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At least 19 recordsLinked to original sources
PubMed1998

[Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis].

PURPOSE: To compare the performances of computed tomography (CT) and water soluble contrast enema in the diagnosis and evaluation of the severity of acute left colonic diverticulitis, and to propose indications for elective colectomy after a first episode of diverticulitis successfully treated medically. PATIENTS AND METHODS: Prospective non-randomized study (1986-1997) of 542 patients (290 women and 252 men with a median age of 64 years) whose final diagnosis was confirmed either histologically or radiologically. 465 patients (86%) had a CT, 439 (81%) had a water soluble contrast enema, and 420 (77%) had both examinations. Diverticulitis was considered moderate when CT showed localized thickening of colonic wall (> or = 5 mm) and inflammation of pericolic fat and water soluble contrast enema showed segmental lumen narrowing and tattered mucosa; it was considered severe when abscess and/or extraluminal air/or extraluminal contrast were described by CT or the two latter by water soluble contrast enema. RESULTS: 410 patients (76%) were treated medically and 132 were operated during their hospitalization. Sensitivity of CT for diagnosis of diverticulitis was 96%, compared to 87% for water soluble contrast enema (p < 0.0001). Severe diverticulitis was found in 139 patients (30%) by CT and in 45 patients (11%) by water soluble contrast enema (p < 0.0001). Age < or = 50 years, severe diverticulitis in the initial CT and associated pelvic abscess were found to be statistically significant parameters to predict the risk of secondary complications after a first episode of diverticulitis successfully treated medically. CONCLUSIONS: Performances of CT for diagnosis and evaluation of severity of acute diverticulitis are statistically higher than that of water soluble contrast enema. We would recommend elective colectomy in patients 50 years of age or younger with a severe diverticulitis in initial CT, and in all patients with an associated pelvic abscess.

Abdominal Abscess↗
PubMed1994

Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis.

OBJECTIVE: The purpose of this study was to analyze the usefulness of two specific CT signs of sigmoid mesenteric inflammation (fluid at the root of the mesentery and vascular engorgement) for identifying and differentiating sigmoid diverticulitis from carcinoma. MATERIALS AND METHODS: CT scans of 69 patients with surgically proved sigmoid diverticulitis were retrospectively reviewed and compared with CT findings in 29 patients with surgically proved sigmoid carcinoma. Two specific patterns of inflammation of the sigmoid mesentery were analyzed: fluid at the root of the sigmoid mesentery and engorgement of the sigmoid mesenteric vessels. RESULTS: The CT findings were present more often in patients with sigmoid diverticulitis than in those with carcinoma (p < .001). Fluid at the base of the mesentery had a sensitivity, specificity, and positive predictive value for diverticulitis of 36%, 90%, and 89% respectively. Vascular engorgement alone had a sensitivity, specificity, and positive predictive value of 29%, 100%, and 100%, respectively. CONCLUSION: Our results suggest that CT findings of fluid at the root of the mesentery and vascular engorgement are useful in distinguishing sigmoid diverticulitis from carcinoma of the sigmoid.

Adult↗
PubMed1976

[Colonic diverticulitis: diverticulitis with complications and its treatment (author's transl)].

Complications (stenosis, intestinal obstruction, abscess or fistula formation, inflammation, etc.) of colonic diverticulitis are seen in 35% of patients affected. Multiple operative procedures involve less risk than surgery performed in a single session. The mortality in emergency surgery is reported to be up to 40%, while subsequent resection of the diseased colon involves the usual mortality of surgery on the colon, i.e. 1.5-9%. The vital factor in this illness is the earliest possible surgical treatment of the diseased diverticulum, so that the extremely problematical complications can be avoided.

Colonic Diseases↗
PubMed2002

[Surgical therapy of inflammatory bowel diseases: ulcerative colitis--diverticulitis. Surgical choices in diverticulitis--conventional or laparoscopic surgery?].

