Surgical management of complicated colonic diverticulitis.
Explore the source record for details and available documents.
Colorectal Surgery↗
SEARCH · PubMed Health
Results for “Diverticulitis, Colonic”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Surgical management of complicated colonic diverticulitis.
Explore the source record for details and available documents.
Colorectal Surgery↗
[Round-table discussion: colonic diverticulitis].
Explore the source record for details and available documents.
Diverticulitis, Colonic↗
Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period.
INTRODUCTION: In contrast to sigmoid diverticular disease, right colonic diverticulitis is a rare disease in Western countries. The clinical presentation is often similar to acute appendicitis. OBJECTIVE: The aim of this study was to analyze surgical challenge in right-sided diverticulitis. MATERIALS AND METHODS: All patients who underwent resection for both right-sided and sigmoid diverticular disease were registered prospectively in a database (observation period, 1996-2005). A retrospective analysis of all patients who underwent resection for right-sided colonic diverticulitis (ileocolic resection, right colectomy) was performed. Special focus was set on incidence, clinical symptoms, indication, procedure, clinical outcome, and histopathologic findings including immunohistochemistry. RESULTS: From a total of 593 patients treated surgically for recurring or acute complicated diverticular disease, the majority (97.8%) suffered from sigmoid diverticulitis (n = 580), whereas 2.2% (n = 16) underwent surgery for right-sided diverticulitis (including three patients with combined sigmoid and cecal diverticulitis). Related to the total number of appendectomies (n = 1167), this represented an incidence of 1.4%. In five of 16 patients, acute appendicitis was presumed preoperatively. Most common diagnostic was ultrasonography. In the group of patients with right-sided diverticulitis, the most common procedure was right hemicolectomy (n = 10), followed by ileocolic resection (n = 3) and combined right colonic resection with sigmoid resection (n = 3). Histopathological investigation confirmed complicated diverticulitis of the cecum with local perforation or abscess in 75% of the patients (12/16). Hypoganglionosis or aganglionosis was diagnosed in seven of the 16 resected specimens. DISCUSSION: As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis may be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis. As most cases will remain clinically unimminent, surgery is only indicated in complicated right-sided cases. Resection of the inflamed colonic segment with primary anastomosis is safe and can be performed laparoscopically. It can only be speculated whether hypoganglionosis or aganglionosis is a causative factor in the etiology of right-sided diverticulitis.
Adult↗
[Clinical characteristics of colonic diverticulitis in Koreans].
BACKGROUND/AIMS: In western countries, symptomatic diverticulitis develops in about 20% of the population with colonic diverticula, and it is mainly located at the left-sided colon. The clinical characteristics of diverticulitis have rarely been investigated although its incidence is increasing in Asia including Korea. The aim of this study was to compare diverticulitis with asymptomatic diverticulosis and to compare the clinical characteristics of right-sided diverticulitis with those of left-sided diverticulitis. METHODS: We retrospectively investigated the medical records of the patients who had symptoms and signs of diverticulitis. Their diagnosis was confirmed with computed tomography, barium study, colonoscopy and/or operations at Samsung Medical Center from September 1998 to February 2002. The control cases of asymptomatic and incidental diverticulosis were randomly selected during routine health check-up after matching age and sex. RESULTS: Twenty-seven patients with diverticulitis (male : female = 14 : 13) were included. The mean age was 53 (27~86). The ratio of right and left diverticulitis was 20:7, which was similar to the ratio of diverticulosis. The complications, especially perforation, were more frequent in the patients with left-sided diverticulitis (p<0.05). CONCLUSIONS: Colonic diverticulitis is more prevalent at the right colon and left colonic diverticulitis has more complications than right colonic diverticulitis in Korea.
Adult↗
Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients.
This prospective study evaluated the use of multi-slice CT (MSCT) for detection of clinically suspected left-sided colonic diverticulitis with regard to diagnosis, complications and alternative diagnoses. One hundred twenty patients with clinically suspected acute left-colonic diverticulitis underwent MSCT of the lower abdomen with IV contrast after rectal application of iodic contrast. The MSCT results were compared with histopathological and intraoperative findings or other radiological or endoscopic methods and clinical outcome. Acute diverticulitis was proven in 67 of the 120 (55.8%) patients, which was detected by MSCT with an accuracy of 98% (sensitivity 97%, specificity 98%). Contained perforation or abscess formation were detected with an accuracy of 96% (sensitivity 100%, specificity 91%) and 98% (sensitivity 100%, specificity 97%), respectively. In 31 of 120 (25.8%) patients diagnoses other than diverticulitis caused abdominal pain, which was correctly diagnosed by MSCT in 71%. The MSCT as well as other concurrently performed diagnostic methods showed normal findings and no causes for the patients symptoms in 22 of the 120 (18.4%) patients. Multi-slice CT is reliable in detecting diverticulitis, including extracolic complications, and often reveals other diagnoses; therefore, MSCT is recommended as standard diagnostic procedure in suspected acute diverticulitis.
