*pathology ; Humans ; Observer Variation ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Severity of Illness Index ; *Terminology as Topic ; Video Recording ; },
abstract = {BACKGROUND AND AIM: An endoscopic classification of Diverticular Disease (DD), called DICA (Diverticular Inflammation and Complication Assessment) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement levels for this classification among an endoscopist community setting.
METHODS: A total of 66 endoscopists independently scored a set of DD endoscopic videos. The percentages of overall agreement on the DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of the inter-rater agreement.
RESULTS: The overall agreement levels were: 70.2% for DICA 1, 70.5% for DICA 2, 81.3% for DICA 3. The free marginal κ was: 0.553 for DICA 1, 0.558 for DICA 2, 0.719 for DICA 3. The agreement levels among the expert group were: 78.8% for DICA 1, 80.2% for DICA 2, 88.5% for DICA 3. The free marginal κ among the expert group were: 0.682 for DICA 1, 0.712 for DICA 2, 0.828 for DICA 3. The agreement of expert raters on the single item of the DICA classification was superior to the agreement of the overall group.
CONCLUSIONS: The overall inter-rater agreement for DICA score in this study ranges from moderate to good, with a significant improvement in the expert subgroup of raters. Diverticular Inflammation and Complication Assessment is a simple and reproducible endoscopic scoring system.},
}
@article {pmid30839393,
year = {2019},
author = {Järbrink-Sehgal, ME and Rassam, L and Jasim, A and Walker, MM and Talley, NJ and Agréus, L and Andreasson, A and Schmidt, PT},
title = {Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study.},
journal = {The American journal of gastroenterology},
volume = {114},
number = {3},
pages = {500-510},
doi = {10.14309/ajg.0000000000000113},
pmid = {30839393},
issn = {1572-0241},
mesh = {Aged ; C-Reactive Protein/immunology ; Case-Control Studies ; Cecum/immunology/*pathology ; Colitis/immunology/*pathology ; Colonoscopy ; Diverticulum/immunology/pathology/physiopathology ; Diverticulum, Colon/immunology/*pathology/physiopathology ; Female ; Humans ; Inflammation ; Linear Models ; Logistic Models ; Male ; Middle Aged ; },
abstract = {INTRODUCTION: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology.
METHODS: In a nested case-control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models.
RESULTS: Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls.
CONCLUSIONS: In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.},
}
@article {pmid30838745,
year = {2019},
author = {Barbaro, MR and Cremon, C and Fuschi, D and Scaioli, E and Veneziano, A and Marasco, G and Festi, D and Stanghellini, V and Barbara, G},
title = {Nerve fiber overgrowth in patients with symptomatic diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {31},
number = {9},
pages = {e13575},
doi = {10.1111/nmo.13575},
pmid = {30838745},
issn = {1365-2982},
mesh = {Aged ; Colonoscopy/methods ; Diverticulosis, Colonic/*diagnosis/*immunology ; Enteric Nervous System/*immunology/*pathology ; Female ; Humans ; Intestinal Mucosa/immunology/pathology ; Male ; Middle Aged ; Nerve Fibers/*immunology/*pathology ; Pilot Projects ; },
abstract = {BACKGROUND: Colonic diverticulosis is a common condition in industrialized countries. Up to 25% of patients with diverticula develop symptoms, a condition termed symptomatic uncomplicated diverticular disease (SUDD). The aim of the present study was to characterize neuroimmune interactions and nerve fiber plasticity in the colonic mucosa of patients with diverticula.
METHODS: Controls, patients with diverticulosis and with SUDD were enrolled in the study. Mucosal biopsies were obtained close to diverticula (diverticular region) and in a normal mucosa (distant site), corresponding to sigmoid and descending colon in the controls. Quantitative immunohistochemistry was used to assess mast cells, T cells, macrophages, nerve fibers, and neuronal outgrowth (growth-associated protein 43, GAP43+fibers).
KEY RESULTS: No difference emerged in mast cells and T cells among the three groups. Macrophages were increased in patients with SUDD and diverticulosis as compared to controls. Nerve fibers were enhanced in patients with SUDD and diverticulosis in comparison with controls in the diverticular region. GAP43+ fibers were increased only in patients with SUDD as compared to controls and to patients with diverticulosis in the diverticular region. In patients with SUDD, GAP43 density was increased in the diverticular region compared to distant site. Macrophages close to GAP43+ fibers were increased in the diverticular region of patients with SUDD. Significant correlations were found between GAP43+ fibers and immune cells.
CONCLUSIONS AND INFERENCES: Patients with diverticula are characterized by increased macrophage counts, while nerve fiber sprouting is increased only in the diverticular region of patients with SUDD suggesting a role in symptom generation.},
}
@article {pmid30826747,
year = {2019},
author = {Weersma, RK and Parkes, M},
title = {Diverticular disease: picking pockets and population biobanks.},
journal = {Gut},
volume = {68},
number = {5},
pages = {769-770},
pmid = {30826747},
issn = {1468-3288},
mesh = {*Biological Specimen Banks ; Connective Tissue ; *Diverticular Diseases ; *Diverticulum ; Genome-Wide Association Study ; Humans ; },
}
@article {pmid30825120,
year = {2020},
author = {Schwandner, F and Klimars, U and Gock, M and Schiffmann, L and Witte, M and Schiergens, T and Rentsch, M and Klar, E and Kühn, F},
title = {The Water-Holding Procedure for Ensuring Postoperative Continence Prior Restoring Intestinal Continuity.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {2},
pages = {411-417},
pmid = {30825120},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anal Canal/*physiopathology/surgery ; Defecation ; *Enterostomy ; Fecal Incontinence/*physiopathology ; Female ; Gastrointestinal Diseases/surgery ; Humans ; Male ; Manometry ; Middle Aged ; Pilot Projects ; Postoperative Period ; Predictive Value of Tests ; Prospective Studies ; Water ; },
abstract = {BACKGROUND: A defunctioning stoma can become necessary in a relevant number of patients undergoing gastrointestinal surgery. As a matter of course, patients seek an early closure of the stoma. However, preoperative management of these patients varies and the prediction of continence after stoma removal can become challenging. Patients might be fully continent despite low manometric pressures and vice versa. An easy and reliable way to predict continence after stoma reversal would improve patients' management and outcome. Although frequently performed in various surgical centers in Germany, there is no published data on the water-holding test. Hence, this is the first study evaluating the role of the test in clinical practice.
METHOD: We performed a prospective pilot study to evaluate the role of anorectal manometry and the water-holding procedure as a predictor of postoperative continence prior to stoma reversal. Inclusion criteria were a successfully passed water-holding test, any type of fecal diversion and the possibility of restoring intestinal continuity. Preoperative low manometric pressure levels were not an exclusion criteria for stoma reversal. Fifty-two patients with ostomy were consecutively enrolled in this study between October 2013 and February 2016. Anorectal manometry was performed in all patients prior to stoma reversal. After stoma removal, patients were followed-up for 6 months. Postoperative incontinence was determined using the Wexner incontinence score.
RESULTS: A total of 52 patients (38 males, 14 females) were included at an average age of 59 (range 33-83) years. Most frequent indications for intestinal diversion were rectal cancer surgery, IBD-related surgery, or surgery for diverticular disease. Low anterior rectal resection was performed in 17 patients (32.7%), followed by a proctocolectomy in 9 (17.3%), colectomy in 9 (17.3%), and recto-sigmoid resection in 7 patients (13.5%). Median time from stoma creation to reversal was 206 days (range 48-871 days). All patients had successfully passed the standardized water-holding test. At the same time, the majority of patients had low preoperative manometric pressure values and would normally not have been reversed at that point. The median postoperative Wexner incontinence score was at 1.5 (range 0-20), 0.5 (range 0-14), and 0 (range 0-11) at 14, 60, and 180 days after stoma reversal. Low preoperative manometric squeeze and/or resting pressure levels were not associated with a higher postoperative incontinence score at 14, 60, or 180 days after stoma reversal.
CONCLUSION: A standardized water-holding test can function as an easy and reliable method before stoma reversal to predict sufficient postoperative fecal continence. In case of a sufficient water-holding test despite low manometric pressure levels, the risk for postoperative anal incontinence seems to be low. Preoperative manometric pressure levels do not appear to predict postoperative continence.},
}
@article {pmid30809418,
year = {2018},
author = {Kadiyska, T and Tourtourikov, I and Popmihaylova, AM and Kadian, H and Chavoushian, A},
title = {Role of TNFSF15 in the intestinal inflammatory response.},
journal = {World journal of gastrointestinal pathophysiology},
volume = {9},
number = {4},
pages = {73-78},
pmid = {30809418},
issn = {2150-5330},
abstract = {Gastrointestinal diseases, specifically Crohn's disease, ulcerative colitis, diverticular disease, and primary biliary cirrhosis are all characterized by complicated inflammation of the digestive tract. Their pathology is multifactorial, and risk factors encompass both genetic and environmental factors. Recent advances in the genetic component of inflammatory bowel diseases (IBDs) have revealed that the tumor necrosis factor superfamily member 15 (TNFSF15) contains a number of risk alleles associated not only with IBD but also with other diseases such as diverticular disease and primary biliary cirrhosis. These risk alleles in TNFSF15 and the altered expression of its gene product can serve as the common ground between these disorders by explaining at least some of the underlying processes that lead to a dysregulated immune response and subsequent chronic inflammation. Here, we aim to outline how the TNFSF15 gene is involved in the proliferation and cell fate of different populations of T cells and subsequently in the control of both pro- and anti-inflammatory cytokines. Furthermore, we summarize what is currently known of TNFSF15 control region variants, how they are associated with each mentioned disease, and how these variants can explain the autoimmune pathology of said diseases through altered TNFSF15 expression.},
}
@article {pmid30793380,
year = {2019},
author = {Tague, LK and Adams, W and Young, KA and Kwon, OJ and Mahoney, E and Lowery, EM},
title = {Association between diverticular disease requiring surgical intervention and mortality in the postlung transplant population - a retrospective cohort study.},
journal = {Transplant international : official journal of the European Society for Organ Transplantation},
volume = {32},
number = {7},
pages = {739-750},
pmid = {30793380},
issn = {1432-2277},
support = {K23 AA022126/AA/NIAAA NIH HHS/United States ; T32 HL007317/HL/NHLBI NIH HHS/United States ; K23AA022126//NIH/NIAA/ ; T32HL007317-39//Washington University Division of Pulmonary and Critical Care Medicine/ ; },
mesh = {Aged ; Cystic Fibrosis/complications/mortality/surgery ; Diverticulitis/*complications/mortality/*surgery ; Female ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression Therapy ; Lung Diseases/*complications/mortality/*surgery ; Lung Transplantation/*adverse effects ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome ; alpha 1-Antitrypsin Deficiency/complications/mortality/surgery ; },
abstract = {Lung Transplant recipients are at increased risk of complicated diverticular disease. We aim to assess the rate of diverticular surgery in a postlung transplantation population and identify risk factors for surgery. We performed a retrospective cohort study of lung transplant recipients from 2007 to 2011. Demographic variables were evaluated with the Mann-Whitney U and chi-squared tests. Cox regression was performed to evaluate 1- and 2-year landmark survival, assess predictor variables of diverticular surgery and evaluate impact of surgery on CLAD development. Of 17 of 158 patients (10.7%) underwent diverticular-related surgery. Surgical patients had significantly worse survival than nonsurgical patients at 1 year [aHR 2.93 (1.05-8.21), P = 0.041] and 2 year [aHR 4.17 (1.26-13.84), P = 0.020] landmark analyses. Transplant indication of alpha-1 antitrypsin disease and cystic fibrosis were significantly associated with the need for diverticular surgery. Emergent surgery was associated with poorer survival [aHR 5.12(1.00-26.27), P = 0.050]. Lung transplant patients requiring surgery for complicated diverticular disease have significantly poorer survival than those who do not require surgery. Surgery was more common in patients transplanted for A1AT and CF. Optimal assessment and risk stratification of diverticular disease is necessary to prevent excessive morbidity and mortality following transplantation.},
}
@article {pmid30791758,
year = {2019},
author = {Bassotti, G and Usai Satta, P and Bellini, M},
title = {Prucalopride for the treatment of constipation: a view from 2015 and beyond.},
journal = {Expert review of gastroenterology & hepatology},
volume = {13},
number = {3},
pages = {257-262},
doi = {10.1080/17474124.2019.1568238},
pmid = {30791758},
issn = {1747-4132},
mesh = {Benzofurans/adverse effects/economics/*therapeutic use ; Constipation/diagnosis/*drug therapy/economics/physiopathology ; Cost-Benefit Analysis ; Defecation/*drug effects ; Drug Costs ; Gastrointestinal Motility/*drug effects ; Humans ; Intestines/*drug effects/physiopathology ; Laxatives/adverse effects/economics/*therapeutic use ; Recovery of Function ; Serotonin 5-HT4 Receptor Agonists/adverse effects/economics/*therapeutic use ; Treatment Outcome ; },
abstract = {INTRODUCTION: Prucalopride is a prokinetic drug, that has been commercially available in recent years for the treatment of chronically constipated patients. In this update of a previous 2016 article, we reviewed the more recent data supporting its role in the treatment of constipation and constipation-associated conditions. Areas covered: We carried out an extensive literature review on the effects of prucalopride for the years 2012-2018 by means of scientific databases and manual research. More evidence was found on its possible therapeutic role in conditions in which constipation plays a role as an associated symptom, such as opioid-induced constipation, constipation-predominant irritable bowel syndrome, post-operative ileus, colonic diverticular disease, drug-related constipation, and chronic intestinal pseudo-obstruction. Expert opinion: Based on the added literature evidence, we feel that prucalopride is an effective, although expensive, drug for the treatment of primary and secondary forms of constipation, and of other clinical conditions associated with constipation.},
}
@article {pmid30790412,
year = {2020},
author = {Ayoubi, S and Chen, M and Ravindran, P and Gibson, K},
title = {Ischio-anal abscess as a first presentation of complicated diverticular disease.},
journal = {ANZ journal of surgery},
volume = {90},
number = {1-2},
pages = {169-171},
doi = {10.1111/ans.15042},
pmid = {30790412},
issn = {1445-2197},
mesh = {Abdominal Abscess/*etiology/surgery ; Anus Diseases/*etiology/surgery ; *Colon, Sigmoid ; Colonic Diseases/*etiology/surgery ; Cutaneous Fistula/*etiology/surgery ; Diverticulitis, Colonic/*complications/surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Ischium ; Middle Aged ; },
}
@article {pmid30781964,
year = {Wint},
author = {Skála, M and Liška, V and Třeška, V},
title = {Mesenteric diverticuli as a reason of acute abdomen.},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {98},
number = {1},
pages = {27-30},
pmid = {30781964},
issn = {0035-9351},
mesh = {*Abdomen, Acute/etiology/surgery ; Aged ; *Diverticulum/complications/surgery ; Humans ; *Intestinal Diseases/complications/surgery ; Mesentery ; Retrospective Studies ; },
abstract = {INTRODUCTION: Diverticula of the small bowel are quite rare findings, frequently confirme only by necropsy. The authors describe the signs and symptoms resulting from complications of small bowel diverticula as well as the diagnostic options and treatment modalities. The paper also presents the results of treatment in the Department of Surgery at University Hospital in Pilsen.
METHOD: Our retrospective study involved 6 patients who were operated on due to complications of small bowel mesenteric diverticulum at the Department of Surgery at University Hospital in Pilsen between 1 January 2006 and 1 January 2016. We assessed the number of days in hospital, emesis or pathological stools (diarrhoea or bleeding), admission body temperature and abdominal clinical signs, operating time and postoperative complications according to the Clavien-Dindo classification. As for laboratory parameters, leukocytosis and C-reactive protein levels were evaluated.
RESULTS: The results of our study are similar to those reported in available literature. After medical history and physical examination which are ne-cessary, laboratory methods, and less frequently also imaging methods, can be used in diagnosis. The treatment of complications of small bowel diverticular disease is only surgical. The postoperative course is burdened by comorbidities of these patients as they are very often elderly.
CONCLUSION: Management of complicated small bowel diverticular disease is only surgical and consists in laparotomy with thorough lavage of the abdominal cavity and with drainage. Key words: small bowel acute abdome.},
}
@article {pmid30765881,
year = {2019},
author = {Arnold, CA and Graham, RP and Jain, D and Kakar, S and Lam-Himlin, DM and Naini, BV and Wu, TT and Yeh, MM and Torbenson, MS},
title = {Knowledge gaps in the appendix: a multi-institutional study from seven academic centers.},
journal = {Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc},
volume = {32},
number = {7},
pages = {988-996},
doi = {10.1038/s41379-019-0216-x},
pmid = {30765881},
issn = {1530-0285},
mesh = {Adenocarcinoma, Mucinous/*pathology ; Appendiceal Neoplasms/*pathology ; Appendix/*pathology ; Carcinoid Tumor/*pathology ; Humans ; },
abstract = {Appendix pathology represents uncommonly encountered specimens with unique diagnostic challenges. To delineate common knowledge gaps, extramural consults submitted to seven institutions between 2016-2017 were reviewed. All appendix consults were resections (100%, n = 43), and the majority were directed for consultation by the originating pathologist (95%, n = 41) with no additional studies performed by the consultant (65%, n = 28). This study was dominated by inquiries related to low grade appendiceal mucinous neoplasms (44%, n = 19) and goblet cell carcinoid related neoplasms (19%, n = 8). Of the 43 appendiceal consults, 19 were submitted by the contributing pathologist as low grade appendiceal mucinous neoplasm, but only half of these were diagnosed by the consultant as such (n = 9). Low grade appendiceal mucinous neoplasm-related consultation themes included diverticular disease, criteria for invasion, high grade atypia, extra-appendiceal mucin, and staging. Examples of major disagreements that were downgraded included consults submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as serrated polyp (n = 3), appendicitis (n = 1), and benign appendix (n = 1). Examples of major disagreements-upgraded included cases submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as low grade appendiceal mucinous neoplasm with high-risk features (n = 2) and mucinous adenocarcinoma (n = 2). One case contained both a major disagreement-upgrade (low grade appendiceal mucinous neoplasm changed to high grade appendiceal mucinous neoplasm) and a major disagreement-downgrade (pT3 changed to Tis). Of the 15 cases diagnosed by the consultants as low grade appendiceal mucinous neoplasm, submitted diagnoses included low grade appendiceal mucinous neoplasm (n = 9), adenocarcinoma (n = 5), and one case was submitted without a diagnosis. For goblet cell carcinoid-related consults, the usual inquiry related to distinguishing goblet cell carcinoid from goblet cell carcinoid with adenocarcinoma (adenocarcinoma ex-goblet cell carcinoid). Of the 38 overall consults with a submitted diagnosis, 53% (n = 20) were disagreements, and most of these were major disagreements-downgraded (n = 13).},
}
@article {pmid30758535,
year = {2019},
author = {Lebert, P and Ernst, O and Zins, M},
title = {Acquired diverticular disease of the jejunum and ileum: imaging features and pitfalls.},
journal = {Abdominal radiology (New York)},
volume = {44},
number = {5},
pages = {1734-1743},
doi = {10.1007/s00261-019-01928-1},
pmid = {30758535},
issn = {2366-0058},
mesh = {Diagnosis, Differential ; Diverticular Diseases/*complications/*diagnostic imaging ; Humans ; Jejunal Diseases/*complications/*diagnostic imaging ; *Tomography, X-Ray Computed ; },
abstract = {PURPOSE: To present radiological aspects of jejunoileal diverticulosis and its complications.