There are no prospective randomized studies available to decide which surgical approach should be superior to treat sigmoid diverticulosis. Analysis of clinical studies evaluating laparoscopic or conventional surgery are presenting results as follows: for elective surgery morbidity ranges between 12-20% and mortality rates between 0-2% indicating comparable complication rates. For emergency operations only data from open surgery are available, with morbidity of 33-57% and mortality rates of 7-16%. Advantages of conventional approach are availability, reliability of the surgical technique and there is no patient selection required. Laparoscopic access may offer superior patients comfort and reduce cost, length of hospital stay and resocialisation. It remains to be proven, which approach may be the option of choice in the future, while this surgical technique is still developing.

Diverticulitis, Colonic↗
PubMed2001

Colonic diverticulitis: impact of imaging on surgical management -- a prospective study of 542 patients.

The aim of this study was to compare the performance of the CT and the water-soluble contrast enema (CE) in the diagnosis and the severity of acute left-colonic diverticulitis, and to recognize the impact of CT during the acute phase and after a first acute episode successfully treated medically. From 1986 to 1997, all patients admitted in our emergency center with clinically suspected left-colonic diverticulitis had a CE and a CT within 72 h of their admission, unless clinical findings required immediate laparotomy. They were prospectively included in the study if one or both radiological exams showed signs of acute diverticulitis and/or diverticulitis was surgically removed and histologically proven. Diverticulitis was considered moderate when CT showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat and CE showed segmental lumen narrowing and tethered mucosa; it was considered severe when abscess and/or extraluminal air and/or contrast were observed on CT and when one or both of the latter signs were seen on CE. Five hundred forty-two patients entered the study; 465 patients (86%) had a CT exam, 439 (81%) had a CE, and 420 (77%) had both exams. The performance of CT is significantly superior to CE in terms of sensitivity (98 vs 92%, p<0.01), and in the evaluation of the severity of the inflammation (26 vs 9%, p<0.02). Moreover, of 69 patients who had an associated abscess seen on CT, only 20 (29%) had indirect signs of this complication on CE. During the acute phase the chances of medical treatment failure are statistically greater when diverticulitis is considered severe on CT than when it is considered moderate (26% for the severe diverticulitis vs 4% for the moderate ones, p<0.0001). After successful medical treatment of the acute episode, patients with severe diverticulitis on the CT had statistically greater incidence of secondary bad outcome than patients with moderate diverticulitis (36 vs 17%, p<0.0001). Computed tomography should be preferred to CE as the initial radiological exam of diverticulitis because of its statistically significant superiority in sensitivity and for its statistically much higher performance in the detection of severe infection, especially when an abscess is associated with the disease. The severity of diverticulitis on CT is statistically predictive of the risk of medical treatment failure during the acute phase and of the chances of bad secondary outcome after a successful medical treatment of the first episode.

Abscess↗
PubMed2003

The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients.

The aim of this study was to evaluate the role of ultrasound in the diagnosis and management of acute diverticulitis and its capacity to predict posterior complications in patients undergoing medical treatment. A review was made of the histories of 208 hospitalized patients (262 admissions) initially diagnosed with acute diverticulitis over a 5-year period. Ultrasound was performed in all patients upon first admission. Diverticulitis was retrospectively classified as either simple or complicated, the latter being defined by the presence of extraluminal air and/or abscesses. Diverticulitis was finally diagnosed in 203 patients. Ultrasound exhibited a sensitivity of 86% in 77 cases subjected to surgery, and of 94% in the global 203 patients (192 true-positive and 11 false-negative findings). Of 34 patients with diverticulitis and emergency surgery, 10 had false-negative US exams. Twenty of the 73 cases (27%) with signs of complicated diverticulitis in the initial ultrasound study required emergency surgery, compared with only 4 of the 119 patients (3%) with US evidence of simple diverticulitis (p<0.001). Of the 169 patients with diverticulitis undergoing conservative management, 54 (32%) developed complications during follow-up. The patients under age 50 years with signs of complicated diverticulitis suffered more complications (65%) than the rest of groups (p<0.001). In subjects with recurrences (26%), these were either similar to or less than the first episode in 84% of the cases. The present study shows that ultrasound constitutes a feasible technique for diagnosing acute diverticulitis. The severity of diverticulitis according to US is statistically predictive of surgical risk during the acute phase. Severity is also related to the appearance of posterior complications in patients undergoing conservative management, although only in younger patients (<50 years).