Acute Disease↗
[Colon diverticulitis: imaging diagnosis with ultrasound--a prospective study].
In a prospective study, we investigated the value of high resolution sonography for the imaging diagnosis of colonic diverticulitis. A total of 161 patients with abdominal complaints on account of which acute diverticulitis entered into differential diagnosis were included in the study. 74 of these finally had proven colonic diverticulitis (prevalence, 46%). The results of intestinal sonography and the working diagnoses on admission were evaluated on the basis of final diagnoses. According to history, symptoms, and clinical findings on admission, the working diagnosis of diverticulitis was graded as being "highly suspect" in 26 (35.1%) of these 74 diverticulitis patients, as being "possible/equivocal" in 36 (48.6%), and as being "very unlikely" in in 12 (16.2%). In 7 (9.5%) patients with diverticulitis, the diagnosis was clinically unsuspected and primarily established by ultrasound. Overall accuracy, sensitivity, and specificity of intestinal sonography with regard to the diagnosis of diverticulitis were 97.5%, 98.6%, and 96.5%, respectively. There were three false positive ultrasonic diagnoses of diverticulitis which were made in two patients with perforated carcinoma of the sigmoid and in one case of sigmoid volvulus (positive predictive value, 96%). Ultrasound failed to visualize sigmoid diverticulitis with perforation in one patient (negative predictive value, 98%). In 19 out of 20 patients with abdominal abscesses (prevalence, 12.4%), the diagnoses were established by means of sonography. Nine of these patients with abscesses initially were treated by ultrasound guided percutaneous drainage enabling elective surgery. In 26 (70%) of 36 patients with morphological disorders other than diverticulitis, ultrasound findings substantially added for the definite diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis.
PURPOSE: To determine the frequency of visualization of the arrowhead sign and an inflamed diverticulum on abdominal computed tomographic (CT) scans in patients with acute colonic diverticulitis and to assess the specificity of these signs. MATERIALS AND METHODS: One hundred fifty consecutive patients suspected of having diverticulitis prospectively underwent helical CT after the administration of contrast material by means of an enema. Sixty-four patients (43%) had a final clinical diagnosis of colonic diverticulitis. Each scan was reviewed for the arrowhead sign, an arrowhead-shaped collection of contrast material within focal colonic wall thickening, and for an inflamed diverticulum, a rounded, paracolic outpouching centered within fat stranding. RESULTS: The arrowhead sign was noted at CT in 17 (27%) of the 64 patients with diverticulitis. An inflamed diverticulum was noted in 21 patients (33%) at CT, with either calcium or similar high-attenuation material in 10 (48%) of the 21 patients, soft-tissue attenuation in six patients (29%), air attenuation in four patients (19%), and barium attenuation in one patient (5%). Neither sign was demonstrated in patients with alternative conditions (100% specificity). CONCLUSION: The arrowhead sign and an inflamed diverticulum are occasional, specific CT signs of colonic diverticulitis. Their identification can add diagnostic specificity to CT of acute colonic processes.
Acute Disease↗
Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions.
BACKGROUND AND AIMS: Right-sided diverticulitis is rare in Western societies but is not uncommon in Asian countries. Many of the patients are operated with the presumptive diagnosis of appendicitis. This study compared the results of emergency surgery for patients with right-sided and left-sided diverticulitis. PATIENTS AND METHODS: Demographic data, type of operation, and surgical outcome were recorded in 60 patients who had undergone emergency surgery for colonic diverticulitis (37 right-sided, 23 left-sided). RESULTS: Patients with right-sided disease were significantly younger (mean age 41.9 vs. 74.2), and there was a tendency to male predominance (78.4% vs. 56.5%). All patients with right-sided disease had localized peritonitis while 74% of patients with perforated left-sided diverticulitis had generalized faecal or purulent peritonitis. Mortality rates for right-sided disease and left-sided disease were 0% and 13%, respectively, and morbidity was 14.2% and 61%, respectively. Longer hospital stay was also found in patients with left-sided diverticulitis. CONCLUSIONS: There are major differences in the demographics, presentation, type of operation and outcome of patients who had emergency surgery for colonic diverticulitis, with emergency operation for left-sided diverticulitis being associated with higher mortality and morbidity.