RESULTS: Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery.
CONCLUSION: Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known.},
}
@article {pmid30747633,
year = {2018},
author = {Valizadeh, N and Suradkar, K and Kiran, RP},
title = {Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis.},
journal = {The American surgeon},
volume = {84},
number = {11},
pages = {1781-1786},
pmid = {30747633},
issn = {1555-9823},
mesh = {Aged ; Colectomy/*methods/mortality ; Databases, Factual ; Diverticulitis/diagnosis/*surgery ; Elective Surgical Procedures/*methods/mortality ; *Emergencies ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/*mortality/physiopathology ; Predictive Value of Tests ; Preoperative Care/methods ; Propensity Score ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Time Factors ; },
abstract = {The aim of this study was to identify preoperative characteristics that may determine the need for emergency surgery for diverticulitis and assess postoperative outcomes for these patients when compared with elective surgery. All patients included in the ACS-NSQIP-targeted colectomy database from 2012 to 2013 who underwent colectomy with an underlying diagnosis of diverticulitis were included. Preoperative characteristics and 30-day postoperative outcomes were evaluated for patients who underwent elective versus emergent/urgent surgery using univariable and multivariable analyses. Of 8708 patients with diverticular disease, 28.1 per cent underwent emergent/urgent colectomy. Patients who underwent emergent/urgent colectomy had greater preoperative steroid use, diabetes mellitus, disseminated cancer, chronic renal failure, hypertension, chronic heart failure, chronic liver disease, COPD, and dependent functional health status (P < 0001). There were more patients with age >65 years (P < 0001), smoking history (P < 0.05), and BMI < 18.5 kg/m² (P < 0001) in the emergent/urgent colectomy group. After performing multivariable analysis, preoperative steroid use, weight loss >10 per cent, BMI < 18 kg/m², smoking, age > 65, and comorbid conditions were associated with a higher rate of emergent/urgent surgery. Mortality (5.2% vs 0.2%) and infectious and noninfectious complications were higher after nonelective colectomy. Emergent/urgent colectomy was also associated with longer hospital stay and reoperation. Emergency and urgent colectomy for diverticulitis is associated with significantly worse outcomes than after elective surgery, and patients with comorbid conditions who develop attacks of diverticulitis may in fact be the population that might best benefit from a lower threshold for an elective colectomy.},
}
@article {pmid30740206,
year = {2019},
author = {Prough, H and Jaffe, S and Jones, B},
title = {Jejunal diverticulitis.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {1},
pages = {rjz005},
pmid = {30740206},
issn = {2042-8812},
abstract = {Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Small bowel diverticular disease has been reported in approximately 0.3-1.3% cases of post mortem studies (Fisher JK, Fortin D. Partial small bowel obstruction secondary to ileal diverticulitis. Radiology 1977;122:321-322.) and in only 0.5-1.9% of contrast media study cases (Cattell RB, Mudge TJ. The surgical significance of duodenal diverticula. N Engl J Med 1952;246:317-324). Diverticula located within the small bowel may have presentations and complications similar to that of colonic diverticular disease. However, there is no consensus for the management for small bowel diverticulitis. Given that small bowel diverticulitis, like a colonic diverticulitis, can cause an acute abdomen, surgical intervention may be required. In this particular case, a patient presented with symptoms of lower abdominal pain, nausea and fever. Following an x-ray and CT scan, the patient underwent an open laparotomy and small bowel resection of a portion of jejunum that contained a symptomatic diverticulum.},
}
@article {pmid30740013,
year = {2019},
author = {Nevo, Y and Shapiro, R and Froylich, D and Meron-Eldar, S and Zippel, D and Nissan, A and Hazzan, D},
title = {Over 1-Year Followup of Laparoscopic Treatment of Enterovesical Fistula.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {23},
number = {1},
pages = {},
pmid = {30740013},
issn = {1938-3797},
mesh = {Adult ; Aged ; Anastomosis, Surgical ; Crohn Disease/complications ; Diverticular Diseases/complications ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Urinary Bladder Fistula/etiology/*surgery ; Young Adult ; },
abstract = {Background and Objective: Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. The aim of this study was to assess the feasibility and safety of laparoscopic surgery in the treatment of EVFs in patients with complicated diverticular and Crohn's disease.
Methods: All patients with the diagnosis of EVF who underwent laparoscopic surgery were identified from prospective collected data based in two institutions between 2007 and 2017. Patients with malignancy were excluded. Recorded parameters included operative time, conversion to open surgery, the presence of a protective loop ileostomy, perioperative complications, number of units of blood transfused, postoperative course, and histologic findings.
Results: Seventeen patients were included in the study: 10 patients with a colo-vesical fistula due to diverticular disease, and 7 patients with an ileo-vesical fistula due to Crohn's disease. There were no conversions to open surgery and none of the patients needed a protective ileostomy. The bladder was sutured in 12 patients (70%). No intra-operative complications were met, and no blood transfusions were needed; there were no anastomotic leaks, nor mortality in both groups.
Conclusions: The laparoscopic approach for benign EVF in selected patients is both feasible and safe in the hands of experienced surgeons with extensive expertise in laparoscopic surgery.},
}
@article {pmid30734381,
year = {2019},
author = {Renzi, C and Lyratzopoulos, G and Hamilton, W and Rachet, B},
title = {Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses.},
journal = {European journal of cancer care},
volume = {28},
number = {2},
pages = {e13000},
pmid = {30734381},
issn = {1365-2354},
support = {TP Gunton research grant//British Medical Association/ ; C48748/A18667//Cancer Research UK/United Kingdom ; C8640/A23385//CanTest Collaborative, Cancer Research UK/ ; },
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Anemia/etiology ; Colonic Neoplasms/*diagnosis/epidemiology ; Early Detection of Cancer ; Emergencies ; Emergency Treatment/statistics & numerical data ; England/epidemiology ; Female ; Humans ; Incidental Findings ; Intestinal Diseases/etiology ; Male ; Middle Aged ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Sex Distribution ; Young Adult ; },
abstract = {OBJECTIVES: To identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP).
METHODS: Cohort of 5,745 colon cancers diagnosed in England 2005-2010, with individually linked cancer registry and primary care data for the 5-year pre-diagnostic period.
RESULTS: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p = 0.002) had alarm symptoms (anaemia/rectal bleeding/change in bowel habit) 2-12 months pre-diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% vs. 6% among women and men (p = 0.002). EP was more likely in women (OR = 1.20; 95% CI 1.1-1.4), independently of socio-demographic factors and symptoms. Benign diagnoses in the pre-diagnostic year (OR = 2.01; 95% CI 1.2-3.3) and anaemia 2-5 years pre-diagnosis (OR = 1.91; 95% CI 1.2-3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40-59 with a recent benign diagnosis vs. none (OR = 4.41; 95% CI 1.3-14.9).
CONCLUSIONS: Women have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40-59 years with new-onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One-fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis.},
}
@article {pmid30733953,
year = {2018},
author = {Al Harakeh, H and Paily, AJ and Doughan, S and Shaikh, I},
title = {Recurrent Acute Diverticulitis: When to Operate?.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {91-99},
pmid = {30733953},
issn = {2296-9365},
abstract = {Objective: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life.
Methods: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. The literature was thoroughly searched for major studies tackling this topic. Furthermore, studies reporting on decision making based on quality of life were included. Risks of developing recurrent diverticulitis and the potential need of surgery were identified. Relevant surgical details that would decrease recurrence were also denoted.
Results: Surgery has been the mainstay of treatment for quite some time. However, the paradigms of treatment have changed over the last few years, especially when long-term population studies confirmed that not all patients require surgical treatment with its associated risk of morbidity.
Conclusion: Treatment now has to be patient-tailored with special attention to the subgroup of high-risk patients. These patients must be adequately selected, identifying the impact of the disease on the quality of life and weighing in the risks of the surgical intervention.},
}
@article {pmid30733951,
year = {2018},
author = {Rezapour, M and Stollman, N},
title = {Antibiotics in Uncomplicated Acute Diverticulitis: To Give or Not to Give?.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {75-79},
pmid = {30733951},
issn = {2296-9365},
abstract = {Acute uncomplicated diverticulitis (AUD) is generally felt to be caused by obstruction and inflammation of a colonic diverticulum and occurs in about 4-5% of patients with diverticulosis. The cornerstone of AUD treatment has conventionally been antibiotic therapy, but with a paradigm shift in the underlying pathogenesis of the disease from bacterial infection to more of an inflammatory process, as well as concerns about antibiotic overuse, this dogma has recently been questioned. We will review emerging data that supports more selective antibiotic use in this population, as well as newer guidelines that advocate this position as well. While there are no discrete algorithms to guide us, we will attempt to suggest clinical scenarios where antibiotics may reasonably be withheld.},
}
@article {pmid30733949,
year = {2018},
author = {Imaeda, H and Hibi, T},
title = {The Burden of Diverticular Disease and Its Complications: West versus East.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {61-68},
pmid = {30733949},
issn = {2296-9365},
abstract = {Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs.
Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk.
Key Messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.},
}
@article {pmid30733947,
year = {2018},
author = {Sharara, AI},
title = {Diverticular Disease of the Colon.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {53-54},
doi = {10.1159/000495019},
pmid = {30733947},
issn = {2296-9365},
}
@article {pmid30675092,
year = {2019},
author = {Raskin, ER and Keller, DS and Gorrepati, ML and Akiel-Fu, S and Mehendale, S and Cleary, RK},
title = {Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {23},
number = {1},
pages = {},
pmid = {30675092},
issn = {1938-3797},
mesh = {Adolescent ; Adult ; Aged ; Colectomy/adverse effects/methods/statistics & numerical data ; Databases, Factual ; Diverticular Diseases/*surgery ; Elective Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Propensity Score ; Retrospective Studies ; *Robotic Surgical Procedures ; Sigmoid Diseases/*surgery ; Treatment Outcome ; United States ; Young Adult ; },
abstract = {Background and Objectives: The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States.
Methods: This is a retrospective propensity score-matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons.
Results: There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications-ileus, wound complications, and acute renal failure-and more patients discharged directly to home.
Conclusions: The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.},
}
@article {pmid30671801,
year = {2020},
author = {Choi, KK and Martinolich, J and Canete, JJ and Valerian, BT and Chismark, DA and Ata, A and Lee, EC},
title = {Elective Laparoscopic Sigmoid Colectomy for Diverticulitis-an Updated Look at Recurrence After Surgery.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {2},
pages = {388-395},
pmid = {30671801},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Irritable Bowel Syndrome/complications ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Surgical management of diverticulitis is evolving and the decision to offer elective sigmoidectomy for diverticulitis has become more individualized. However, preoperative variables that may predict recurrent diverticulitis after resection and guide surgical decision-making were not well studied.
METHODS: This was a retrospective chart review with a prospective questionnaire follow-up of patients. Patients who underwent elective sigmoidectomy for diverticulitis from 2002 to 2016 at a tertiary academic colorectal surgery practice were included and their medical records reviewed. They were then contacted with a questionnaire to inquire about recurrence of diverticulitis since resection. The primary outcome was rate of recurrent diverticulitis after elective sigmoidectomy. The secondary outcome was risk factors for recurrence after sigmoidectomy.
RESULTS: Of 662 patients who underwent elective sigmoidectomy for diverticulitis, 361 had long-term follow-up data available. Mean follow-up was 86 months. Indication for surgery was uncomplicated recurrent diverticulitis in 50%. Recurrent diverticulitis developed in 15 (4.2%) patients. Mean time to recurrence was 55 (range, 6-109) months. All recurrences were confirmed by CT scan. Univariate analysis showed that preoperative diagnosis of irritable bowel syndrome and uncomplicated recurrent diverticulitis was significantly more prevalent in patients who experienced recurrent diverticulitis after sigmoidectomy (p = 0.049 and p = 0.02); however, these variables did not predict recurrence after resection.
CONCLUSIONS: Overall rate of recurrent diverticulitis after elective sigmoidectomy was 4.2%. Preoperative diagnosis of irritable bowel syndrome and uncomplicated recurrent diverticulitis was associated with but not significant predictor of recurrence after elective resection.},
}
@article {pmid30668711,
year = {2019},
author = {He, E and Alison, R and Blanks, R and Pirie, K and Reeves, G and Ward, RL and Steele, R and Patnick, J and Canfell, K and Beral, V and Green, J},
title = {Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England.},
journal = {International journal of epidemiology},
volume = {48},
number = {2},
pages = {549-558},
pmid = {30668711},
issn = {1464-3685},
support = {/MRC_/Medical Research Council/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Aged ; Colorectal Neoplasms/*diagnosis/epidemiology ; England/epidemiology ; Female ; Gastrointestinal Hemorrhage/*etiology ; Hematologic Diseases/*diagnosis/epidemiology ; Humans ; Inflammatory Bowel Diseases/*diagnosis/epidemiology ; Logistic Models ; Mass Screening/methods ; Middle Aged ; *Occult Blood ; Prospective Studies ; Time Factors ; },
abstract = {BACKGROUND: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.
METHODS: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.
RESULTS: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.
CONCLUSIONS: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.},
}
@article {pmid30661054,
year = {2019},
author = {Schafmayer, C and Harrison, JW and Buch, S and Lange, C and Reichert, MC and Hofer, P and Cossais, F and Kupcinskas, J and von Schönfels, W and Schniewind, B and Kruis, W and Tepel, J and Zobel, M and Rosendahl, J and Jacobi, T and Walther-Berends, A and Schroeder, M and Vogel, I and Sergeev, P and Boedeker, H and Hinrichsen, H and Volk, A and Erk, JU and Burmeister, G and Hendricks, A and Hinz, S and Wolff, S and Böttner, M and Wood, AR and Tyrrell, J and Beaumont, RN and Langheinrich, M and Kucharzik, T and Brezina, S and Huber-Schönauer, U and Pietsch, L and Noack, LS and Brosch, M and Herrmann, A and Thangapandi, RV and Schimming, HW and Zeissig, S and Palm, S and Focke, G and Andreasson, A and Schmidt, PT and Weitz, J and Krawczak, M and Völzke, H and Leeb, G and Michl, P and Lieb, W and Grützmann, R and Franke, A and Lammert, F and Becker, T and Kupcinskas, L and D'Amato, M and Wedel, T and Datz, C and Gsur, A and Weedon, MN and Hampe, J},
title = {Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms.},
journal = {Gut},
volume = {68},
number = {5},
pages = {854-865},
doi = {10.1136/gutjnl-2018-317619},
pmid = {30661054},
issn = {1468-3288},
support = {MC_PC_17228/MRC_/Medical Research Council/United Kingdom ; MC_QA137853/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Adult ; Aged ; Case-Control Studies ; Colonic Diseases/*genetics/pathology ; Connective Tissue/*physiology ; Databases, Genetic ; Diverticular Diseases/*genetics/pathology ; Epithelium/*physiology ; Female ; Genetic Predisposition to Disease/genetics ; *Genome-Wide Association Study ; Humans ; Male ; Middle Aged ; Neuromuscular Junction/*physiology ; United Kingdom ; },
abstract = {OBJECTIVE: Diverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease.
DESIGN: Discovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Associations were replicated in a European sample of 3893 cases and 2829 diverticula-free controls and evaluated for risk contribution to diverticulitis and uncomplicated diverticulosis. Transcripts at top 20 replicating loci were analysed by real-time quatitative PCR in preparations of the mucosal, submucosal and muscular layer of colon. The localisation of expressed protein at selected loci was investigated by immunohistochemistry.
RESULTS: We discovered 48 risk loci, of which 12 are novel, with genome-wide significance and consistent OR in the replication sample. Nominal replication (p<0.05) was observed for 27 loci, and additional 8 in meta-analysis with a population-based cohort. The most significant novel risk variant rs9960286 is located near CTAGE1 with a p value of 2.3×10-10 and 0.002 (ORallelic=1.14 (95% CI 1.05 to 1.24)) in the replication analysis. Four loci showed stronger effects for diverticulitis, PHGR1 (OR 1.32, 95% CI 1.12 to 1.56), FAM155A-2 (OR 1.21, 95% CI 1.04 to 1.42), CALCB (OR 1.17, 95% CI 1.03 to 1.33) and S100A10 (OR 1.17, 95% CI 1.03 to 1.33).
CONCLUSION: In silico analyses point to diverticulosis primarily as a disorder of intestinal neuromuscular function and of impaired connective fibre support, while an additional diverticulitis risk might be conferred by epithelial dysfunction.},
}
@article {pmid30647541,
year = {2019},
author = {Lightner, AL and Cima, R},
title = {Use of the Rochester Epidemiology Project for Clinical Research in Colon and Rectal Surgery.},
journal = {Clinics in colon and rectal surgery},
volume = {32},
number = {1},
pages = {8-15},
pmid = {30647541},
issn = {1531-0043},
support = {R01 AG034676/AG/NIA NIH HHS/United States ; },
abstract = {The Rochester Epidemiology Project (REP), a longitudinal population-based database, is the largest epidemiologic database in the world. Originally established at Mayo Clinic in Rochester, Minnesota, the REP has been instrumental in defining the natural history of disease states and the impact of treatment in a well-defined population. In the United States, the REP has made important contributions to the colon and rectal literature, largely because healthcare is fragmented with no unique identifier to longitudinally follow-up with a patient throughout the system over his or her lifespan. Investigation with the REP has provided insight to the economic burden associated with inflammatory bowel disease, the benefit of screening for colorectal cancer, and the natural history of Mekel's and diverticular disease. In addition to practice changing research, the REP can be used as a model for future linkage systems in the United States.},
}
@article {pmid30645917,
year = {2018},
author = {Ozturk, O and Koklu, H and Akbal, E and Aksoy, EK and Altan, E and Basar, O and Yuksel, O and Arslan, S and Koklu, S},
title = {Diverticular disease and posture during defecation : a prospective comparative study.},
journal = {Acta gastro-enterologica Belgica},
volume = {81},
number = {4},
pages = {490-495},
pmid = {30645917},
issn = {1784-3227},
mesh = {*Defecation/physiology ; Diverticulosis, Colonic/*epidemiology ; Female ; Humans ; *Posture ; Prevalence ; Prospective Studies ; },
abstract = {BACKGROUND AND STUDY AIMS: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.
