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Dor Abdominal , Apendicite , Humanos , Apendicite/cirurgia , Apendicite/complicações , Dor Abdominal/etiologia , Masculino , Diverticulite/complicações , Diverticulite/cirurgia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/terapia , Colonoscopia/métodos , Pessoa de Meia-Idade , FemininoRESUMO
BACKGROUND: We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. METHODS: A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. RESULTS: Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). CONCLUSIONS: Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.
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Estudos de Viabilidade , Fístula Intestinal , Laparoscopia , Complicações Pós-Operatórias , Humanos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Idoso , Fístula Intestinal/cirurgia , Fístula Intestinal/etiologia , Fístula Intestinal/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Hospitais com Alto Volume de Atendimentos , Adulto , Colectomia/métodos , Colectomia/efeitos adversos , Conversão para Cirurgia Aberta , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/mortalidade , Resultado do Tratamento , Idoso de 80 Anos ou maisRESUMO
PURPOSE: Diverticular abscess is a common manifestation of acute complicated diverticulitis. We aimed to analyze the clinical course of patients with diverticular abscess initially treated conservatively. METHODS: All patients with diverticular abscess undergoing elective or urgent/emergency surgery from October 2004 to October 2022 were identified from our institutional database. Depending on the abscess size, patients were divided into group A (≤ 3 cm) and group B (> 3 cm). Conservative treatment failure was defined as clinical deterioration, persistent or recurrent abscess, or urgent/emergency surgery. Baseline characteristics and short-term perioperative outcomes were recorded and compared between both groups. Uni- and multivariate analyses were conducted to identify determinants of conservative treatment failure and overall ostomy formation. RESULTS: A total of 105 patients were enrolled into group A (n = 73) and group B (n = 32). Uni- and multivariate analyses revealed abscess size as the only significant factor of conservative therapy failure [OR 9.904; p < 0.0001], while overall ostomy formation was significantly affected by an increased body mass index (BMI) [OR 1.366; p = 0.026]. There were no significant differences in perioperative outcome with the exception of a longer total hospital stay in patients managed with abscess drainage compared to antibiotics alone prior surgery in group B (p = 0.045). CONCLUSION: Abscess diameter > 3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. In this subgroup, the choice between primary drainage and antibiotics does not appear to influence outcome at the cost of prolonged hospital stay after drainage insertion.
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Drenagem , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Abscesso/complicações , Abscesso/terapia , Consenso , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/cirurgia , Tratamento Conservador , Resultado do Tratamento , Abscesso Abdominal/etiologia , Abscesso Abdominal/complicações , Tempo de Internação , Antibacterianos/uso terapêutico , Relevância ClínicaRESUMO
INTRODUCTION: Colonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low-quality evidence. METHODS: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest. RESULTS: A total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery. CONCLUSION: NOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.
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Tratamento Conservador , Doença Diverticular do Colo , Humanos , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/complicações , Doença Aguda , Tratamento Conservador/métodos , ArAssuntos
Doença Diverticular do Colo , Humanos , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Doença Aguda , Masculino , Abscesso/cirurgia , Abscesso/terapia , Colonoscopia/métodos , Abscesso Abdominal/cirurgia , Abscesso Abdominal/etiologia , Abscesso Abdominal/terapia , Pessoa de Meia-Idade , Drenagem/métodosRESUMO
A 53-year-old woman with a history of recurrent right lower quadrant pain presented with slightly bloody stools in April 2023. She was initially diagnosed with acute diverticulitis using an abdominal computed tomography (CT) scan and was treated conservatively. On the second day, however, she reported significant hematochezia. A subsequent contrast-enhanced CT scan revealed an extravasation in the ascending colon, which was promptly managed with colonoscopy. Despite initial hemostasis, she experienced recurrent bleeding. Another contrast-enhanced CT scan revealed a pseudoaneurysm with ongoing extravasation in the same area. Angiography confirmed a pseudoaneurysm in a branch of the ileocolic artery, which was successfully treated by embolization. She was discharged after an 18 day hospital stay. This case highlights a pseudoaneurysm caused by diverticulitis.
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Falso Aneurisma , Doença Diverticular do Colo , Embolização Terapêutica , Hemorragia Gastrointestinal , Humanos , Feminino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/complicações , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Pessoa de Meia-Idade , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Embolização Terapêutica/métodos , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Íleo/irrigação sanguínea , Íleo/diagnóstico por imagem , Colonoscopia , Colo/irrigação sanguínea , Colo/diagnóstico por imagemRESUMO
Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.
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Duodenopatias , Humanos , Duodenopatias/complicações , Tomografia Computadorizada por Raios X , Masculino , Idoso , Fístula Intestinal/complicações , Fístula Intestinal/etiologia , Doença Diverticular do Colo/complicações , Feminino , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/etiologia , Diverticulite/complicaçõesRESUMO
This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5-S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.