Acute Disease↗
PubMed1999

Diverticulitis: the effect of age and location on the course of disease.

To examine the effect of patient's age and the location of diverticular disease on the course of the acute disease we retrospectively collected demographic data, symptoms, laboratory findings, imaging techniques, type of treatment (conservative vs. surgical), early and late complications, and follow-up data on 119 patients with acute diverticulitis (74 women, 45 men; mean age 64+/-14 years; follow-up 7-102 months, median 40). Patients were divided by their age into two groups (42 aged 60 years or younger, 77 aged over 60) and on the location of their disease (108 to the left of the middle transverse, 11 to the right). Lower abdominal pain, abdominal tenderness, and fever were the most common complaints (70-97%). In the younger patients we found a significantly greater preponderance in the right colon (P = 0.02) than in older patients. Abdominal abscesses and fistulas were more common in right-sided diverticulitis (P = 0.01). Patients with right-sided colon diverticulitis were treated surgically (82%) and on an emergency basis more often than patients with left-side colon diverticulitis (25%; P = 0.001). Older patients treated conservatively suffered more than younger patients (61% and 33% respectively; P = 0.04) from recurrent abdominal pain but not from recurrent, confirmed diverticulitis. Patients with right-sided diverticulitis treated conservatively suffered more from recurrent diverticulitis episodes than patients with left-sided diverticulitis (P = 0.05). Younger patients thus do not have a more aggressive form of diverticulitis than older patients. Patients with acute diverticulitis in the right colon are likely to be operated earlier and for mistaken diagnoses than patients with left-sided diverticulitis.

Adult↗
PubMed1989

[Recommendation for primary resection with primary anastomosis in complicated sigmoid diverticulitis. Report of experiences of the Herford Surgical Clinic 1973 to 1986].

Of the 107 patients with complicated diverticulitis operated from 1973-1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). The overall mortality of the 107 patients was 9.3% (= 10 patients) and the morbidity of the 97 survivors 34% (= 33 patients). The mortality of the 14 patients with perforated diverticulitis and diffuse purulent peritonitis was 50% of the 68 patients with perforated diverticulitis and localized purulent peritonitis 4.4% and of the 25 patients with acute phlegmonous diverticulitis 0%. Seven of the 10 patients died after operation of the perforated diverticulitis with diffuse purulent peritonitis - 1 (5) after primary resection with primary anastomosis. 3 (5) after Hartmann procedure, 3 (4) after loop colostomy alone. Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis - 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980 - 1986 the mortality decreased for these operations from 35.7% in 1973 - 1979 to 0% in 1980 - 1986. The indication of primary resection with primary anastomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.

Adult↗
PubMed2000

Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticulitis. METHODS: The Norfolk Surgical Group Laparoscopic Surgery Registry identified all patients undergoing laparoscopic colon and rectal surgery. Retrospective chart review was performed for all patients undergoing elective sigmoid resection for a final diagnosis of diverticulitis and minimum follow-up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative course (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Statistical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparoscopic-assisted and conversion groups with regard to postoperative days to flatus, regular diet, and discharge. RESULTS: From June 1992 to September 1997, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 patients. Uncomplicated recurrent diverticulitis was the most common indication for surgery, occurring in 51 of 69 patients (75 percent). No deaths occurred. Complications were identified in seven patients (10.1 percent) including one wound infection and one incarcerated port-site hernia with small bowel obstruction. There were no anastomotic leaks or major septic complications. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). Uncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required conversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion group revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0.0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001), respectively. No difference was noted with regard to operative time or postoperative complications. Median follow-up was 48 (range, 13-76) months, and a single recurrence of diverticulitis has been identified. CONCLUSIONS: Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely performed. Conversion appears to be associated with complicated diverticulitis (fistula or abscess), which may be better approached by laparotomy. Short-term follow-up indicates that recurrence is rare and suggests that laparoscopic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic-assisted sigmoid colectomy offers benefits of decreased ileus and length of stay and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis.

Adult↗
PubMed2002

Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients.