PATIENTS AND METHODS: This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).
RESULTS: The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.
CONCLUSION: Sitting during defecation seems to increase the risk of CD.},
}
@article {pmid30631757,
year = {2018},
author = {Sharara, AI and Ziade, N and Shayto, RH and Rustom, LBO and Chehab, H and Rimmani, HH and Hanna, K and Chalhoub, JM and Sarkis, FS and Rahal, MA and Soweid, A and Mourad, FH and Barada, K and Harb, AH},
title = {The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy.},
journal = {Canadian journal of gastroenterology & hepatology},
volume = {2018},
number = {},
pages = {3690202},
pmid = {30631757},
issn = {2291-2797},
mesh = {Acute Disease ; Aged ; Ambulatory Care/statistics & numerical data ; Colonoscopy/*statistics & numerical data ; Cross-Sectional Studies ; Diverticular Diseases/complications/*epidemiology ; Diverticulosis, Colonic/diagnosis/*epidemiology/etiology ; Female ; Gastrointestinal Hemorrhage/complications/*epidemiology ; Humans ; Incidence ; Male ; Mass Screening/*statistics & numerical data ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {Background: The natural history of colonic diverticulosis is unclear.
Methods: Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview.
Results: 826 patients were included in the screening colonoscopy study. Three were excluded for prior DD. In all, 224 patients (27.2%; mean age 62.3 ± 8.2) had incidental diverticulosis distributed in the left colon (67.4%), right colon (5.8%), or both (22.8%). Up-to-date information was available on 194 patients. Of those, 144 (74.2%) could be reached for detailed interview and constituted the study population. Over a mean follow-up of 7.0 ± 1.7 years, DD developed in 6 out of 144 patients (4.2%) (4 acute cases of diverticulitis, 1 probable case of diverticular bleeding, and 1 acute case of diverticulitis and diverticular bleeding). Two patients were hospitalized, and none required surgery. The time to event was 5.1 ± 1.6 years and the incidence rate was 5.9 per 1000 patient-years. On multivariate analysis, none of the variables collected at baseline colonoscopy including age, gender, obesity, exercise, fiber intake, alcohol use, constipation, or use of NSAIDs were associated with DD.
Conclusion: The natural history of incidental diverticulosis on screening colonoscopy was highly favorable in this well-defined prospectively identified cohort. The common scenario of incidental diverticulosis at screening colonoscopy makes this information clinically relevant and valuable to physicians and patients alike.},
}
@article {pmid30625484,
year = {2019},
author = {Nagata, N and Ishii, N and Manabe, N and Tomizawa, K and Urita, Y and Funabiki, T and Fujimori, S and Kaise, M},
title = {Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association.},
journal = {Digestion},
volume = {99 Suppl 1},
number = {},
pages = {1-26},
doi = {10.1159/000495282},
pmid = {30625484},
issn = {1421-9867},
mesh = {Diverticulitis, Colonic/diagnosis/therapy ; Diverticulosis, Colonic/diagnosis/*therapy ; Gastrointestinal Hemorrhage/diagnosis/*therapy ; Humans ; },
abstract = {Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.},
}
@article {pmid30620240,
year = {2019},
author = {Caso, R and Chang, H and Marshall, MB},
title = {Evolving Options in Management of Minimally Invasive Diverticular Disease: A Single Surgeon's Experience and Review of the Literature.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {6},
pages = {780-784},
doi = {10.1089/lap.2018.0711},
pmid = {30620240},
issn = {1557-9034},
mesh = {Adult ; Aged ; Diverticulum/surgery ; Diverticulum, Esophageal/*surgery ; Esophagus/*surgery ; Female ; Follow-Up Studies ; Fundoplication/*methods ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Myotomy/methods ; Retrospective Studies ; Surgeons ; Thoracic Surgery, Video-Assisted/methods ; Thoracoscopy/methods ; Thoracotomy/methods ; },
abstract = {Background: Esophageal thoracic diverticular disease is a rare condition resulting from multiple etiologies. Surgical management is recommended when symptomatic. Traditionally, a thoracotomy was considered the standard approach; however, the use of minimally invasive approaches has been associated with improved outcomes. Methods: We retrospectively reviewed a single surgeon's experience with minimally invasive esophageal diverticulectomy. Results: Fifteen patients with symptomatic esophageal diverticular disease underwent minimally invasive diverticulectomy between 2005 and 2018. Most patients (86.7%) had epiphrenic diverticula and 53.3% underwent a video-assisted thoracoscopic surgery approach. All patients had a diverticulectomy, while 14 patients (93.3%) also had an esophageal myotomy. Three patients (20%) underwent an extended myotomy, 4 patients (26.7%) underwent a concomitant fundoplication, and 2 patients (13.3%) underwent a concomitant paraesophageal hernia repair. Median length of hospital stay was 2 days (range, 1-16 days). There were no mortalities. Two patients (13.3%) were readmitted with delayed esophageal leaks. Median follow-up was 10.7 months (range, 10 days to 6.3 years). One patient presented with recurrent disease 5 years after his initial operation. Conclusions: In experienced hands, a minimally invasive diverticulectomy is safe, effective, and associated with excellent patient outcomes. A minimally invasive approach should be performed when possible and should be tailored to the individual patient's disease and preoperative workup.},
}
@article {pmid30609274,
year = {2019},
author = {Cirocchi, R and Popivanov, G and Binda, GA and Henry, BM and Tomaszewski, KA and Davies, RJ and Di Saverio, S},
title = {Sigmoid resection for diverticular disease - to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta-analysis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {6},
pages = {623-631},
doi = {10.1111/codi.14547},
pmid = {30609274},
issn = {1463-1318},
mesh = {Adult ; Aged ; Anastomotic Leak/epidemiology/etiology ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Ligation/adverse effects/*methods ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Non-Randomized Controlled Trials as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {AIM: In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta-analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage.
METHOD: A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta-analysis software Review Manager 5.3.
RESULTS: Eight studies met the inclusion criteria and were included in the meta-analysis: two randomized controlled trials (RCTs) and six non-RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26-1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14-2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed.
CONCLUSION: This meta-analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA-preserving technique as mandatory in resection for left-sided colonic diverticular disease.},
}
@article {pmid30593541,
year = {2019},
author = {Di Mario, F and Miraglia, C and Cambiè, G and Violi, A and Nouvenne, A and Franceschi, M and Brandimarte, G and Elisei, W and Picchio, M and Tursi, A},
title = {Long-term efficacy of rifaximin to manage the symptomatic uncomplicated diverticular disease of the colon.},
journal = {Journal of investigative medicine : the official publication of the American Federation for Clinical Research},
volume = {67},
number = {4},
pages = {767-770},
doi = {10.1136/jim-2018-000901},
pmid = {30593541},
issn = {1708-8267},
mesh = {Colon/*pathology ; Diverticular Diseases/*drug therapy/surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Rifaximin/*therapeutic use ; Treatment Outcome ; },
abstract = {Although rifaximin is currently advised in managing symptomatic uncomplicated diverticular disease (SUDD) of the colon, no long-term data are available. This retrospective study assessed the outcome of a large cohort of patients with SUDD, treated with rifaximin, during an 8-year follow-up. The study group (group A) included 346 patients with SUDD (median age 64 years, IQR 58-69, 62.4% females), treated with rifaximin 800 mg/d for 7 days every month. The control group (group B) included 470 patients with SUDD (median age 65 years, IQR 59-74 years, 60.8% females), taking any other treatment on demand. Two symptoms (left lower abdominal pain and bloating) were assessed by a visual analog scale (VAS), graded from 0=no symptom to 10=the most severe symptom. Daily bowel movements were also reported. Median (IQR) VAS score for pain was 6 (5-7) in group A and 6 (6-7) in group B at baseline (p=0.109); at 8-year follow-up it was 3 (3-4) and 6 (5-7), respectively (p<0.000). Both bloating and daily bowel movements were significantly reduced in group A. Acute diverticulitis occurred in 9 (2.6%) patients in group A and in 21 (4.5%) patients in group B (p=0.155). Surgery occurred in 4 (1.2%) patients in group A and 9 (1.9%) in group B (p=0.432). Disease-related mortality occurred in no patient in group A and 2 (0.4%) patients in group B (p=0.239). No side effects were recorded during the entire study period. Rifaximin is effective to relieve symptoms and reduce the risk of disease-related complications in patients with SUDD.},
}
@article {pmid30585680,
year = {2019},
author = {Grass, F and Lovely, JK and Crippa, J and Ansell, J and Hübner, M and Mathis, KL and Larson, DW},
title = {Comparison of recovery and outcome after left and right colectomy.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {4},
pages = {481-486},
doi = {10.1111/codi.14543},
pmid = {30585680},
issn = {1463-1318},
mesh = {Adult ; Aged ; Colectomy/adverse effects/methods/*statistics & numerical data ; Crohn Disease/surgery ; Databases, Factual ; Elective Surgical Procedures/adverse effects/methods/*statistics & numerical data ; *Enhanced Recovery After Surgery ; Female ; Humans ; Ileus/*epidemiology/etiology ; Male ; Middle Aged ; Postoperative Complications/*epidemiology/etiology ; Postoperative Period ; Prospective Studies ; Recovery of Function ; Retrospective Studies ; Risk Factors ; },
abstract = {AIM: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.
METHOD: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI).
RESULTS: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m2 : 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27-5.46) and fluid overload (OR = 2.02, 95% CI: 1.06-3.82) were independent risk factors for POI.
CONCLUSION: Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.},
}
@article {pmid30583721,
year = {2018},
author = {Fagkrezos, D and Manes, K and Paraskeva, K and Lenos, M and Triantopoulou, C and Apessou, D and Maniatis, P},
title = {Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report.},
journal = {Journal of medical case reports},
volume = {12},
number = {1},
pages = {379},
pmid = {30583721},
issn = {1752-1947},
mesh = {Abdominal Pain ; Aged ; Colectomy ; Colon, Sigmoid/*pathology ; Diverticulitis/*pathology/surgery ; Female ; Humans ; Intestinal Perforation/surgery ; Multiple Myeloma/*drug therapy/*pathology ; Plasmacytoma/*pathology/surgery ; Pneumoperitoneum/diagnostic imaging/*pathology ; Radiography, Abdominal ; *Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND: Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Involvement of the gastrointestinal tract occurs in approximately 10% of cases.
CASE PRESENTATION: A 71-year-old Caucasian woman with known diverticular disease of the colon and multiple myeloma diagnosed 3 years previously, with monoclonal bands of immunoglobulin A, lambda light chains, and multiple osteolytic lesions, presented to our hospital with abdominal pain, abdominal discomfort, and pneumoperitoneum. She underwent left colectomy for diverticulitis with perforation, and an extramedullary secondary colonic plasmacytoma was found in histopathological examination of the sigmoid colon.
CONCLUSIONS: Plasmacytoma is known to occur in extraosseous sites. The stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Secondary extramedullary plasmacytoma of the colon is rare. Colonic plasmacytoma may have varying clinical presentations, such as inflammatory bowel disease and multiple colonic strictures. Although these cases are rare, treating physicians as well as radiologists, pathologists, and surgeons should be aware of this entity.},
}
@article {pmid30574746,
year = {2018},
author = {Laghi, L and Mastromarino, P and Elisei, W and Capobianco, D and Zhu, CL and Picchio, M and Giorgetti, G and Brandimarte, G and Tursi, A},
title = {Impact of treatments on fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon: a pilot study.},
journal = {Journal of biological regulators and homeostatic agents},
volume = {32},
number = {5},
pages = {1421-1432},
pmid = {30574746},
issn = {0393-974X},
mesh = {Colon/microbiology/physiopathology ; Dietary Fiber/administration & dosage ; Diverticular Diseases/*microbiology/*therapy ; Dysbiosis ; Feces/*microbiology ; Female ; Humans ; Mesalamine/therapeutic use ; *Metabolome ; *Microbiota ; Pilot Projects ; Probiotics/*therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Symptomatic uncomplicated diverticular disease (SUDD) affects 50% of people having diverticulosis. We performed a pilot study assessing the effect of current treatments on fecal microbiota and metabolome in SUDD. Thirteen consecutive females with SUDD were treated with a 2-week therapeutic trial of 30 g/day fiber supplementation (3 patients), 1.6 g/day of mesalazine (3 patients), 900 billion/day of probiotic mixture VivoMixx® (3 patients), or 800 mg/day of rifaximin (4 patients). Stool samples were collected at entry (T0), at the end of the 2-week therapeutic course (T1), and 30 (T2) and 60 days (T3) after the end of the therapeutic course. Real-time PCR quantified targeted microorganisms. Fecal metabolome patterns were studied by high-resolution proton NMR spectroscopy. At cumulative analysis, symptoms significantly decreased at each time point during follow-up (p less than 0.0001), and only left-lower quadrant pain increased again at T3. The overall bacterial quantity was not altered by the treatments. The amount of Akkermansia muciniphila species was significantly reduced at T1 (p=0.017) and at T2 (p=0.026), while at T3 the reduction was not significant in comparison to enrollment (p=0.090). Fecal molecular profile showed significant changes at T1 and T2, while at T3 it became similar to that of T0. Differences were found for 18 of the quantified molecules (tryptophan, phenylalanine, tyrosine, 4-hydroxyphenylacetate, urocanate, X-6.363, X-5.779, uridylate, galactose, X-4.197, threonine, sarcosine, methionine, 2-oxoisocaproate, 5-aminolevulinate, alanine, leucine, valerate). Metabolome and microbiota changed in patients with SUDD under treatment, confirming a possible role of dysbiosis/dysmetabolome in the pathology.},
}
@article {pmid30574685,
year = {2019},
author = {Macina, S and Imperatore, M and Feleppa, C and Sucameli, F and Talamo, G and Falco, E and Berti, S},
title = {Side-to-Side Anastomosis In Left Hemicolectomy, Why and When: A Single-Center Experience.},
journal = {Surgical technology international},
volume = {34},
number = {},
pages = {183-186},
pmid = {30574685},
issn = {1090-3941},
mesh = {Anastomosis, Surgical/adverse effects/*methods ; Anastomotic Leak/etiology ; Colectomy/*methods ; Colon/*surgery ; Colonic Diseases/*surgery ; Female ; Humans ; Laparoscopy ; },
abstract = {BACKGROUND: Laparoscopic colectomy represents a safe, effective and well-established procedure for both benign and malignant colic disease. Transanal anastomosis (TA) with a circular stapler is the most commonly performed anastomotic technique in laparoscopic left hemicolectomy (LLH). We report our experience with side-to-side anastomosis (STSA) and side-to-end anastomosis (STEA) in selected patients with both emergency and elective LLH.
METHODS: A systematic review of the PubMed database was performed on recent studies that compared different anastomotic techniques after LLH. We collected internal data from June 2014 to July 2018 and compared our experience with the literature. The primary outcome was the anastomotic complication rate.
RESULTS: During the observation period, 158 patients underwent left hemicolectomy (LH). One-hundred-nineteen patients had malignant disease; 36 underwent surgery for complicated diverticular disease, one had a large strangulated incisional hernia, one had a sigmoid volvulus, and one had a sigmoid localization of endometriosis. Thirty open left hemicolectomies were performed. In 128 cases, a minimally invasive approach was used. Since conversion to open was necessary in 10 of these cases, 118 were totally LLH. STSA was performed in 64 cases; seven in an emergency setting and 57 in elective procedures. The overall anastomotic leak rate was 3.1% (2/64) and no anastomotic leak was reported in the emergency group (0/7). TA was performed in 15 cases, 93% in an elective setting (14/15), and the anastomotic leak rate was 13.3% (2/15). In 20 cases, we performed elective STEA and no anastomotic leak was recorded. In 19 cases, it was impossible to perform anastomosis and we decided to create a definitive colostomy.
CONCLUSION: Consistent with the literature data, our experience shows that, in selected cases, STSA and STEA are both safe and effective, with a lower anastomotic complication rate than TA.},
}
@article {pmid30574635,
year = {2018},
author = {Tursi, A and Mastromarino, P and Capobianco, D and Elisei, W and Picchio, M and Brandimarte, G},
title = {No changes in Interleukin-10 expression in symptomatic uncomplicated diverticular disease of the colon.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {476-477},
doi = {10.15403/jgld.2014.1121.274.ink},
pmid = {30574635},
issn = {1842-1121},
mesh = {Aged ; Biomarkers/metabolism ; Colon/*metabolism ; Diverticulosis, Colonic/diagnosis/*metabolism ; Feces/chemistry ; Female ; Humans ; Interleukin-10/*metabolism ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid30574628,
year = {2018},
author = {Trifan, A and Gheorghe, C and Marica Sabo, C and Diculescu, M and Nedelcu, L and Singeap, AM and Sfarti, C and Gheorghe, L and Sporea, I and Tanțău, M and Scripcariu, V and Goldiș, A and Gheonea, D and Manuc, M and Stanciu, C and Scarpignato, C and Dumitrascu, DD},
title = {Diagnosis and Treatment of Colonic Diverticular Disease: Position Paper of the Romanian Society of Gastroenterology and Hepatology.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {449-457},
doi = {10.15403/jgld.2014.1121.274.rom},
pmid = {30574628},
issn = {1842-1121},
mesh = {Consensus ; Diverticulitis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulosis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulum, Colon/*diagnosis/epidemiology/*therapy ; Evidence-Based Medicine/standards ; Gastroenterology/*standards ; Humans ; Predictive Value of Tests ; Prevalence ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease.
METHODS: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus.
RESULTS: Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement.