Adult↗
[About 35 cases of perforated colon diverticulitis (author's transl)].
Thirty-five cases of perforated colon diverticulitis were treated by us between 1960 and 1977. An overall mortality of 34% reveals the seriousness of this disease. Perforation in open peritoneum doubles the mortality and morbidity rate of covered perforations and of secondary fistulisation. The surgical operations used--immediate resection or colostomy and a drainage--were imposed by the status of the patient and the local state of the lesion. The resection of the pathological colon segment, when feasable, caused no death in this series although a mortality of 48% was noted for multiple procedures. The diagnostical and surgical difficulties associated to profound biological and hemodynamic alterations in these old patients, justifies the multiple stage surgery in a large number of cases. Resection of the perforated segment remains the treatment of choice.
Adult↗
[Perforated colonic diverticulitis. Surgical technique].
Emergency surgery is required for performed colonic diverticulitis. Surgical indications are not uniform in literature. In the experience of the authors the operations have been performed in the case of peritonitis subsequent to the perforation or in the case of failure of the conservative treatment. Twenty-four patients underwent surgical intervention because of diffuse (17 cases) or localized peritonitis (7 cases). Exitus were related to cardiovascular complications in patients over seventy. Postoperative results are related to the age, the general conditions of the patient and to the intraoperative finding, of localized or generalized peritonitis. Operations may be divided into two groups: conservative procedures or primary resections. In the first one it is possible to suture the colonic wall without resection; in the second one the intraoperative finding or the extensive necrotic lesions indicates colonic resection or exteriorization. The surgical treatment adopted is correlated both to the age and cardiorespiratory conditions and to the other associated diseases.
Adult↗
Randomized, prospective comparison of cefoxitin and gentamicin-clindamycin in the treatment of acute colonic diverticulitis.
In a randomized, prospective study, single-drug antibiotic therapy with cefoxitin (CFX) was compared to combination therapy with gentamicin and clindamycin (G/C) as definitive treatment for acute colonic diverticulitis. Excluding individuals requiring immediate operation, 51 patients with a clinical diagnosis of diverticulitis, who were hospitalized at five different medical centers, were randomized to receive CFX (30 patients) or G/C (21 patients). Age, sex, and the severity of diverticulitis were similar in the two groups. The cure rates of 90% and 85.7% observed for CFX and G/C, respectively, did not differ significantly. Leukocytosis resolved in a shorter time period in patients treated with CFX than in those treated with G/C (2.5 +/- 0.4 vs 4.1 +/- 0.6 days, respectively) (P = 0.03, Student's t test, unpaired data). Two cases of possibly antibiotic-related toxicity occurred in the CFX group versus three cases in the G/C group. The average cost of a course of CFX therapy was $417 compared with $488 for G/C. In this study, cefoxitin demonstrated efficacy and tolerability similar to that of gentamicin-clindamycin in the treatment of acute colonic diverticulitis and may be preferred in view of its narrower antimicrobial spectrum and lower cost.
Acute Disease↗
[Surgical treatment of colonic diverticulitis].
Diverticulitis is one of the most common benign diseases of the colon, which usually occurs in elderly. Authors assay the surgical treatment of inflammatory complications of colon diverticulitis in the last 19 years. Most frequently inflammation occurs, which in lot of cases leads to acute abdominal disease. Results of 61 acute and 10 elective operations are analysed. Beside the complications and surgical possibilities authors issue the definitive indications of elective operation.
Aged↗
[Prognostic factors for survival in perforated colonic diverticulitis].
In a retrospective study we attempted to find prognostic factors for the mortality in perforated colonic diverticulitis. All patients of the First Surgical Department of Vienna University from 1965-1986 with complicated diverticulitis were included in this study. 47 patients had a perforated diverticulitis with a local abscess or a generalized peritonitis. In 35 patients a resection, in 12 patients a faecal diversion was performed. The mortality was 27%. A marked influence of age and preoperative complications on the prognosis was shown statistically. The operative procedure seems of secondary importance for operative mortality.
Abscess↗
Acute left colonic diverticulitis in young patients.
BACKGROUND: This prospective study was done to compare acute left-sided colonic diverticulitis in young patients (50 years of age or less) and older patients (more than 50 years of age) for severity of disease and immediate and late outcome. STUDY DESIGN: Of the 265 patients studied, 61 were 50 years of age or less; of these, 49 were men. In all instances, diagnosis was confirmed radiologically or histologically. RESULTS: Operations were performed less often upon younger patients than older patients (15 versus 33 percent, p = 0.001). Severe diverticulitis was found more often in younger men than older men (39 versus 23 percent). After successful conservative treatment during the first hospitalization period, younger men had a statistically greater risk of poor outcome than older men (29 versus 5 percent, p = 0.003). CONCLUSIONS: Although younger men have severe acute diverticulitis more often than older men, operative treatment during the first episode is less often needed. On the other hand, after conservative treatment, younger men have a statistically greater chance of poor secondary outcome than older men.