PURPOSE: This study was designed to evaluate the long-term natural history of sigmoid diverticulitis in patients treated nonoperatively after a first acute episode and to assess the role of elective colectomy. METHODS: Between 1986 and 1991, 144 patients were admitted for acute diverticulitis diagnosed by abdominal computed tomography and had a successful nonoperative treatment. Remote complications (persisting or recurring diverticulitis) were also diagnosed by computed tomography. Patients had a poor outcome if they had one of these complications. Diverticulitis was graded mild or severe on computed tomography according to Ambrosetti's criteria. We determined statistically whether young age (< or =50 years old) and severe diverticulitis were risk factors for a poor outcome. RESULTS: One hundred eighteen patients with a contributive computed tomographic scan at admission were followed up. Median age was 63 (range, 23-93) years, with a median follow-up of 9.5 (range, 0.2-13.8) years. Eighty patients had no complications, and 38 had remote complications. The incidence of remote complications was the highest (54 percent at 5 years) for young patients with severe diverticulitis on computed tomography and the lowest (19 percent at 5 years) for older patients with mild disease. Young age and severe diverticulitis taken separately were both statistically significant factors of poor outcome (P = 0.007 and P = 0.003, respectively), although age was no longer significant after stratification for disease severity on computed tomography (P = 0.07). Twenty-four patients died. The cause of death was unrelated to diverticulitis in 21 cases and unknown in the remaining 3. CONCLUSIONS: We propose that after a first acute episode of diverticulitis treated nonoperatively, elective colectomy should be offered to young patients (< or =50 years old) with severe diverticulitis on computed tomography.

Adult↗
PubMed1993

[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↗
PubMed1999

Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.

BACKGROUND: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or the results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic resection of the sigmoid colon for diverticulitis in various stages of severity. RESULTS: Between January 8, 1995 and January 1, 1998, the Laparoscopic Colorectal Surgery Study Group recruited 1,118 patients to the prospective multicenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In most of these patients undergoing laparoscopic surgery (81.9%), the diverticulitis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinchey stages I to IV and late complications of chronic diverticular disease with fistula formation and bleeding accounted for only 18.1% of the cases. For the overall group, the conversion rate was 7.2%. Patients with less severe diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and the rate for complicated cases was 18.2%. Regarding laparoscopically completed interventions, 3 of 282 patients died (1.1%). In the group of patients with peridiverticulitis, stenosis, or recurrent attacks of inflammation the overall complication rate was 14.8%. The group with perforated diverticulitis in Hinchey stages I to IV or those with fistula and bleeding, the corresponding rate was 28.9%, and after conversion it was 31.8%. CONCLUSIONS: Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.

Diverticulitis, Colonic↗
PubMed1998

Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients.

OBJECTIVE: We prospectively evaluated a helical CT technique in which contrast material is administered only through the colon for the imaging of suspected diverticulitis. SUBJECTS AND METHODS: One hundred fifty consecutive patients who presented to our emergency department with clinically suspected diverticulitis underwent helical abdominal CT after contrast material was administered only through the colon. CT findings of diverticulitis included diverticula, muscular wall hypertrophy, focal colonic wall thickening, and pericolonic fat stranding. CT results were correlated with clinical follow-up (all patients) and with pathologic findings (41 patients). RESULTS: A final clinical diagnosis of diverticulitis was made in 64 patients (43%), of whom 62 (97%) had CT results positive for diverticulitis. Of the 86 patients for whom diverticulitis was clinically excluded, all (100%) had CT results that were negative for diverticulitis. CT interpretations had a sensitivity of 97%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 98%, and an overall accuracy of 99%. Alternative diagnoses were noted on CT in 50 (58%) of 86 patients who did not have diverticulitis and included 50 (78%) of the 64 patients in whom an alternative condition other than nonspecific abdominal pain was established. CONCLUSION: Helical CT obtained after contrast material administered only through the colon is accurate (99%) for confirming or excluding clinically suspected diverticulitis and for suggesting alternative conditions (78%) when they are present. This CT technique avoids the risks, discomforts, and costs of oral and i.v. contrast material administration and allows immediate scanning.

Adult↗