CONCLUSION: This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease.},
}
@article {pmid30574613,
year = {2018},
author = {Tursi, A and Scarpignato, C and Brandimarte, G and Di Mario, F and Lanas, A},
title = {Rifaximin for the management of colonic diverticular disease: far beyond a simple antibiotic.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {351-355},
doi = {10.15403/jgld.2014.1121.274.rif},
pmid = {30574613},
issn = {1842-1121},
mesh = {Anti-Bacterial Agents ; *Diverticulosis, Colonic ; *Diverticulum, Colon ; Humans ; Rifaximin ; },
}
@article {pmid30574326,
year = {2018},
author = {Hussey, M and Holleran, G and Stack, R and Moran, N and Tersaruolo, C and McNamara, D},
title = {Same-day colon capsule endoscopy is a viable means to assess unexplored colonic segments after incomplete colonoscopy in selected patients.},
journal = {United European gastroenterology journal},
volume = {6},
number = {10},
pages = {1556-1562},
pmid = {30574326},
issn = {2050-6406},
abstract = {Background: Same-day colon capsule endoscopy (CCE) immediately following incomplete optical colonoscopy (OC) would have a number of advantages for patients, while also presenting unique procedural challenges including the effect of sedation on capsule propulsion and patient tolerance of protracted preparation and fasting.
Aim: The aim of this article is to prospectively assess the efficacy of same-day CCE after incomplete OC in an unselected patient cohort.
Methods: This was an observational, prospective, single-centre study of CCE post-incomplete colonoscopies. Patients with an incomplete OC for any reason other than obstruction or inadequate bowel preparation were recruited. CCE was performed after a minimum of a one-hour fast. Once the patient was fully alert, intravenous metoclopramide was administered after capsule ingestion when possible, and a standard CCE booster protocol was then followed. Relevant clinical information was recorded. CCE completion rates, findings and their impact, and adverse events were noted.
Results: Fifty patients were recruited, mean age = 57 years and 66% (n = 32) were female. Seventy-six per cent (n = 38) of CCEs were complete; however, full colonic views were obtained in 84% (n = 42) of cases. Patients > 50 years of age were five times more likely to have an incomplete CCE and there was also a trend towards known comorbidities associated with hypomobility having reduced excretion rates. Overall diagnostic yield for CCE in the unexplored segments was 74% (n = 37), with 26% (n = 13) of patients requiring significant changes in management based on CCE findings. The overall incremental yield was 38%. CCE findings were normal 26% (n = 13), polyps 38% (n = 19), inflammation 22% (n = 11), diverticular disease 25 (n = 12), angiodysplasia 3% (n = 1) and cancer 3% (n = 1). Significant small bowel findings were found in three (6%) cases, including Crohn's disease and a neuroendocrine tumour. A major adverse event occurred in one patient (2%), related to capsule retention.
Conclusion: Same-day CCE is a viable alternative means to assess unexplored segments of the colon after incomplete OC in selected patients.},
}
@article {pmid30561404,
year = {2018},
author = {Cambiè, G and Violi, A and Miraglia, C and Barchi, A and Nouvenne, A and Capasso, M and Leandro, G and Meschi, T and De' Angelis, GL and Di Mario, F},
title = {Development and usefulness of the new endoscopic classification: DICA.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {89},
number = {9-S},
pages = {113-118},
pmid = {30561404},
issn = {2531-6745},
mesh = {*Colonoscopy/adverse effects ; Constriction, Pathologic ; Diverticulitis/diagnostic imaging/pathology ; Diverticulosis, Colonic/*classification/diagnostic imaging/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; *Severity of Illness Index ; Symptom Assessment ; },
abstract = {Colonic Diverticulosis is one of the most common anatomical findings during colonoscopy. This condition has 60% incidence in the population over 60 years old. About 20% of patients will develop Diverticular Disease, and 5% of them will evolve into Diverticulitis. Until the last years there weren't any approaches for the endoscopic classification of this pathology. In 2013, in Florence, the first endoscopic classification was developed: DICA (Diverticular Inflammation and Complication Assessment). The aim of this article is to focus on the process of the development and the validation of the classification by the pool of gastroenterology experts, and, as well, its usefulness during the clinical practice.},
}
@article {pmid30561403,
year = {2018},
author = {Violi, A and Cambiè, G and Miraglia, C and Barchi, A and Nouvenne, A and Capasso, M and Leandro, G and Meschi, T and De' Angelis, GL and Di Mario, F},
title = {Epidemiology and risk factors for diverticular disease.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {89},
number = {9-S},
pages = {107-112},
pmid = {30561403},
issn = {2531-6745},
mesh = {Adult ; Age Distribution ; Aged ; Comorbidity ; Developed Countries ; Developing Countries ; Diet ; Diverticular Diseases/*epidemiology/physiopathology ; Female ; Gastrointestinal Microbiome ; Gastrointestinal Motility ; Global Health ; Humans ; Incidence ; Life Style ; Male ; Middle Aged ; Obesity/epidemiology ; Prevalence ; Risk Factors ; Serotonin/physiology ; },
abstract = {Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. The prevalence of the disease is higher in elderly patients over 65 years old, recent studies show an increment also in youngers over 40 years old. Even its large prevalence in the population, its pathophysiology still remain poorly understood. It's widely accepted that diverticula are likely to be the result of complex interactions among genetic factors, alteration of colonic motility, lifestyle conditions such as smoking, obesity, alcohol consumption, fiber and meat intake with diet. Recently many authors considered also alterations in colonic microbiota composition, co-morbidity with diabetes and hypertension and the chronic assumption of certain medications like PPI, ARB and aspirin, as important risk factors for the development of diverticulosis. The aim of this narrative review is to summarise current knowledges on this topic.},
}
@article {pmid30522789,
year = {2019},
author = {Lenti, MV and Pasina, L and Cococcia, S and Cortesi, L and Miceli, E and Caccia Dominioni, C and Pisati, M and Mengoli, C and Perticone, F and Nobili, A and Di Sabatino, A and Corazza, GR and , },
title = {Mortality rate and risk factors for gastrointestinal bleeding in elderly patients.},
journal = {European journal of internal medicine},
volume = {61},
number = {},
pages = {54-61},
doi = {10.1016/j.ejim.2018.11.003},
pmid = {30522789},
issn = {1879-0828},
mesh = {Aged ; Aged, 80 and over ; Female ; Gastrointestinal Hemorrhage/etiology/*mortality ; Hospital Mortality ; Humans ; Italy/epidemiology ; Length of Stay/*statistics & numerical data ; Logistic Models ; Male ; *Multimorbidity ; Multivariate Analysis ; Platelet Aggregation Inhibitors/adverse effects ; Prospective Studies ; Registries ; Risk Factors ; Severity of Illness Index ; },
abstract = {BACKGROUND: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients.
METHODS: Since 2008, samples of elderly patients (age ≥ 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed.
RESULTS: 3872 patients were included (mean age 79 ± 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 ± 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 ± 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 ± 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 ± 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51-12.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23-5.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16-4.98) were associated with GIB (p < 0.05).
CONCLUSIONS: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity.},
}
@article {pmid30511196,
year = {2019},
author = {Kline, BP and Schieffer, KM and Choi, CS and Connelly, T and Chen, J and Harris, L and Deiling, S and Yochum, GS and Koltun, WA},
title = {Multifocal Versus Conventional Unifocal Diverticulitis: A Comparison of Clinical and Transcriptomic Characteristics.},
journal = {Digestive diseases and sciences},
volume = {64},
number = {11},
pages = {3143-3151},
pmid = {30511196},
issn = {1573-2568},
mesh = {Adult ; Cohort Studies ; Diverticulitis, Colonic/*diagnostic imaging/*genetics/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sequence Analysis, RNA/*methods ; Transcriptome/*genetics ; },
abstract = {BACKGROUND: The management of diverticulitis is compromised by difficulty in identifying patients who require surgery for recurrent or persistent disease. Here, we introduce the concept of multifocal diverticulitis (MFD), characterized by multiple episodes of diverticulitis occurring at different locations within the colon.
AIMS: To compare clinical characteristics, success of surgical management, and colonic transcriptomes of MFD patients to patients with conventional unifocal diverticulitis (UFD).
METHODS: This retrospective study included 404 patients with CT-confirmed diverticulitis episodes. Patients with diverticulitis seen in at least two different colonic locations were classified as the MFD group and compared to the UFD group based on number of episodes, sites of disease, family history, surgeries performed, and postoperative recurrence. RNA-seq was conducted on full-thickness colonic tissues of ten MFD and 11 UFD patients.
RESULTS: Twenty-eight patients (6.9%) with MFD were identified. MFD patients had more diverticulitis episodes and were more likely to have positive family history, have right-sided disease, require surgery, and have recurrence after surgery. All MFD patients treated with segmental resection had recurrence, while recurrence was less common in patients undergoing more extensive surgery (P < 0.001). Using RNA-seq, we identified 69 genes that were differentially expressed between MFD and UFD patients. Significantly down-regulated genes were associated with immune response pathways.
CONCLUSIONS: MFD appears to be a more severe subset of diverticulitis with a possible genetic component. Transcriptomic data suggest that MFD may be associated with alteration of the immune response.},
}
@article {pmid30510761,
year = {2018},
author = {Dhadlie, S and Mehanna, D},
title = {Rates of colorectal cancer detection in screening colonoscopy post appendicectomy in patients 50 years and over.},
journal = {Annals of medicine and surgery (2012)},
volume = {36},
number = {},
pages = {239-241},
pmid = {30510761},
issn = {2049-0801},
abstract = {Introduction: Acute appendicitis in older adults is relatively uncommon and could be the first presentation of an underlying colorectal carcinoma. Colonoscopy in these individuals affords the opportunity for earlier diagnosis and treatment. The finding of increased rates of colorectal cancer (CRC) with older patients who have had appendicitis was supported by a number of small studies and case reports in the early 1980s.With the advent of CT scanning and laparoscopic appendicectomy, increased ability to visualize the caecum has been achieved.
Purpose: A retrospective 12-month study of all patients presenting with acute appendicitis aged 50 years and over from 1st May 2017 to 31st May 2018, and review of post operative screening colonoscopy findings.
Results: Forty-three patients met inclusion criteria. The patients' median age was 62 years (range 50-85 years). 47% of the patients were male. 86% of patients had abdominal CT scans prior to surgery with acute appendicitis visualized in 97% of these cases. Acute appendicitis was found in 100% of cases with no clinical suggestion of CRC operatively or pathologically. 46% of patients had pertinent findings on colonoscopy. This included a malignant obstructing tumour at the hepatic flexure and a tubular adenoma in the transverse colon in a second patient. The remaining findings in this cohort of patients included diverticular disease and benign polyps.
Conclusion: Despite the advancement in visualization of anatomy with CT scan and laparoscopic appendicectomy there is still a role for screening colonoscopy in patients greater than 50 years of age with appendicitis particularly if they have associated bowel symptoms or risk factors for CRC.},
}
@article {pmid30487956,
year = {2018},
author = {Jones, K and Qassem, MG and Sains, P and Baig, MK and Sajid, MS},
title = {Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial.},
journal = {World journal of gastrointestinal oncology},
volume = {10},
number = {11},
pages = {449-464},
pmid = {30487956},
issn = {1948-5204},
abstract = {AIM: To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).
METHODS: Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
RESULTS: One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.
CONCLUSION: RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.},
}
@article {pmid30487459,
year = {2018},
author = {Dreher, ML},
title = {Whole Fruits and Fruit Fiber Emerging Health Effects.},
journal = {Nutrients},
volume = {10},
number = {12},
pages = {},
pmid = {30487459},
issn = {2072-6643},
support = {NA//Hass Avocado Board/ ; },
mesh = {Cardiovascular Diseases ; *Diet ; *Dietary Fiber ; *Feeding Behavior ; *Fruit ; Gastrointestinal Diseases ; *Health ; Humans ; Mental Disorders ; Metabolic Diseases ; Neoplasms ; Respiratory Tract Diseases ; },
abstract = {Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.},
}
@article {pmid30466667,
year = {2019},
author = {Pearlman, M and Akpotaire, O},
title = {Diet and the Role of Food in Common Gastrointestinal Diseases.},
journal = {The Medical clinics of North America},
volume = {103},
number = {1},
pages = {101-110},
doi = {10.1016/j.mcna.2018.08.008},
pmid = {30466667},
issn = {1557-9859},
mesh = {Dairy Products ; *Diet ; Food ; Gastrointestinal Diseases/*diet therapy/etiology ; Gastrointestinal Tract/physiopathology ; Humans ; Sweetening Agents ; },
abstract = {Food plays an essential role in normal cellular processes; however, certain foods may also trigger or worsen certain disease states. This article focuses particularly on the role of food in common gastrointestinal and liver diseases, and discusses the current evidence that either supports or debunks common dietary recommendations. Nutrition topics discussed include the use of artificial sweetener for weight loss, avoidance of all dairy products in the setting of lactose intolerance, dietary recommendations for diverticular disease, and dietary management in cirrhotic patients with hepatic encephalopathy.},
}
@article {pmid30464167,
year = {2018},
author = {Strati, TM and Sapalidis, K and Koimtzis, GD and Pavlidis, E and Atmatzidis, S and Liavas, L and Chrysogonidis, I and Samoilis, G and Zarampouka, K and Michailidou, K and Kesisoglou, II and Kosmidis, C},
title = {Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature.},
journal = {The American journal of case reports},
volume = {19},
number = {},
pages = {1386-1392},
pmid = {30464167},
issn = {1941-5923},
mesh = {Aged ; Cecal Diseases/diagnosis/*etiology/surgery ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Fistula/*diagnosis/*etiology/surgery ; Intestinal Obstruction/diagnosis/*etiology/surgery ; Sigmoid Diseases/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention. CASE REPORT A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain. The clinical and radiological examinations revealed a recurrent episode of acute diverticulitis of the sigmoid colon. However, it was of great interest that we detected a sigmoido-cecal fistula in the abdominal computed tomography (CT). The patient was admitted to the hospital for conservative treatment. After 48 hours, the patient's clinical status deteriorated, with pain aggravation, abdominal distension, bloating, and metallic bowel sounds. The simple abdominal x-ray revealed large-bowel obstruction and the CT demonstrated worsening inflammation of the sigmoid colon. An exploratory laparotomy revealed an inflamed dolichol-sigmoid colon forming a fistulous tract with the cecum and thus, mimicking a closed loop obstruction. The sigmoid colon was transected en bloc with the sigmoido-cecal fistula and a Hartmann's procedure was performed. CONCLUSIONS This case is extremely unusual as the patient presented at the same time two complications of diverticular disease, both obstruction and this rare formation of sigmoido-cecal fistula. It is presented in order to acquaint surgeons with the possibility of an unexpected course of this disease which indeed necessitates an individualized management.},
}
@article {pmid30458857,
year = {2018},
author = {Partington, R and Helliwell, T and Muller, S and Abdul Sultan, A and Mallen, C},
title = {Comorbidities in polymyalgia rheumatica: a systematic review.},
journal = {Arthritis research & therapy},
volume = {20},
number = {1},
pages = {258},
pmid = {30458857},
issn = {1478-6362},
support = {RP_2014-04-026//Department of Health/United Kingdom ; },
mesh = {Age Factors ; Comorbidity ; Cross-Sectional Studies ; Giant Cell Arteritis/diagnosis/epidemiology ; Humans ; Neoplasms/diagnosis/epidemiology ; Polymyalgia Rheumatica/*diagnosis/*epidemiology ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND AND AIM: Comorbidities are known to exist in many rheumatological conditions. Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition affecting older people which, prior to effective treatment, causes severe disability. Our understanding of associated comorbidities in PMR is based only on case reports or series and small cohort studies. The objective of this study is to review systematically the existing literature on the comorbidities associated with PMR.
METHODS: MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched for original observational research from inception to November 2016. Papers containing the words 'Polymyalgia Rheumatica' OR 'Giant Cell Arteritis' OR the terms 'PMR' OR 'GCA' were included. Article titles were reviewed based on pre-defined criteria by two reviewers. Following selection for inclusion, studies were quality assessed using the Newcastle-Ottawa tool and data were extracted.
RESULTS: A total of 17,329 papers were reviewed and 41 were incorporated in this review, including three published after the search took place. Wide variations were found in study design, comorbidities reported and populations studied. Positive associations were found between PMR diagnosis and stroke, cardiovascular disease, peripheral arterial disease, diverticular disease and hypothyroidism. Two studies reported a positive association between PMR and overall malignancy rate. Seven studies reported an association between PMR and specific types of cancer, such as leukaemia, lymphoma, myeloproliferative disease and specified solid tumours, although nine studies found either no or negative association between cancer and PMR.
CONCLUSION: Quantification of the prevalence of comorbidities in PMR is important to accurately plan service provision and enable identification of cases of PMR which may be more difficult to treat. This review highlights that research into comorbidities in PMR is, overall, methodologically inadequate and does not comprehensively cover all comorbidities. Future studies should consider a range of comorbidities in patients with a validated diagnosis of PMR in representative populations.},
}
@article {pmid30454933,
year = {2018},
author = {Tursi, A and Scarpignato, C},
title = {Symptomatic Uncomplicated Diverticular Disease: Chronic Abdominal Pain in Diverticulosis Is Not Enough to Make the Diagnosis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {16},
number = {12},
pages = {2001-2002},
doi = {10.1016/j.cgh.2018.06.033},
pmid = {30454933},
issn = {1542-7714},
mesh = {Abdominal Pain ; *Diverticular Diseases ; *Diverticulosis, Colonic ; *Diverticulum, Colon ; Humans ; Inflammation ; },
}
@article {pmid30447778,
year = {2019},
author = {Sen, A and Callisen, H and Libricz, S and Patel, B},
title = {Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.},
journal = {Critical care clinics},
volume = {35},
number = {1},
pages = {169-186},
doi = {10.1016/j.ccc.2018.08.011},
pmid = {30447778},
issn = {1557-8232},
mesh = {Aged ; Cardiovascular Diseases/etiology/nursing ; Critical Care Nursing/*standards ; Female ; Gastrointestinal Diseases/etiology/nursing ; Humans ; Infection Control/*standards ; Kidney Diseases/etiology/*nursing ; Male ; Middle Aged ; Nervous System Diseases/etiology/nursing ; Organ Transplantation/*adverse effects/*nursing ; Postoperative Care/*standards ; Postoperative Complications/*etiology/*nursing ; Practice Guidelines as Topic ; },
abstract = {Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.},
}
@article {pmid30444482,
year = {2018},
author = {Spiridakis, KG and Intzepogazoglou, DS and Flamourakis, ME and Sfakianakis, EE and Gkionis, IG and Strataki, KG and Tsagataki, ES and Kostakis, GE and Christodoulakis, MS},
title = {Acute diverticulitis in patients under 50 years of age.},
journal = {Il Giornale di chirurgia},
volume = {34},
number = {5},
pages = {319-322},
pmid = {30444482},
issn = {0391-9005},
mesh = {Acute Disease ; Adult ; Age Distribution ; Age of Onset ; Diverticulitis/diagnostic imaging/*epidemiology/surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Patient Readmission/statistics & numerical data ; Recurrence ; Retrospective Studies ; Sex Distribution ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {Acute diverticulitis typically occurs in patients over 80 years old. The last five years we observed an increased incidence of acute diverticulitis in patients under 50 years. The aim of this study is to evaluate the increased rate of patients under 50 years that are hospitalized due to acute diverticulitis. Also, we aim to confirm the common symptoms for this disease and the laboratory data, the changes in dietary history (Mediterranean diet) and lifestyle and to calculate the differences in the treatment and the severity in the course of the disease, between younger (<50) and older (>50) patients.