Abscess↗
[Patients with diagnosed colonic diverticulitis admitted to a department of surgery].
In 1995-96, 148 patients with the diagnosis diverticulitis of the colon were admitted a total of 176 times to the Department of Gastroenterologic Surgery at Ullevaal Hospital in Oslo. Data on treatment and outcome were recorded retrospectively from patient files. 92% of the hospitalisations were emergency cases of abdominal pain. In 113 hospitalisations, patients were initially treated with intravenous antibiotics, aspiration of the stomach, later oral antibiotics. No deaths were recorded. In 8 out of 64 patients (13%) hospitalised with diverticulitis for the first time, the diagnosis could not be verified by coloscopy or bowel enema. In 63 hospitalisations (36%), the patients underwent surgery. Hartmann's procedure was performed in 31 out of 49 emergency cases. 22 patients undergoing surgery in an emergency setting had perforated diverticulitis; 5 of these patients died within 15 days. 14 patients had planned surgery with bowel resection and 15 patients had a planned closing of the stoma. Two of these 29 patients died post-operatively. Acute diverticulitis is a serious condition, especially when the bowel has perforated. Complications develop both after emergency and elective surgery. We recommend careful selection of patients.
Adult↗
Computed tomography in acute left colonic diverticulitis.
BACKGROUND: The use of computed tomography (CT) in acute left colonic diverticulitis remains controversial. The purpose of this study was to define the value of CT both during the acute phase of inflammation and, later, to indicate secondary complications after successful medical treatment. METHODS: Some 423 patients with radiologically or histologically proven diverticulitis were studied prospectively from 1986 to 1995. Diverticulitis was considered moderate when CT showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat; it was considered severe when abscess and/or extraluminal air and/or extraluminal contrast were observed. RESULTS: The sensitivity of CT was 97 per cent. Of 42 patients who failed conservative treatment, 32 had severe diverticulitis on CT, compared with 74 (24 per cent) of 303 who had successful conservative treatment (P < 0.0001). After a median follow-up of 46 months, 60 (20 per cent) of 300 patients had secondary complications despite initially successful conservative treatment: 28 (47 per cent) of these had initial severe diverticulitis on CT compared with 44 (19 per cent) of 236 patients who had no complications (P < 0.0001). CONCLUSION: Abscess formation and extracolonic contrast or gas are findings that may be used to predict failure of medical treatment during the first admission and a high risk of secondary complications after initially successful medical management of acute diverticulitis.
Acute Disease↗
Prospective evaluation of ultrasonography in acute colonic diverticulitis.
BACKGROUND: The clinical diagnosis of acute colonic diverticulitis (ACD) can be difficult and ultrasonography by experts is valuable in establishing the diagnosis. This prospective observational trial aimed to assess the diagnostic accuracy and clinical value of ultrasonography performed routinely by surgical residents in training. METHODS: The clinical course of 187 unselected consecutive patients admitted with suspected ACD was studied prospectively. Patients who had surgery for generalized peritonitis were excluded, leaving 143 for evaluation. Ultrasonographic findings and clinical assessment on admission were correlated with the patient's clinicopathological data and discharge diagnosis respectively. RESULTS: Of 74 patients with proven ACD (prevalence 52 per cent) the diagnosis was made by ultrasonography in 62, with an accuracy of 88 per cent, sensitivity 84 per cent and specificity 93 per cent. Ultrasonography gave a false-negative result in 12 patients (negative predictive value (NPV) 84 per cent) and there were five false-positive findings (positive predictive value (PPV) 93 per cent). The final diagnosis in the latter five patients was colitis (two patients), caecal carcinoma (one), colonic ileus due to perforated sigmoid carcinoma (one) and suppurative pyosalpingitis with involvement of the sigmoid colon (one). The accuracy of clinical evaluation on admission was 71 per cent (sensitivity 82 per cent, specificity 55 per cent, PPV 72 per cent, NPV 68 per cent); however, in only 53 per cent of patients was the diagnosis considered clinically unequivocal. CONCLUSION: Ultrasonography is a useful and valid modality for imaging ACD and its differential diagnoses in the hands of sonographically trained surgeons. It is especially helpful when the clinical findings are equivocal.
Acute Disease↗