PATIENTS AND METHODS: From 2003 to 2008, 118 patients were admitted to our Surgical Department for acute diverticulitis. 32 patients were under 50 years old. In the next five year period (2008-2013) the number of patients under 50 that were admitted due to acute diverticulitis doubled to 183 with 102 patients being over 50 years and 61 patients under 50. For all these patients, the medical and dietary history, laboratory and clinical examinations, radiographic and endoscopic findings were recorded.
RESULTS: For patients aged over 50 years there is a predominance in male sex. Symptoms were the same in both groups and no difference in treatment was noted. Furthermore, readmission and recurrence rates were the same for both groups. The condition was equally aggressive in both groups. The only difference observed was increased obesity rate for patients under 50 and variation from the traditional Mediterranean diet to western diet habits.
CONCLUSIONS: Although our study has limitations it seems that new cases of diverticular disease in patients have increased due to dietary changes, but treatment and severity have remained the same.},
}
@article {pmid30425936,
year = {2018},
author = {Meyer, J and Buchs, NC and Ris, F},
title = {Risk of colorectal cancer in patients with diverticular disease.},
journal = {World journal of clinical oncology},
volume = {9},
number = {6},
pages = {119-122},
pmid = {30425936},
issn = {2218-4333},
abstract = {Colorectal cancer constitutes an important burden on the healthcare system. Screening at-risk populations to reduce colorectal cancer-related morbidity and mortality has become part of good clinical practice. However, recommendations regarding subgroups of patients with diverticular disease are subject to controversy. Herein, we review the most recent literature regarding the prevalence of colorectal cancer in patients with diverticular disease, diverticulitis and uncomplicated diverticulitis. The recent literature does not identify diverticular disease as a long-term risk factor for colorectal cancer. However, the risk of colorectal cancer is increased in the short-term period after hospitalization related to diverticular disease. According to a recent systematic review and meta-analysis, the prevalence of colorectal cancer is 1.6% in patients with acute diverticulitis who underwent colonoscopy. The risk of having colorectal cancer after an episode of acute diverticulitis is 44-fold higher than that of an age- and gender-adjusted reference population. Despite lower among patients with uncomplicated episode, the risk of colorectal cancer remains 40-fold higher in that subpopulation than that in the reference population. To conclude, the recent literature describes an increased risk of colorectal cancer among patients with acute diverticulitis compared to the reference population. Colonoscopy is therefore recommended in patients with diverticulitis to exclude colorectal cancer.},
}
@article {pmid30413459,
year = {2018},
author = {Syed, H and Syed, L and Parampalli, U and Uheba, M},
title = {Adult intussusception secondary to diverticular disease.},
journal = {BMJ case reports},
volume = {2018},
number = {},
pages = {},
pmid = {30413459},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Colon, Sigmoid/diagnostic imaging/surgery ; Constriction, Pathologic/complications/diagnostic imaging/surgery ; Diagnosis, Differential ; Diverticular Diseases/*complications/diagnostic imaging/*surgery ; Humans ; Intestinal Obstruction/complications/diagnostic imaging/surgery ; Intussusception/diagnostic imaging/*etiology/*surgery ; Male ; Tomography, X-Ray Computed ; },
abstract = {Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.},
}
@article {pmid30407258,
year = {2019},
author = {Alamo, RZ and Quigley, EMM},
title = {Irritable bowel syndrome and colonic diverticular disease: overlapping symptoms and overlapping therapeutic approaches.},
journal = {Current opinion in gastroenterology},
volume = {35},
number = {1},
pages = {27-33},
doi = {10.1097/MOG.0000000000000499},
pmid = {30407258},
issn = {1531-7056},
mesh = {Abdominal Pain ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diagnosis, Differential ; Diverticulosis, Colonic/*diagnosis/therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Irritable Bowel Syndrome/*diagnosis/therapy ; Mesalamine/*therapeutic use ; Probiotics/*therapeutic use ; Randomized Controlled Trials as Topic ; Rifaximin/*therapeutic use ; },
abstract = {PURPOSE OF REVIEW: Irritable bowel syndrome (IBS) is a common symptomatic disorder in the Western world and colonic diverticula are also prevalent; however, relationships between IBS-type symptoms and diverticula have been a source of much debate. Our goal was to reassess these relationships in the light of new data.
RECENT FINDINGS: On removing from consideration clinical scenarios which are directly related to diverticula (i.e., diverticulitis, diverticular hemorrhage, and complications of diverticulitis, such as stricture and fistula), relationships between IBS and diverticula can be seen to revolve around a number of questions. First, are IBS and symptomatic uncomplicated diverticular disease (SUDD) the same condition? Or, in other words is SUDD no more than IBS in an individual who just happens to have diverticula? Although coincident IBS and diverticula inevitably do occur there is some evidence to indicate that SUDD may be somewhat distinctive with SUDD being characterized by more frequent and severe pain. Second, and analogous to interactions between IBS and inflammatory bowel disease or celiac disease, can an episode of acute diverticulitis lead to the de novo development of IBS? There is now epidemiological and pathophysiological evidence to support this occurrence.
SUMMARY: Although relationships between uncomplicated diverticular disease and IBS have been reexamined their status remains unclear. As yet, however, none of the newer concepts related to this relationship have led to new therapeutic approaches in IBS or diverticular disease.},
}
@article {pmid30406387,
year = {2019},
author = {Cassini, D and Depalma, N and Grieco, M and Cirocchi, R and Manoochehri, F and Baldazzi, G},
title = {Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure.},
journal = {Surgical endoscopy},
volume = {33},
number = {8},
pages = {2583-2590},
pmid = {30406387},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Diverticulitis/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/methods ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; *Robotic Surgical Procedures/adverse effects ; },
abstract = {BACKGROUND: Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis.
METHODS: Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon's compliance were evaluated.
RESULTS: One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon's compliance revealed a better performance in the robotic arm (p 0.059).
CONCLUSIONS: This preliminary study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon's compliance.},
}
@article {pmid30395126,
year = {2018},
author = {Mohammed Ilyas, MI and Haggstrom, DA and Maggard-Gibbons, MA and Wendel, CS and Rawl, S and Schmidt, CM and Ko, CY and Krouse, RS},
title = {Patients With Temporary Ostomies: Veterans Administration Hospitals Multi-institutional Retrospective Study.},
journal = {Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society},
volume = {45},
number = {6},
pages = {510-515},
doi = {10.1097/WON.0000000000000478},
pmid = {30395126},
issn = {1528-3976},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colorectal Neoplasms/surgery ; Colostomy/methods/statistics & numerical data ; Diverticular Diseases/surgery ; Humans ; Ileostomy/methods/statistics & numerical data ; Male ; Middle Aged ; Ostomy/*methods/*statistics & numerical data ; Psychometrics/instrumentation/methods ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; United States ; United States Department of Veterans Affairs/organization & administration/statistics & numerical data ; },
abstract = {PURPOSE: The purpose of this study was to describe clinical outcomes of patients with temporary ostomies in 3 Veterans Health Administration hospitals.
DESIGN: Retrospective descriptive study, secondary analysis.
SAMPLE AND SETTING: Veterans with temporary ostomies from 3 Veterans Health Administration hospitals who were enrolled in a previous study. The sample comprised 36 participants all were male. Their mean age was 67.05 ± 9.8 years (mean ± standard deviation). Twenty patients (55.6%) had ileostomies and 16 patients (44.4%) had colostomies.
METHODS: This was a secondary analysis of data collected using medical record data. Variables examined included etiology for creation and type of ostomy, health-related quality of life, time to reversal, reasons for nonreversal, postoperative complications after reversal, and mortality in the follow-up period.
RESULTS: Colorectal cancer and diverticular disease were the main reasons for temporary stoma formation. The reversal rate was 50%; the median time to reversal was 9 months in our sample; temporary ileostomies were reversed more often than temporary colostomies (P = .18). Comorbid conditions were identified as the main reason for nonreversal. Mortality was not significantly different between the reversal and nonreversal groups. No significant differences were reported with health-related quality-of-life parameters between reversal and nonreversal groups.
CONCLUSIONS: This study identified that the proportion of temporary ostomies was limited to 50%. Complications during the index operation, medical comorbidities, and progression of cancer are the main reasons for nonreversal of temporary stomas. Study findings should be included in the counseling of patients who are likely to get intestinal stomas with temporary intention, and during consideration for later reversal of a stoma.},
}
@article {pmid30342390,
year = {2018},
author = {Kao, EN and Liao, KH and Chen, TW and Chan, DC and Yu, JC},
title = {Colon perforation caused by swallowing a shrimp leg: A case report.},
journal = {International journal of surgery case reports},
volume = {52},
number = {},
pages = {114-116},
pmid = {30342390},
issn = {2210-2612},
abstract = {INTRODUCTION: Ingestion of a foreign body rarely results in perforation of the gastrointestinal tract. Foreign bodies such as dentures, fish bones, chicken bones, toothpicks and cocktail sticks have been known to cause bowel perforation; however, bowel perforation caused by shrimp leg has not been reported so far.
PRESENTATION OF CASE: We report a case of a 69-years-old man who presented with a 4-months epigastric pain. Laboratory data revealed inflammation at the first hospital visit. Computed tomography revealed a hypodense lesion containing a hyperdense foreign body in the abdomen. Intra-abdominal abscess caused by foreign body perforation was diagnosed.
DISCUSSION: An increased incidence of perforation has been reported in association with Meckel's diverticulum, the appendix, and diverticular disease. The abdominal abscess in this case was located beside the diverticulum of transverse colon, so the perforation most likely occurred in the diverticulum of transverse colon.
CONCLUSION: Perforation of colon by shrimp leg is very rare and not reported currently. Although some cases have been successfully treated chronic foreign-body perforation with abscess by using antibiotics alone, typical treatments remains surgical drainage of the abscess and removal of foreign body.},
}
@article {pmid30320044,
year = {2018},
author = {Iannone, A and Ruospo, M and Wong, G and Barone, M and Principi, M and Di Leo, A and Strippoli, GFM},
title = {Mesalazine for People with Diverticular Disease: A Systematic Review of Randomized Controlled Trials.},
journal = {Canadian journal of gastroenterology & hepatology},
volume = {2018},
number = {},
pages = {5437135},
pmid = {30320044},
issn = {2291-2797},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticular Diseases/diagnosis/drug therapy ; Diverticulitis/diagnosis/*drug therapy ; Diverticulum, Colon/diagnosis/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*therapeutic use ; *Quality of Life ; Randomized Controlled Trials as Topic ; Risk Assessment ; Treatment Outcome ; },
abstract = {Background: Diverticular disease treatment is limited to fibres, antibiotics, and surgery. There is conflicting evidence on mesalazine benefits and harms.
Aim: We systematically reviewed current evidence on benefits and harms of mesalazine versus all other treatments in people with diverticular disease.
Methods: We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov for studies published to July 2018. We estimated risk ratios (RR) for dichotomous outcomes (disease remission/recurrence, acute diverticulitis in symptomatic uncomplicated diverticular disease, need for surgery/hospitalization, all-cause/disease-related mortality, adverse events), mean differences (MD) or standardized MD (SMD) for continuous outcomes (quality of life, symptoms score, time to recurrence/remission), and their 95% confidence intervals (CI) using random-effects models. We quantified heterogeneity by Chi2 and I2 tests. We performed subgroup analyses by disease subtype, comparator, follow-up duration, mesalazine dose, and mode of administration.
Results: We identified 13 randomized trials (n=3028 participants). There was a higher likelihood of disease remission with mesalazine than controls in acute uncomplicated diverticulitis (1 trial, 81 participants, RR=2.67, 95%CI=1.05-6.79), but not in symptomatic uncomplicated diverticular disease (1 trial, 123 participants, RR=1.04, 95%CI=0.81-1.34). There was a lower likelihood of disease recurrence with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 216 participants, RR=0.52, 95%CI=0.28-0.97), but not in acute uncomplicated diverticulitis (7 trials, 2196 participants, RR=0.90, 95%CI=0.61-1.33). There was no difference in the likelihood of developing acute diverticulitis in symptomatic uncomplicated diverticular disease between the two groups (3 trials, 484 participants, RR=0.26, 95%CI=0.06-1.20). There was a higher global symptoms score reduction with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 326 participants, SMD=-1.01, 95%CI=-1.51,-0.52) and acute uncomplicated diverticulitis (2 trials, 153 participants, SMD=-0.56, 95%CI=-0.88,-0.24).
Conclusions: Mesalazine may reduce recurrences in symptomatic uncomplicated diverticular disease. There is uncertainty on the effect of mesalazine in achieving diverticular disease remission. Mesalazine may not prevent acute diverticulitis in symptomatic uncomplicated diverticular disease.},
}
@article {pmid30293416,
year = {2019},
author = {Elisei, W and Brandimarte, G and Tursi, A},
title = {Diverticulosis today.},
journal = {Minerva gastroenterologica e dietologica},
volume = {65},
number = {1},
pages = {42-52},
doi = {10.23736/S1121-421X.18.02525-4},
pmid = {30293416},
issn = {1827-1642},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Dietary Fiber/administration & dosage ; Diverticulitis/therapy ; Diverticulum/diagnosis/*therapy ; Gastrointestinal Agents/therapeutic use ; Humans ; Mesalamine/therapeutic use ; Primary Prevention ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; Secondary Prevention ; Terminology as Topic ; },
abstract = {The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the prevalence of diverticular disease of the colon, including acute diverticulitis, is substantial and is becoming a significant burden on National Health Systems in terms of direct and indirect costs. Fiber, non-absorbable antibiotics and probiotics seem to be effective in treating symptomatic and uncomplicated patients, and 5-aminosalicylic acid might help prevent acute diverticulitis. Unfortunately, robust evidence on the effectiveness of a medical strategy to prevent acute diverticulitis recurrence is still lacking. Focus is now being drawn on identifying a new endoscopic classification of the disease to evaluate the correct therapeutic approach by testing various treatments.},
}
@article {pmid30291995,
year = {2018},
author = {Cuomo, R and Cargiolli, M and Cassarano, S and Carabotti, M and Annibale, B},
title = {Treatment of diverticular disease, targeting symptoms or underlying mechanisms.},
journal = {Current opinion in pharmacology},
volume = {43},
number = {},
pages = {124-131},
doi = {10.1016/j.coph.2018.09.006},
pmid = {30291995},
issn = {1471-4973},
mesh = {Animals ; Dietary Fiber/*administration & dosage/adverse effects ; Diverticular Diseases/epidemiology/physiopathology/*prevention & control/therapy ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Primary Prevention/*methods ; Probiotics/adverse effects/*therapeutic use ; Risk Factors ; Secondary Prevention/*methods ; Treatment Outcome ; },
abstract = {Diverticular disease (DD) is a highly prevalent disease in western industrialized countries that encompasses a complex set of disorders. Because of its complexity and heterogeneity, both from a pathogenic and a clinical point of view, the management of this disease represent a challenge in clinical practice. This review aims to analyze and summarize the most recent evidence on the medical strategies for DD, considering separately the different stages of the disease, from prevention of diverticula formation to treatment of acute diverticulitis and prevention of recurrences. Based on some evidence, dietary fiber is useful to prevent diverticula formation and in diverticulosis, with no pharmacological treatment in these settings. Treatment of symptomatic uncomplicated diverticular disease as well as primary prevention of acute diverticulitis is based on probiotics, fibres, mesalazine and rifaximin, individually or as combination therapy, although a standard approach has not yet been defined. On the contrary, in acute diverticulitis (AD) recent acquisitions have clarified and standardized the role of systemic antibiotics, reserving its use only to complicated forms and in selected cases of uncomplicated disease. Secondary prevention of AD is essentially based on mesalazine and rifaximin but, despite promising results, no strong evidence have been produced. To date, grey areas remain in the medical management of DD.},
}
@article {pmid30274796,
year = {2019},
author = {Pauza, AG and Rysevaite-Kyguoliene, K and Malinauskas, M and Lukosiene, JI and Alaburda, P and Stankevicius, E and Kupcinskas, J and Saladzinskas, Z and Tamelis, A and Pauziene, N},
title = {Alterations in enteric calcitonin gene-related peptide in patients with colonic diverticular disease: CGRP in diverticular disease.},
journal = {Autonomic neuroscience : basic & clinical},
volume = {216},
number = {},
pages = {63-71},
doi = {10.1016/j.autneu.2018.09.006},
pmid = {30274796},
issn = {1872-7484},
mesh = {Adult ; Aged ; Aged, 80 and over ; Calcitonin Gene-Related Peptide/*metabolism/pharmacology ; Calcitonin Receptor-Like Protein/metabolism ; Colon, Sigmoid/metabolism ; Diverticulosis, Colonic/*metabolism ; Female ; Humans ; Male ; Middle Aged ; Muscle, Smooth/drug effects ; },
abstract = {Diverticular disease (DD) is one of the most prevalent diseases of the large bowel. Lately, imbalance of neuro-muscular transmission has been recognized as a major etiological factor for DD. Neuronal calcitonin gene-related peptide (CGRP) is a potent gastrointestinal smooth muscle relaxant shown to have a widespread effect within the alimentary tract. Nevertheless, CGRPergic innervation of the enteric ganglia has never been considered in the context of motility impairment observed in DD patients. Changes in CGRP and calcitonin receptor-like receptor (CRLR) abundance within enteric ganglia were investigated in sigmoid samples from symptomatic and asymptomatic DD patients using quantitative fluorescence microscopy. CGRP effect on gastrointestinal smooth muscle was investigated using organ bath technique. We found CGRP levels within the enteric ganglia to be declined by up to 52% in symptomatic DD patients. Conversely, CRLR within the enteric ganglia was upregulated by 41% in symptomatic DD. Longitudinal smooth muscle displayed an elevated (+10.5%) relaxant effect to the exogenous application of CGRP in colonic strips from symptomatic DD patients. Samples from asymptomatic DD patients consistently showed intermediate values across different experiments. In conclusion, the present study demonstrates that CGRPergic signaling is subject to alteration in DD. Our results suggest that a hypersensitization mechanism to gradually decreasing levels of CGRP-IR nerve fibers takes place during DD progression. Alterations to CGRPergic signaling in DD disease may have implications for physiological abnormalities associated with colonic DD.},
}
@article {pmid30265178,
year = {2018},
author = {Rosenlund, IM and Leivseth, L and Førde, OH and Revhaug, A},
title = {Regional variation in hospitalizations and outpatient appointments for diverticular disease in Norway: a nationwide cross-sectional study.},
journal = {Scandinavian journal of gastroenterology},
volume = {53},
number = {10-11},
pages = {1228-1235},
doi = {10.1080/00365521.2018.1506047},
pmid = {30265178},
issn = {1502-7708},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diverticular Diseases/*epidemiology/therapy ; Endoscopy, Gastrointestinal/statistics & numerical data ; Female ; Geography, Medical/statistics & numerical data ; Hospitalization/*statistics & numerical data/*trends ; Humans ; Male ; Middle Aged ; Norway/epidemiology ; Outpatients/*statistics & numerical data ; Sex Distribution ; Surgical Procedures, Operative/statistics & numerical data ; },
abstract = {OBJECTIVE: To investigate the use of specialized health care services for diverticular disease in different hospital referral regions in Norway.
MATERIALS AND METHODS: Nationwide cross-sectional study with data from the Norwegian Patient Registry and Statistics Norway. All Norwegian inhabitants aged 40 years and older in the years 2012-16 (2,517,938) were included. We obtained the rates (n/100,000 population) for hospitalizations, outpatient appointments, and surgery for diverticular disease for the population in each hospital referral region. We also quantified the use of lower gastrointestinal (LGI) endoscopy in hospitalizations and outpatient appointments for diverticular disease and the use of LGI endoscopy performed on any indication.
RESULTS: There were 131 hospitalizations and 381 outpatient appointments for diverticular disease per 100,000 population annually. Hospitalization rates varied 1.9-fold across regions from 94 to 175. Outpatient appointment rates varied 2.5-fold across regions from 258 to 655. Outpatient appointments were strongly correlated to hospitalizations (rs=0.75, p < .001) and outpatient LGI endoscopy for any indication (rs=0.67, p < .001). Hospitalization and surgery rates remained stable over the study period, while outpatient appointment rates increased by 37%. Concurrently, rates of outpatient LGI endoscopy performed on any indication increased by 35%.
CONCLUSION: There was considerable regional variation in both hospitalizations and outpatient appointments for diverticular disease. The extent of variation and the correlation with diagnostic intensity of LGI endoscopy indicate that the regional variation in health care utilization for diverticular disease to a large extent can be explained by regional differences in clinical practice rather than disease burden.},
}
@article {pmid33655142,
year = {2018},
author = {Ostosh, AC and Saleh, A and Boehm, KM},
title = {An Atypical Case of Transverse Diverticulitis and the Changing Management of Diverticular Disease.},
journal = {Spartan medical research journal},
volume = {3},
number = {2},
pages = {6979},
pmid = {33655142},
issn = {2474-7629},
abstract = {Diverticulitis is an inflammation of an out pouching of the lower gastrointestinal tract, particularly in the large intestine. Although the condition is taught to medical students as typically occurring in the left lower quadrant of the abdomen, right-sided and transverse forms diverticulitis can occur. Uncomplicated, e.g., non-perforated, diverticulitis is usually treated with antibiotics. Complicated, e.g. perforated, is usually treated with surgery. The purpose of this case report is to present an atypical case of perforated diverticulitis and review current recommendations for this condition. This was a case of transverse diverticulitis in a man in his late 40's who recovered with non-operative treatment. The widespread use of computerized tomography (CT) scans makes diagnosing diverticular disease relatively simple, but treatment is evolving. The case summarized here shows that less invasive measures can be used in treating both complicated and uncomplicated diverticular disease. After an uncomplicated in-patient admission for intravenous antibiotics, the patient was discharged in stable condition with a prescription for oral antibiotics and clinic follow-up. Classic medical school teaching concerning treatments for complicated and uncomplicated forms of diverticulitis have been updated but require further research testing.},
}
@article {pmid30240473,
year = {2018},
author = {Picchio, M and Elisei, W and Tursi, A},
title = {Mesalazine to treat symptomatic uncomplicated diverticular disease and to prevent acute diverticulitis occurrence. A systematic review with meta-analysis of randomized, placebo-controlled trials.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {3},
pages = {291-297},
doi = {10.15403/jgld.2014.1121.273.pic},
pmid = {30240473},
issn = {1842-1121},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use ; Diverticulitis, Colonic/diagnosis/epidemiology/*prevention & control ; Diverticulum, Colon/diagnosis/*drug therapy/epidemiology ; Female ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Male ; Mesalamine/adverse effects/*therapeutic use ; Middle Aged ; Primary Prevention/*methods ; Randomized Controlled Trials as Topic ; Risk Factors ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND AND AIMS: Symptomatic Uncomplicated Diverticular disease (SUDD) affects about 25% of patients harboring colonic diverticula. We assessed the effectiveness of mesalazine in improving symptoms (namely abdominal pain, primary outcome) and in preventing diverticulitis occurrence (secondary outcome) in patients with SUDD.
METHODS: Pertinent studies were selected from the Medline and the Cochrane Central Register of Controlled Trials. Only randomized clinical trials (RCTs) (irrespective of language, blinding, or publication status), which compared mesalazine, irrespective of the dosage assumption, with placebo in SUDD were evaluated.
RESULTS: Four RCTs enrolled 379 patients, 197 treated with mesalazine and 182 with placebo. Two studies provided data on symptom relief according to definition: it was achieved in 97/121 (80%) patients in the mesalazine group and in 81/129 (62.7%) patients in the placebo group (OR 0.43; 95% CI 0.24-0.75; p=0.003 in favour of the mesalazine group). Two studies provided information regarding occurrence of diverticulitis during follow-up. It occurred in 23/119 (19.3%) patients in the mesalazine group and in 34/102 (33.3%) patients in the placebo group (OR 0.35; 95% CI 0.17-0.70; p=0.003 in favour of the mesalazine group).
CONCLUSIONS: Treatment with mesalazine seems to be effective in achieving symptom relief and in the primary prevention of diverticulitis in patients with SUDD.},
}
@article {pmid30228909,
year = {2018},
author = {Patel, A and Mahendran, K and Collins, M and Abdelaziz, M and Khogali, S and Luckraz, H},
title = {Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications.},
journal = {Open heart},
volume = {5},
number = {2},
pages = {e000855},
pmid = {30228909},
issn = {2053-3624},
abstract = {Objectives: The aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre-transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients.
Methods: Consecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient's history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis.
Results: Seventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98).
Conclusions: Incidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.},
}
@article {pmid30223660,
year = {Summ},
author = {Špičák, J and Kučera, M and Suchánková, G},
title = {Diverticular disease: diagnosis and treatment.},
journal = {Vnitrni lekarstvi},
volume = {64},
number = {6},
pages = {621-634},
pmid = {30223660},
issn = {0042-773X},
mesh = {Acute Disease ; Adult ; *Anti-Bacterial Agents/therapeutic use ; *Diverticulitis/complications/diagnosis/therapy ; Drainage ; Humans ; *Peritonitis/etiology ; },
abstract = {Diverticular disease is one of the most common gastroenterological diseases. Its morphological basis are diverticula, whose prevalence in adults nears 50 %, with 25% clinical symptomatology and 5% occurrence of complications. It is a disease of older age, however its incidence is also rising in younger individuals, where it takes a more severe course. Its incidence is ascribed to a diet with a relatively low fibre content, however studies do not yield such clear results. Further risk factors include smoking, use of opiates and corticoids, obesity, alcoholism and smoking, hypertension, polycystosis, immunosuppression and use of non-steroid antiflogistics. Patients with diverticular disease also present with abnormal intestinal motility, intestinal dysbiosis and other physiological and morphological abnormalities. The most types of diverticulosis occur in the sigmoid colon, though especially in Asia the colon ascendens is more frequently affected. There are several classification schemes among which an individual assessment of complications is gaining in importance. The diagnosis includes clinical data, routine laboratory tests for inflammation, calprotectin in stool, coloscopy, ultrasound, CT and magnetic resonance. The basis for the treatment of symptomatic uncomplicated diverticular disease consists of drugs bringing symptomatic relief, fibre, probiotics, mesalazine and non-absorbable antibiotics, nonetheless the results of a number of studies are not fully convincing. The recommended treatment should be initiated with dietary fibre and probiotics, in the case of lasting problems add a non-absorbable antibiotic rifaximine with cyclic administration. Mild diverticulitis should essentially be treated by means of hydration and adjustments in the dietary regimen, antibiotics are not necessary when its course is uncomplicated and improvement is achieved, however the decision is individual and risk factors such as immunosuppression, diabetes, old age, pregnancy etc. Antibiotics are reserved for the treatment of severe or repeated diverticulitis, sepsis and complications. As prevention of further attacks, again probiotics, mesalazine and cyclically non-absorbable antibiotics are used, e,g. for a period of 10 days at monthly intervals. The proportion of surgeries is decreasing also where acute conditions are concerned and the efficiency of conservative treatment of diverticulitis is on the increase. Abscess should primarily be treated via non-surgical drainage. Even perforation and peritonitis can be treated via laparoscopic drainage without subsequent surgery being necessary, of course considering an overall condition an individual decision needs to be made. Generalized and fecal peritonitis are treated by open surgery. Earlier, elective resection was recommended after 2 attacks of diverticulitis, currently an individual approach is emphasized with respect to age, comorbidities and a character of the complaint and it is only indicated exceptionally. The proportion of laparoscopic resections is growing. The results are basically identical for Hartmann's procedure as well as primary resection. Key words: calprotecin - diverticular disease - dietary fibre - diverticulosis - mesalazine - non-absorbable antibiotics - probiotics.},
}
@article {pmid30219818,
year = {2019},
author = {Urabe, M and Nishida, T and Shimakoshi, H and Shimoda, A and Amano, T and Sugimoto, A and Takahashi, K and Mukai, K and Matsubara, T and Yamamoto, M and Hayashi, S and Nakajima, S and Fukui, K and Tanida, T and Komori, T and Morita, S and Inada, M},
title = {Distinct Clinical Factors in Hospitalized Patients with Diverticular Bleeding and Diverticulitis.},
journal = {Digestion},
volume = {99},
number = {3},
pages = {239-246},
doi = {10.1159/000491875},
pmid = {30219818},
issn = {1421-9867},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*epidemiology/etiology/therapy ; Diverticulum/*complications/therapy ; Female ; Gastrointestinal Hemorrhage/*epidemiology/etiology/therapy ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*adverse effects ; Prevalence ; Retrospective Studies ; Risk Factors ; Young Adult ; },
abstract = {BACKGROUND/AIMS: It is unclear why colonic diverticular bleeding and diverticulitis rarely coexist. This study compared the characteristics of these conditions.
METHODS: This single-center retrospective study examined 310 consecutive patients hospitalized with an episode of diverticular disease (cases) and outpatients without a diverticular episode (controls) from January 2012 to December 2015. We investigated distinct clinical factors in hospitalized patients with diverticular bleeding and diverticulitis.
RESULTS: We identified 183 patients with 263 episodes of diverticular bleeding and 127 patients with 135 episodes of diverticulitis during the study period. Patients with diverticular bleeding were significantly older than those with diverticulitis (median age 76 vs. 56 years) and had more cardiovascular disease, hypertension, diabetes, cerebrovascular disease, chronic kidney disease, lipid disorder, or a poorer performance status. Significantly more diverticular bleeding patients were taking antiplatelet drugs, anticoagulant drugs, proton pump inhibitors, or laxative agents. Multivariate analysis revealed that an age > 65 years (OR 5.42), and antiplatelet agent use (OR 7.29) were more significant risk factors for diverticular bleeding than for diverticulitis.
CONCLUSIONS: Elderly people using antiplatelet drugs may be more susceptible to diverticular bleeding than diverticulitis.},
}
@article {pmid30204549,
year = {2018},
author = {Huston, JM and Zuckerbraun, BS and Moore, LJ and Sanders, JM and Duane, TM},
title = {Antibiotics versus No Antibiotics for the Treatment of Acute Uncomplicated Diverticulitis: Review of the Evidence and Future Directions.},
journal = {Surgical infections},
volume = {19},
number = {7},
pages = {648-654},
doi = {10.1089/sur.2018.115},
pmid = {30204549},
issn = {1557-8674},
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Humans ; Treatment Outcome ; },
abstract = {BACKGROUND: Acute diverticulitis occurs in 25% of individuals with diverticular disease and is associated with significant morbidity and mortality rates. Disease severity is classified as uncomplicated or complicated, with the latter including perforation, fistula, obstruction, or distant abscess. Uncomplicated diverticulitis often improves without surgery or invasive therapies. Administration of antibiotics is a standard of care for treatment of acute uncomplicated diverticulitis. However, recent data suggest antibiotics do not influence outcomes significantly. To address these conflicting approaches, the Surgical Infection Society hosted an Update Symposium at its 37th Annual Meeting examining the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Here, we provide a synopsis of the symposium's findings and a brief review of recent prospective and randomized clinical trials on the topic.
METHODS: A search of Embase, MEDLINE, and the Cochrane Library was performed for prospective series and randomized clinical trials published between January 1, 2010, and January 1, 2018, comparing outcomes of antibiotic versus no antibiotic therapy for acute uncomplicated diverticulitis.
RESULTS: We identified two single-center prospective series and two randomized clinical trials comparing outcomes for patients with acute uncomplicated diverticulitis treated with antibiotics versus no antibiotics.
CONCLUSION: Current evidence does not support administration of antibiotics to improve outcomes in carefully selected healthy patients with acute uncomplicated left-sided diverticulitis. Further studies should help identify specific subpopulations of patients who would derive benefit from antibiotic therapy and help define appropriate antibiotic regimens and treatment durations that minimize cost, adverse effects, and risk of anti-microbial resistance.},
}
@article {pmid30177863,
year = {2018},
author = {Maguire, LH and Handelman, SK and Du, X and Chen, Y and Pers, TH and Speliotes, EK},
title = {Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease.},
journal = {Nature genetics},
volume = {50},
number = {10},
pages = {1359-1365},
pmid = {30177863},
issn = {1546-1718},
support = {MC_PC_17228/MRC_/Medical Research Council/United Kingdom ; MC_QA137853/MRC_/Medical Research Council/United Kingdom ; R01 DK106621/DK/NIDDK NIH HHS/United States ; R01 DK107904/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Case-Control Studies ; Diverticular Diseases/epidemiology/*genetics ; Female ; Genetic Loci ; Genetic Predisposition to Disease ; *Genome-Wide Association Study/methods/statistics & numerical data ; Humans ; Male ; Middle Aged ; *Polymorphism, Single Nucleotide ; *Quantitative Trait Loci ; United Kingdom/epidemiology ; },
abstract = {Diverticular disease is common and has a high morbidity. Treatments are limited owing to the poor understanding of its pathophysiology. Here, to elucidate its etiology, we performed a genome-wide association study of diverticular disease (27,444 cases; 382,284 controls) from the UK Biobank and tested for replication in the Michigan Genomics Initiative (2,572 cases; 28,649 controls). We identified 42 loci associated with diverticular disease; 39 of these loci are novel. Using data-driven expression-prioritized integration for complex traits (DEPICT), we show that genes in these associated regions are significantly enriched for expression in mesenchymal stem cells and multiple connective tissue cell types and are co-expressed with genes that have a role in vascular and mesenchymal biology. Genes in these associated loci have roles in immunity, extracellular matrix biology, cell adhesion, membrane transport and intestinal motility. Phenome-wide association analysis of the 42 variants shows a common etiology of diverticular disease with obesity and hernia. These analyses shed light on the genomic landscape of diverticular disease.},
}
@article {pmid30169396,
year = {2020},
author = {McKenna, NP and Bews, KA and Behm, KT and Mathis, KL and Lightner, AL and Habermann, EB},
title = {Do Patients With Inflammatory Bowel Disease Have a Higher Postoperative Risk of Venous Thromboembolism or Do They Undergo More High-risk Operations?.},
journal = {Annals of surgery},
volume = {271},
number = {2},
pages = {325-331},
doi = {10.1097/SLA.0000000000003017},
pmid = {30169396},
issn = {1528-1140},
mesh = {Adult ; Aged ; *Digestive System Surgical Procedures ; Female ; Humans ; Inflammatory Bowel Diseases/*surgery ; Male ; Middle Aged ; Postoperative Complications/*epidemiology/prevention & control ; Risk Factors ; United States ; Venous Thromboembolism/*epidemiology/prevention & control ; },
abstract = {OBJECTIVE: To determine the relative or combined effects of Crohn disease (CD) and ulcerative colitis (UC) and the operation performed on postoperative venous thromboembolism (VTE) to better guide recommendations on extended VTE prophylaxis.
SUMMARY BACKGROUND DATA: There is growing evidence to suggest patients with inflammatory bowel disease have an increased risk of postoperative VTE, but prior studies have not accounted for the operation performed nor acknowledged differences between CD and UC.
METHODS: The American College of Surgeons National Surgical Quality Improvement Project database from 2005 to 2016 was queried for patients with a diagnosis of CD, UC, malignancy, or benign disease (diverticular disease, Clostridium difficile) undergoing major abdominal surgery. Operations with a VTE rate >3% were designated high risk. Operation-specific univariate and multivariable logistic regression analyses were conducted.
RESULTS: A total of 231,718 operations were analyzed with 4426 patients experiencing a VTE (1.9%). The overall rate of VTE ranged widely based on the operation performed from 0.7% for enterostomy closure to 5.3% for open subtotal colectomy. Seven operations met our threshold of 3% to be considered high risk. For each operation, postoperative VTE rates were similar regardless of diagnostic indication when performed in the elective setting. However, when performed emergently, the same operations had significantly higher VTE rates. Compared with the malignancy and benign disease groups, neither CD nor UC was associated with increased odds of VTE after any operation.
CONCLUSIONS: Postoperative VTE risk varies widely by the operation performed, and a diagnostic indication of CD or UC does not play a role. Extended duration VTE prophylaxis should be considered in all patients undergoing high-risk operations, regardless of their underlying diagnosis.},
}
@article {pmid30155336,
year = {2018},
author = {Kuhn, G and Lekeufack, JB and Chilcott, M and Mbaidjol, Z},
title = {Subcutaneous Emphysema Caused by an Extraperitoneal Diverticulum Perforation: Description of Two Rare Cases and Review of the Literature.},
journal = {Case reports in surgery},
volume = {2018},
number = {},
pages = {3030869},
pmid = {30155336},
issn = {2090-6900},
abstract = {The onset of colon diverticular disease is a frequent event, with a prevalence that increases with age. Amongst possible complications, free peritoneal perforation with abscess formation may occur. We herein describe two rare presentations of an extraperitoneal sigmoid diverticulum perforation. Our first patient, an 89-year-old female with no signs of distress, developed a subcutaneous abscess and emphysema in an incisional hernia following an appendectomy through a McBurney incision. The second patient, an 82-year-old female, was in general distress at the time of her admission and had a more advanced infection following the occurrence of a sigmoid perforation in a hernial sac. Complicated diverticulitis has a known course and evolution, but with an extraperitoneal presentation, this etiology is not expected. A computed tomography (CT) scan should be completed if the patient is hemodynamically stable, and wide debridement should be performed. Subcutaneous emphysema with an acute abdomen may be a sign of sigmoid perforation. Clinicians should keep this etiology in mind, regardless of the initial presentation.},
}
@article {pmid30151643,
year = {2019},
author = {Storz, C and Rothenbacher, T and Rospleszcz, S and Linseisen, J and Messmann, H and De Cecco, CN and Machann, J and Lorbeer, R and Kiefer, LS and Wintermeyer, E and Rado, SD and Nikolaou, K and Elser, S and Rathmann, W and Reiser, MF and Peters, A and Schlett, CL and Bamberg, F},
title = {Characteristics and associated risk factors of diverticular disease assessed by magnetic resonance imaging in subjects from a Western general population.},
journal = {European radiology},
volume = {29},
number = {3},
pages = {1094-1103},
pmid = {30151643},
issn = {1432-1084},
mesh = {Aged ; Body Mass Index ; Cohort Studies ; Colon/*pathology ; Diverticular Diseases/*diagnosis/epidemiology ; Female ; Germany/epidemiology ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; },
abstract = {OBJECTIVES: Diverticular disease represents an increasing pathology and healthcare burden worldwide. Our aim was to study the prevalence, extent and distribution of asymptomatic diverticular disease assessed by magnetic resonance imaging (MRI) in a sample of a Western population.
METHODS: Subjects from a population-based cohort study who underwent 3-T MRI were analyzed for the prevalence and extent of diverticula of the colon using an isotropic VIBE-Dixon gradient-echo sequence. The extent of diverticular disease was categorized according to the number of diverticula in each colonic segment. Univariate and adjusted analyses were performed to assess associated characteristics and risk factors.
RESULTS: Among 393 subjects included in the analysis (56.4 ± 9.2 years, 57.5% males), 164 (42%) had diverticular disease, with the highest prevalence in the left-sided colonic segments (93% diverticular disease in the descending and sigmoid segment). Subjects with advanced diverticular disease were older (62.1 vs. 54.4 years) and had a higher body mass index (BMI), LDL cholesterol levels and systolic blood pressure (30.2 ± 5.1 vs. 27.8 ± 4.9 kg/m2, 149.8 ± 29.3 vs. 135.2 ± 32.9 mg/dl and 128.2 ± 14.1 vs. 118.4 ± 16.1 mmHg, respectively; all p > 0.003) compared with subjects without diverticular disease. In contrast, no significant correlation could be found for gender, physical activity, smoking status and alcohol consumption (all p > 0.31). Intra-rater reliability was excellent for all colonic segments (intra-class correlation [ICC] = 0.99-1.00), and inter-rater reliability was excellent for left- and right-sided colonic segments (ICC = 0.84-0.97).
CONCLUSIONS: These findings provide insights into the disease mechanism of asymptomatic diverticular disease and may help to improve prevention of diverticulosis and its associated complications.
KEY POINTS: • Overall prevalence of asymptomatic diverticular disease assessed by MRI was 42%, affecting predominantly the left-sided colon. • Asymptomatic diverticular disease was associated with age and cardiometabolic risk factors. • Magnetic resonance imaging reveals insights into the pathophysiologic mechanism of asymptomatic diverticular disease.},
}
@article {pmid30143468,
year = {2019},
author = {Ubaldi, E and Grattagliano, I and Lapi, F and Pecchioli, S and Cricelli, C},
title = {Overview on the management of diverticular disease by Italian General Practitioners.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {51},
number = {1},
pages = {63-67},
doi = {10.1016/j.dld.2018.07.015},
pmid = {30143468},
issn = {1878-3562},
mesh = {Adult ; Age Distribution ; Aged ; Anti-Bacterial Agents/therapeutic use ; Comorbidity ; Cross-Sectional Studies ; Databases, Factual ; *Diverticulitis, Colonic/classification/drug therapy/epidemiology ; Female ; Gastrointestinal Agents/therapeutic use ; General Practice/*methods ; Hospitalization/statistics & numerical data ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; },
abstract = {BACKGROUND: Although very common in Western countries, poor epidemiological data on diverticular disease (DD) is available from the family practice.
AIMS: To evaluate the behavior of Italian General Practitioners (GPs) on approaching DD.
METHODS: Health Search Database was analyzed retrospectively.
RESULTS: On a population of 975,523 individuals, 33,597 patients had a registered diagnosis of DD ("lifetime" prevalence = 3.4%, M = 3.2%, F = 3.7%; higher values are found in females over-65 years old; low rates of complications: diverticulitis = 0.3%, bleeding = 0.002%). As risk factors, NSAIDs and ASA were taken by 14.8% and 26.5% respectively, opioids by 7.5%, corticosteroids by 5.2%; as protective factors, 30.4% were under statins and 17.7% under calcium-antagonists. Approximately 13% of patients were referred to specialists. Colonoscopy and abdominal CT were prescribed to 48.5% and to 13% of already diagnosed patients. Among DD sufferers, 27% experienced hospitalization, but only 3.4% of cases were for a DD-linked problem. Treatment included rifaximin (61%), mesalazine (14.7%), probiotics (12.4%), ciprofloxacin (7.6%).
CONCLUSION: DD has a large impact in general practice with a higher prevalence in the elderly. GPs are required to pay particular attention to risk factors both for disease development and for its complications in order to reduce the costs deriving from diagnostic procedures, referral and hospitalization.},
}
@article {pmid30116674,
year = {2018},
author = {Haddad, FG and El Bitar, S and Al Moussawi, H and Deeb, L},
title = {Granulomatous Diverticulitis: Who Would Have Thought!.},
journal = {Cureus},
volume = {10},
number = {6},
pages = {e2795},
pmid = {30116674},
issn = {2168-8184},
abstract = {Diverticular disease (DD) can have different presentations, including chronic colitis. However, diverticular disease-associated colitis (DAC) is a separate entity that can be associated with a granulomatous inflammation. DAC usually affects the left colon with no involvement of the cecum and the ascending colon. In this setting, Crohn's disease is high in the differential diagnosis. Although granulomatous colitis associated with diverticulosis has been previously described, this is the first case affecting the right colon to be reported in the English literature according to our search of the PubMed database. The patient presented with a tumor-like mass abutting the right colon that was further diagnosed as a granulomatous reaction secondary to DAC.},
}
@article {pmid30112933,
year = {2018},
author = {Bakopoulos, A and Tsilimigras, DI and Syriga, M and Koliakos, N and Ntomi, V and Moris, D and Bistarakis, D and Schizas, D},
title = {Diverticulitis of the transverse colon manifesting as colocutaneous fistula.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {},
number = {},
pages = {e1-e3},
pmid = {30112933},
issn = {1478-7083},
abstract = {The transverse colon is a particularly rare site for a diverticulum to develop, with only few reports of solitary diverticula described in the literature. Among the reported complications, colocutaneous fistulas appear relatively infrequently. We describe the case of an 80-year-old woman with a solitary diverticulum of the transverse colon presenting as acute diverticulitis with abscess formation in the epigastric region. A fistulous tract was found between the inflamed colon and the skin. A wedge resection of the inflamed colon together with the fistula and the solitary diverticulum was performed followed by primary suturing of the healthy colonic tissue. Despite the sufficient treatment and thorough clearance of the area, the patient died ten days later from ventilator associated pneumonia. Although rare, in patients presenting with a subcutaneous abscess in the abdominal region, there should be a high level of suspicion for active intraperitoneal inflammation derived from complicated diverticular disease given the continuously elevated prevalence of the condition in Western societies. The decision regarding proper management of this clinical state should be based on thorough clinical examination and imaging.},
}
@article {pmid30091821,
year = {2018},
author = {Hamilton, AER and Warren, CD and Stevenson, ARL},
title = {Neurovascular sparing during anterior resections for diverticular disease: the century-long debate.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {20},
number = {10},
pages = {932-933},
doi = {10.1111/codi.14368},
pmid = {30091821},
issn = {1463-1318},
mesh = {Diverticular Diseases/*surgery ; Humans ; Mesenteric Artery, Inferior/*surgery ; Organ Sparing Treatments/*methods ; Proctectomy/*methods ; Rectum/surgery ; Vascular Surgical Procedures/*methods ; },
}
@article {pmid30084005,
year = {2019},
author = {Mahmood, MW and Abraham-Nordling, M and Håkansson, N and Wolk, A and Hjern, F},
title = {High intake of dietary fibre from fruit and vegetables reduces the risk of hospitalisation for diverticular disease.},
journal = {European journal of nutrition},
volume = {58},
number = {6},
pages = {2393-2400},
pmid = {30084005},
issn = {1436-6215},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Dietary Fiber/administration & dosage/*pharmacology ; Diverticular Diseases/*diet therapy/prevention & control ; Female ; *Fruit ; Hospitalization/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sweden ; *Vegetables ; },
abstract = {BACKGROUNDS AND AIMS: High intake of dietary fibres has been associated with a reduced risk of DD. However, reports on which type of dietary fibre intake that is most beneficial have been conflicting. The aim of this study was to investigate the association between different dietary fibres and hospitalisation due to diverticular disease (DD) of the colon.
METHODS: This was a major cohort study. The Swedish Mammography Cohort and the Cohort of Swedish Men were linked to the Swedish Inpatient Register and the Causes of Death Register. Data on the intake of dietary fibre were collected through questionnaires. The effect of intake (in quartiles) of different types of dietary fibre on the incidence of hospitalisation due to DD was investigated using multivariable Cox regression. Estimates were adjusted according to age, BMI, physical activity, co-morbidity, intake of corticosteroids, smoking, alcohol intake and education level.
RESULTS: Women with intake of fruit and vegetable fibres in the highest quartile (median 12.6 g/day) had a 30% decreased risk of hospitalisation compared to those with the lowest intake (4.1 g/day). Men within the highest quartile (10.3 g/day) had a 32% decreased risk compared to those with a low intake (2.9 g/day). High intake of fibres from cereals did not affect the risk.
CONCLUSION: A high intake of fruits and vegetables may reduce the risk of hospitalisation due to DD. Intake of cereals did not influence the risk.},
}
@article {pmid30064583,
year = {2018},
author = {Simmerman, EL and King, RS and Ham, PB and Hooks, VH},
title = {Feasibility and Safety of Intraoperative Colonoscopy after Segmental Colectomy and Primary Anastomosis.},
journal = {The American surgeon},
volume = {84},
number = {7},
pages = {1175-1179},
pmid = {30064583},
issn = {1555-9823},
mesh = {Adenomatous Polyps/complications/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; *Colectomy/methods ; Colitis/surgery ; Colonic Neoplasms/surgery ; *Colonoscopy/methods ; Colorectal Neoplasms/surgery ; Feasibility Studies ; Female ; Hospitals, University ; Humans ; Intestinal Obstruction/etiology/surgery ; *Intraoperative Care/methods ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; },
abstract = {Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.},
}
@article {pmid30062801,
year = {2018},
author = {De Nardi, P and Gazzetta, P},
title = {Does inferior mesenteric artery ligation affect outcome in elective colonic resection for diverticular disease?.},
journal = {ANZ journal of surgery},
volume = {88},
number = {11},
pages = {E778-E781},
doi = {10.1111/ans.14724},
pmid = {30062801},
issn = {1445-2197},
mesh = {Adult ; Aged ; Anastomotic Leak/epidemiology/etiology/*prevention & control ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/*methods ; Female ; Humans ; Laparoscopy ; Ligation ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The aim of our study was to analyse the role of inferior mesenteric artery (IMA) ligation during elective colonic resection for diverticular disease (DD) with respect to surgical outcome.
METHODS: All patients who underwent elective laparoscopic or open colonic resection for DD from January 2006 to December 2012 were studied. The patients were divided into two groups based on IMA ligation or preservation. The primary end point was to compare anastomotic leakage in the two groups. The secondary end points were operative time, stoma formation, overall post-operative complications, restoration of bowel function and length of post-operative hospital stay.
RESULTS: During the study period, 219 elective colonic resections with primary anastomosis for DD were performed. A laparoscopic technique was employed in 132 (60.3%) cases. IMA ligation was performed in 66 patients (30.1%). Overall anastomotic leakage rate was 4.1%, 4.5% in IMA ligation and 3.9% in IMA preservation group, respectively (P = ns). Mean operative time was 225 ± 43.4 and 191 ± 41.7 min in IMA ligation and preservation group, respectively (P = 0.002). No differences were observed in the rate of overall complications, stoma formation, restoration of bowel function and post-operative length of hospital stay.
CONCLUSIONS: No differences were observed in surgical outcome in IMA ligation and preservation groups, particularly preservation or ligation of the IMA did not affect leakage rate.},
}
@article {pmid30056095,
year = {2018},
author = {Vajravelu, RK and Mamtani, R and Scott, FI and Waxman, A and Lewis, JD},
title = {Incidence, Risk Factors, and Clinical Effects of Recurrent Diverticular Hemorrhage: A Large Cohort Study.},
journal = {Gastroenterology},
volume = {155},
number = {5},
pages = {1416-1427},
pmid = {30056095},
issn = {1528-0012},
support = {K08 DK095951/DK/NIDDK NIH HHS/United States ; K23 CA187185/CA/NCI NIH HHS/United States ; K24 DK078228/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Anticoagulants/adverse effects ; Diverticulum/*epidemiology/etiology ; Female ; Gastrointestinal Hemorrhage/*epidemiology/etiology ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: Although recurrent diverticular hemorrhage is common, its incidence and risk factors have not been measured outside of small institutional cohorts. We analyzed the incidence of and risk factors for recurrent diverticular hemorrhage and whether discontinuing anticoagulation after diverticular hemorrhage is associated with ischemic stroke.
METHODS: We performed a retrospective cohort study of patients enrolled in the OptumInsight Clinformatics database from 2000 through 2016. Incidence rates for initial and recurrent diverticular hemorrhage were calculated by identifying patients who had hospitalizations with a primary discharge diagnosis consistent with diverticular hemorrhage. The hazard ratios of second diverticular hemorrhage associated with anticoagulants or platelet aggregation inhibitors were calculated using Cox proportional hazards regression adjusted for demographics, comorbidities, and medication use. The hazard ratio for ischemic stroke among patients who discontinued anticoagulation after diverticular hemorrhage was calculated similarly.
RESULTS: In the cohort analyzed, 14,925 patients had an initial diverticular hemorrhage; 1368 of these patients had a second episode. The unstandardized incidence rates of initial and second diverticular hemorrhage were 10.9 per 100,000 person-years (95% confidence interval [CI] 10.7-11.0) and 3625.6 per 100,000 person-years (95% CI 3436.0-3823.0). Platelet aggregation inhibitors were associated with second episodes of diverticular hemorrhage (hazard ratio 1.47; 95% CI 1.15-1.88), whereas all classes of anticoagulation agents were not associated. Among patients with a potential indication for stroke prophylaxis, those who discontinued anticoagulation after the diverticular hemorrhage had an increased hazard of ischemic stroke (hazard ratio 1.93; 95% CI 1.17-3.19).
CONCLUSIONS: In this retrospective cohort study, platelet aggregation inhibitors, but not anticoagulants, were associated with recurrent diverticular hemorrhage. Discontinuing anticoagulation was associated with increased hazard for ischemic stroke.},
}
@article {pmid30048723,
year = {2018},
author = {Singh, S and Singh, G and Arya, SK},
title = {Mannans: An overview of properties and application in food products.},
journal = {International journal of biological macromolecules},
volume = {119},
number = {},
pages = {79-95},
doi = {10.1016/j.ijbiomac.2018.07.130},
pmid = {30048723},
issn = {1879-0003},
mesh = {Animal Feed/analysis ; Animals ; Biological Products/chemistry ; *Food ; Food Analysis ; Humans ; Hydrolysis ; Mannans/*chemistry/classification ; Mannosidases/chemistry ; Polysaccharides/chemistry ; },
abstract = {This review aims to emphasize the occurrence and abundant presence of mannans in nature, their classification, structural differences and significance in food and feed industry. With rising demand from the consumers' end for novel natural foods, usage of galactomannan and glucomannan has also increased alternatively. Non toxicity of mannans permits their usage in the pharmaceutical, biomedical, cosmetics, and textile industries. In the food industry, mannans have various applications such as edible films/coating, gel formation, stiffeners, viscosity modifiers, stabilizers, texture improvers, water absorbants, as prebiotics in dairy products and bakery, seasonings, diet foods, coffee whiteners etc. Applications and functions of these commonly used commercially available mannans have therefore, been highlighted. Mannans improve the texture and appeal of food products and provide numerous health benefits like controlling obesity and body weight control, prebiotic benefits, constipation alleviaton, prevent occurrence of diarrhea, check inflammation due to gut related diseases, management of diverticular disease management, balance intestinal microbiota, immune system modulator, reduced risk of colorectal cancer etc. Mannan degrading enzymes are the key enzymes involved in degradation and are useful in various industrial processes such as fruit juice clarification, viscosity reduction of coffee extracts etc. besides facilitating the process steps and improving process quality.},
}
@article {pmid30046356,
year = {2018},
author = {Lanas, A and Abad-Baroja, D and Lanas-Gimeno, A},
title = {Progress and challenges in the management of diverticular disease: which treatment?.},
journal = {Therapeutic advances in gastroenterology},
volume = {11},
number = {},
pages = {1756284818789055},
pmid = {30046356},
issn = {1756-283X},
abstract = {Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic diverticulosis to symptomatic uncomplicated diverticulosis, segmental colitis associated with diverticulosis, and acute diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and inflammation relief and preventing disease progression or recurrence. The basis for preventing disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or dysbiosis with rifaximin or probiotics, or using mesalazine for low-grade inflammation in uncomplicated symptomatic diverticulosis. Most acute diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary antibiotic therapy, but patients with comorbidities, sepsis, or immunodeficiency should receive broad spectrum and appropriate antibiotics. Complicated acute diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute diverticulitis recurrence remains undefined, as do therapeutic strategies. Mesalazine with or without probiotics has failed to prevent diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and disease progression or recurrence mechanisms to implement appropriate preventive strategies.},
}
@article {pmid30039786,
year = {2018},
author = {Cochetti, G and Del Zingaro, M and Boni, A and Cocca, D and Panciarola, M and Tiezzi, A and Gaudio, G and Balzarini, F and Ursi, P and Mearini, E},
title = {Colovesical fistula: review on conservative management, surgical techniques and minimally invasive approaches.},
journal = {Il Giornale di chirurgia},
volume = {39},
number = {4},
pages = {195-207},
pmid = {30039786},
issn = {0391-9005},
mesh = {Colectomy/methods ; Colonic Neoplasms/complications/surgery ; *Conservative Treatment ; Cystectomy/methods ; Humans ; Intestinal Fistula/diagnostic imaging/mortality/*surgery/therapy ; Laparoscopy/methods ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Recurrence ; Robotic Surgical Procedures/methods ; Surgical Flaps ; Urinary Bladder Fistula/diagnostic imaging/mortality/*surgery/therapy ; Urinary Bladder Neoplasms/complications/surgery ; },
abstract = {Colovesical fistula (CVF) is an abnormal communication between bowel and urinary bladder. Main causes are represented by complicated diverticular disease, colonic and bladder cancer and iatrogenic complications. Diagnosis is often based on patognomonic signs: faecaluria, pneumaturia and recurrent urinary tract infections. Treatment of CVF includes non-surgical and surgical strategy. The non-surgical treatment is reserved to selected patients who are unfit for surgery. Surgery of CVFs is determined by the site of the colonic lesion and patient's comorbidity. However the surgical one-stage approach should be preferred, reserving the multi-stage procedure in patients with a pelvic abscess, or with advanced malignancy, or previous radiation therapy. The sole defunctioning stoma may be an option to improve the quality of life in patients unfit for bowel resection. In open surgery the standard operative management consists in resection and anastomosis of the involved bowel segment and closure of the bladder. Laparoscopic treatment of CVFs is feasible and safe if performed by skilled surgeons. Robotic surgery for CVF treatment is safe and feasible similarly to laparoscopic one and it seems to reduce the conversion rate with respect to laparoscopy. However, further studies are needed to evaluate the advantages of robotic surgery over laparoscopy in the management of CVF. Currently, in Literature it is still debated which is the best surgical approach for CFV treatment due to the lack of RCTs and CCTs, the small sample size and the short follow-up. Further studies with higher quality and larger sample size are necessary to state the gold standard surgical treatment of CVFs.},
}
@article {pmid30023071,
year = {2018},
author = {Carabotti, M and Cuomo, R and Barbara, G and Pace, F and Andreozzi, P and Cremon, C and Annibale, B},
title = {Demographic and clinical features distinguish subgroups of diverticular disease patients: Results from an Italian nationwide registry.},
journal = {United European gastroenterology journal},
volume = {6},
number = {6},
pages = {926-934},
pmid = {30023071},
issn = {2050-6406},
abstract = {Background: Clinical features and lifestyle factors associated with diverticulosis compared to diverticular disease (DD), either symptomatic uncomplicated diverticular disease (SUDD) or in patients who have had previous diverticulitis (PD), are unclear.
Objective: The objective of this article is to compare cross-sectionally demographic and clinical features and quality of life (QoL) in diverticulosis, SUDD and PD patients.
Methods: The REMAD Registry is a prospective, observational, multicentre, cohort study. Patients were categorised according to: diverticulosis; SUDD (recurrent abdominal symptoms attributed to diverticula in absence of overt inflammation) and PD (≥1 previous diverticulitis).
Results: A total of 1217 patients (57.9% diverticulosis, 24.7% SUDD and 17.4% PD) were included. Compared to diverticulosis, female gender was associated to SUDD (OR 1.94; 95% CI: 1.43-2.62) and PD (OR 1.79; 95% CI: 1.24-2.56); age ≤ 60 years was associated to PD (OR 2.10; 95% CI: 1.42-3.08 vs diverticulosis, OR 1.57; 95% CI: 1.01-2.45 vs SUDD). PD patients showed an association with past bleeding (OR 29.29; 95% CI: 8.17-104.98 vs diverticulosis, OR 16.84; 95% CI: 3.77-75.25 vs SUDD). Compared to diverticulosis, family history for diverticula was associated to PD (OR 1.88; 95% CI: 1.27-2.78). Patients with diverticulosis showed higher QoL scores, both physical (p = 0.0001 and 0.0257) and mental (p < 0.0001 and 0.0038), in comparison to SUDD and PD.
Conclusion: Family history for diverticula and history of bleeding distinguish diverticulosis from DD. These clinical features should be kept in mind in the management of DD.},
}
@article {pmid30020228,
year = {2018},
author = {Ramsay, G and Wohlgemut, JM and Jansen, JO},
title = {Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery.},
journal = {The journal of trauma and acute care surgery},
volume = {85},
number = {3},
pages = {500-506},
doi = {10.1097/TA.0000000000002010},
pmid = {30020228},
issn = {2163-0763},
mesh = {Comorbidity ; Cross-Sectional Studies ; Diagnosis-Related Groups/trends ; Emergencies ; Emergency Medical Services/*statistics & numerical data/trends ; Emergency Service, Hospital/*standards ; Female ; Health Workforce/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; National Health Programs/organization & administration ; Patient Discharge/standards ; Scotland/epidemiology ; Surgeons/*statistics & numerical data ; United Kingdom/epidemiology ; Workload ; },
abstract = {BACKGROUND: The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development.
METHODS: This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included.
RESULTS: There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate.
CONCLUSIONS: Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.
LEVEL OF EVIDENCE: Epidemiologic study, level III.},
}
@article {pmid29980885,
year = {2018},
author = {Emile, SH and Elfeki, H and Sakr, A and Shalaby, M},
title = {Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure.},
journal = {Techniques in coloproctology},
volume = {22},
number = {7},
pages = {499-509},
pmid = {29980885},
issn = {1128-045X},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Conservative Treatment/*methods ; Diverticulitis, Colonic/etiology/*therapy ; Female ; Humans ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Recurrence ; Regression Analysis ; Treatment Failure ; },
abstract = {BACKGROUND: Diverticulitis is a common complication of diverticular disease of the colon. While complicated diverticulitis often warrants intervention, acute uncomplicated diverticulitis (AUD) is usually managed conservatively. The aim of the present review was to evaluate the efficacy and safety of conservative treatment of AUD without antibiotics compared to standard antibiotic treatment.
METHODS: A systematic literature review in compliance with PRISMA guidelines was conducted. Electronic databases including PubMed/Medline, Scopus, Embase and Cochrane central register of controlled trials were searched. Studies that assessed efficacy and safety of treatment of AUD without antibiotics were included. Outcome parameters were rates of treatment failure, recurrence of diverticulitis, complications and mortality, readmission to hospital, and need for surgery.
RESULTS: Nine studies including 2565 patients were included to the review. Of these patients, 65.1% were treated conservatively without antibiotics. Treatment failure was observed in 5.1% of patients not-given-antibiotic treatment versus 3.4% of those given antibiotic treatment. Recurrent diverticulitis occurred in 9.3% of patients in the non-antibiotic group versus 12.1% of patients in the antibiotic group. On meta-analysis of the studies, there were no significant differences between non-antibiotic and antibiotic treatment groups regarding rates of treatment failure (OR = 1.5, p = 0.06), recurrence of diverticulitis (OR = 0.81, p = 0.2), complications (OR = 0.56, p = 0.25), readmission rates (OR = 0.97, p = 0.91), need for surgery (OR = 0.59, p = 0.28), and mortality (OR = 0.64, p = 0.47). The only variable that was significantly associated with treatment failure in the non-antibiotic treatment group was associated comorbidities (standard error (SE) = - 0.07, 95% CI - 0.117 - 0.032; p < 0.001).
CONCLUSIONS: Treatment of AUD without antibiotics is feasible, safe, and effective. Adding broad-spectrum antibiotics to the treatment regimen did not serve to decrease treatment failure, recurrence, complications, hospital readmissions, and need for surgery significantly compared to non-antibiotic treatment.},
}
@article {pmid29971261,
year = {2018},
author = {Hebbar, M and Riaz, W and Sains, P and Baig, MK and Sajid, MS},
title = {Meta-analysis of randomized controlled trials only exploring the role of single incision laparoscopic surgery versus conventional multiport laparoscopic surgery for colorectal resections.},
journal = {Translational gastroenterology and hepatology},
volume = {3},
number = {},
pages = {30},
pmid = {29971261},
issn = {2415-1289},
abstract = {Background: The objective of this article is to evaluate the surgical outcomes in patients undergoing single incision laparoscopic surgery (SILS) versus conventional multi-incision laparoscopic surgery (MILS) for colorectal resections.
Methods: The data retrieved from the published randomized controlled trials (RCTs) reporting the surgical outcomes in patients undergoing SILS versus MILS for colorectal resections was analysed using the principles of meta-analysis. The combined outcome of dichotomous data was represented as risk ratio (RR) and continuous data was shown as standardized mean difference (SMD).
Results: Five RCTs on 525 patients reported the colorectal resections by SILS versus MILS technique. In the random effects model analysis using the statistical software Review Manager 5.3, the operation time (SMD, 0.20; 95% CI, -0.11 to 0.52; z=1.28; P=0.20), length of in-patient stay (SMD, -0.18; 95% CI, -0.51 to 0.14; z=1.10; P=0.27) and lymph node harvesting (SMD, 0.09; 95% CI, -0.14 to 0.33; z=0.76; P=0.45) were comparable between both techniques. Furthermore, post-operative complications (RR, 1.00; 95% CI, 0.65-1.54; z=0.02; P=0.99), post-operative mortality, surgical site infection rate (RR, 3.00; 95% CI, 0.13-70.92; z=0.68; P=0.50), anastomotic leak rate (RR, 0.43; 95% CI, 0.11-1.63; z=1.24; P=0.21), conversion rate (P=0.13) and re-operation rate (P=0.43) were also statistically similar following SILS and MILS.
Conclusions: SILS failed to demonstrate any superiority over MILS for colorectal resections in all post-operative surgical outcomes.},
}
@article {pmid29953098,
year = {2018},
author = {Okhotnikov, OI and Yakovleva, MV and Shevchenko, NI and Grigoriyev, SN and Pakhomov, VI},
title = {[X-ray-surgery of diverticular disease complicated by abscess formation].},
journal = {Khirurgiia},
volume = {},
number = {6},
pages = {35-40},
doi = {10.17116/hirurgia2018635-40},
pmid = {29953098},
issn = {0023-1207},
mesh = {*Abdominal Abscess/etiology/surgery ; *Diverticular Diseases/complications/surgery ; *Drainage/adverse effects/methods ; Emergency Treatment/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Postoperative Complications/diagnosis/etiology/*prevention & control ; Russia ; Surgery, Computer-Assisted/*methods ; Tomography, X-Ray Computed/*methods ; Ultrasonography/*methods ; },
abstract = {PURPOSE: Show the possibility of an alternative use of interventional radiology techniques in complex treatment of patients with inflammatory complications of the diverticular disease of the colon.
MATERIAL AND METHODS: In 2012-2016, there were 87 patients under our supervision with complicated diverticular disease. In 57 (65.5%) cases were diagnosed infiltrate, in 24 (27.6%) cases - abscess of paracolon area (Ib-II type by Hinchey), in 6 (6.9%) cases (III-IV type according Hinchey) generalized peritonitis have been identified.
RESULTS: Emergency laparotomy was performed in 13 patients. Abscesses of paracolon (Ib-II type by Hinchey) area were diagnosed sonographically during the initial examination in 17 patients. 26 percutaneous drainage of diverticulogenous abscesses of different localizations self-locking drainage #8Fr 'pig tail' was carried out under the combined ultrasonic and X-ray control in this group of patients. The technical success of percutaneous drainaging of the abscesses was achieved in all manipulations. 13 patients had a single drainaging, and for diverticular disease - disease-free during the observation period of 1 year to 5 years. Resection of the colon in a planned manner after percutaneous drainage of recurrent abscess of paracolon area was performed in 4 patients. Complications related with the technique of installing drainage were not reported, mortality in the group of drained patients was absent.
CONCLUSION: Ultrasound examination of patients with suspected inflammatory complications of diverticular disease - a necessary and sufficient method for initial diagnosis of the disease. Percutaneous drainage of diverticulogenous abscesses (Hinchey Ib-II) is represented by the pragmatic 'first line' choice in patients with complicated diverticular disease, that allows to treat the pathology steadfastly in most of the cases.},
}
@article {pmid29945147,
year = {2018},
author = {Ramphal, W and Schreinemakers, JMJ and Seerden, TCJ and Gobardhan, PD},
title = {Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {36},
number = {5},
pages = {362-368},
doi = {10.1159/000489926},
pmid = {29945147},
issn = {1421-9875},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms/diagnosis/*etiology/*pathology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: The association between diverticulitis and colorectal cancer (CRC) remains unclear, though both share epidemiological characteristics. The aim of this study was to investigate whether there is higher risk for CRC after an episode of uncomplicated diverticulitis. Furthermore, in cases of CRC, we sought to determine specific tumour characteristics.
METHODS: This retrospective observational study includes patients with acute diverticulitis (Hinchey 0 and 1) who were conservatively treated with or without antibiotics between 2008 and 2013. Patients with endoscopic follow-up were included for analysis. Tumour characteristics of patients diagnosed with CRC during colonoscopic follow-up according to patients' presentation of alarm symptoms were considered to be the primary endpoint.
RESULTS: A total of 977 patients were conservatively treated for an episode of acute diverticulitis, 645 of whom underwent colonoscopy during follow-up. Ten patients were diagnosed with CRC, nine of whom exhibited alarm symptoms. One patient was diagnosed with stage I disease, 4 had stage II, and 5 had stage III disease.
CONCLUSIONS: This study strongly suggests that even though CRC is rare after uncomplicated diverticulitis, in cases of alarm symptoms, a colonoscopy is indicated. In cases where CRC is diagnosed, it is often advanced with a higher TNM stage and poor prognosis.},
}
@article {pmid29942217,
year = {2018},
author = {Mohanty, S and Webb, SP},
title = {Uncommon Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {258-262},
pmid = {29942217},
issn = {1531-0043},
abstract = {This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.},
}
@article {pmid29942216,
year = {2018},
author = {Lin, M and Raman, SR},
title = {Evaluation of Quality of Life and Surgical Outcomes for Treatment of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {251-257},
pmid = {29942216},
issn = {1531-0043},
abstract = {The prevalence of diverticular disease in the Western and industrialized nations has increased over the last century, and our understanding of this disease and its management continues to evolve. In this article, we review the literature regarding the postoperative quality of life (QOL) and functional outcomes following surgical management of diverticulitis, including information regarding bowel function, recurrence of symptoms, and other postoperative sequelae. While objective parameters, such as attacks of diverticulitis, complications, and clinical episodes have been studied, there is a paucity of data on less objective factors, such as overall patient satisfaction after operative management of diverticular disease. The literature shows improvement in QOL following surgical intervention for diverticulitis if preoperative QOL was significantly low, secondary to severe/complicated diverticulitis. However, a subset of patients does continue to have symptoms following surgical intervention for diverticulitis. Often neglected in the literature, there remains a need for prospective data evaluating preoperative function to ascertain the impact of surgery on patients' QOL and postoperative function.},
}
@article {pmid29942214,
year = {2018},
author = {Neale, JA},
title = {Surgical Management of Diverticular Disease in the Elective Setting.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {236-242},
pmid = {29942214},
issn = {1531-0043},
abstract = {Diverticulosis is a common condition that has increased in prevalence in industrialized countries over the past century. Estimates of developing diverticular disease in the United states range from 5% by 40 years of age up, to over 80% by age 80. It is estimated that approximately 20% of patients with diverticulosis develop diverticulitis over the course of their lifetime. Diverticular disease can be divided into simple and chronic diverticulitis with various sub categories. There are various instances and circumstances where elective resection is indicated for both complex and simple forms of this disease process. When planning surgery there are general preoperative considerations that are important to be reviewed prior to surgery. There are also more specific considerations depending on secondary problem attributed to diverticulitis, that is, fistula vs stricture. Today, treatment for elective resection includes open, laparoscopic and robotic surgery. Over the last several years we have moved away from open surgery to laparoscopic surgery for elective resection. With the advent of robotic surgery and introduction of 3D laparoscopic surgery the discussion of superiority, equivalence between these modalities, is and should remain an important discussion topic.},
}
@article {pmid29942213,
year = {2018},
author = {Theodoropoulos, D},
title = {Current Options for the Emergency Management of Diverticular Disease and Options to Reduce the Need for Colostomy.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {229-235},
pmid = {29942213},
issn = {1531-0043},
abstract = {This article reviews the current options and recommendations for the emergency management of acute diverticulitis, including the spectrum of antibiotics, percutaneous drainage, laparoscopic lavage, and surgical options for resection with the restoration of bowel continuity.},
}
@article {pmid29942212,
year = {2018},
author = {Ghalyaie, N},
title = {Management of Diverticular Disease in the Setting of Other Colorectal Pathology: Data on Simultaneous Issues in Segmental Colitis, Inflammatory Bowel Disease, Cancer, and Complications.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {226-228},
pmid = {29942212},
issn = {1531-0043},
abstract = {Diverticulosis of the colon is a very common anatomical condition. In the Western world, it affects more than 70% of over 65 years old population and represents the fifth most important gastrointestinal disease in terms of health care costs in Western countries. The diagnosis of diverticular disease and diverticulitis can be challenging. Often, there is overlap with other colonic pathologies, such as segmental colitis, ischemia,