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Isquemia , Humanos , Masculino , Adulto , Isquemia/etiologia , Isquemia/diagnóstico , Espaço Retroperitoneal , Osteomielite/complicações , Osteomielite/diagnóstico , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Extremidade Inferior/irrigação sanguínea , Antibacterianos/uso terapêutico , Abscesso Abdominal/cirurgia , Abscesso Abdominal/etiologia , Embolectomia/métodos , Colostomia , Abscesso/complicações , Abscesso/terapia , Abscesso/diagnósticoRESUMO
BACKGROUND: Laparoscopic lavage (LPL) has been suggested for treatment of non-feculent perforated diverticulitis. In this observational study, the surgical treatment of diverticular disease in Sweden outside prospective trials was investigated. METHODS: This population-based study used the National Patient Register to identify all patients in Sweden with emergency admissions for diverticular disease, as defined by ICD codes from July 2014 to December 2020. Demographics, surgical procedures and outcomes were assessed. In addition, register data since 1997 were retrieved to assess co-morbidities, previous abdominal surgeries, and previous admissions for diverticular disease. RESULTS: Among 47 294 patients with emergency hospital admission, 2035 underwent LPL (427 patients) or sigmoid resection (SR, 1608 patients) for diverticular disease. The mean follow-up was 30.8 months. Patients selected for LPL were younger, healthier and with less previous abdominal surgery for diverticular disease than those in the SR group (P < 0.01). LPL was associated with shorter postoperative hospital stay (mean 9.4 versus 14.9 days, P < 0.001) and lower 30-day mortality (3.5% versus 8.7%, P < 0.001). Diverticular disease-associated subsequent surgery was more common in the SR group than the LPL group except during the first year (P < 0.001). LPL had a lower mortality rate during the study period (stratified HR 0.70, 95% c.i. 0.53-0.92, P = 0.023). CONCLUSION: Laparoscopic lavage constitutes a safe alternative to sigmoid resection for selected patients judged clinically to require surgery.
Diverticulitis is inflammation in pouches of the large bowel. Rarely, diverticulitis can lead to a bowel perforation causing peritonitis. Traditionally, it was treated by resection of the inflamed bowel with a stoma. A milder treatment has been proposed in which the abdomen is rinsed with saline laparoscopically and drained (laparoscopic lavage). This study aimed to examine the outcomes of laparoscopic lavage in Sweden. Our findings support the use of this method in younger and healthier patients with a history of no or only minor previous abdominal surgery.
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Doença Diverticular do Colo , Perfuração Intestinal , Laparoscopia , Lavagem Peritoneal , Sistema de Registros , Humanos , Masculino , Feminino , Idoso , Suécia/epidemiologia , Lavagem Peritoneal/métodos , Pessoa de Meia-Idade , Perfuração Intestinal/cirurgia , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/terapia , Tempo de Internação , Resultado do Tratamento , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: The risk of recurrence is an important consideration when deciding to treat patients medically or with elective colectomy after recovery from diverticulitis. It is unclear whether age is associated with recurrence. This study aimed to examine the relationship between age and the risk of recurrent diverticulitis while considering important epidemiologic factors, such as birth decade. METHODS: The Utah Population Database was used to identify individuals with incident severe diverticulitis, defined as requiring an emergency department visit or hospitalization, between 1998 and 2018. This study measured the relationship between age and recurrent severe diverticulitis after adjusting for birth decade and other important variables, such as sex, urban/rural status, complicated diverticulitis, and body mass index using a Cox proportional hazards model. RESULTS: The cohort included 8606 individuals with a median age of 61 years at index diverticulitis diagnosis. After adjustment, among individuals born in the same birth decade, increasing age at diverticulitis onset was associated with an increased risk of recurrent diverticulitis (hazard ratio [HR] for 10 years, 1.8; 95% CI, 1.5-2.1). Among individuals with the same age of onset, those born in a more recent birth decade were also at greater risk of recurrent diverticulitis (HR, 1.9; 95% CI, 1.6-2.3). CONCLUSION: Among individuals with an index episode of severe diverticulitis, recurrence was associated with increasing age and more recent birth decade. Clinicians may wish to employ age-specific strategies when counseling patients regarding treatment options after a diverticulitis diagnosis.
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Doença Diverticular do Colo , Diverticulite , Humanos , Pessoa de Meia-Idade , Criança , Doença Diverticular do Colo/epidemiologia , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Estudos Retrospectivos , Diverticulite/complicações , Hospitalização , Colectomia/efeitos adversos , RecidivaRESUMO
BACKGROUND: Imaging-based classifications do not always reflect the clinical severity and prognosis of acute left-sided colonic diverticulitis. This study aims to investigate the role of an early procalcitonin assessment in the emergency department as a risk stratification tool for severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis. METHODS: In this retrospective cohort study, all adult patients consecutively admitted from January 2015 to September 2020 for acute left-sided colonic diverticulitis and having a procalcitonin determination at admission were enrolled. The following data were collected: age, sex, comorbidities, laboratory parameters, level of urgency, clinical presentation, type of treatment, complications, and post-management outcomes. The association between the procalcitonin value at admission and the following endpoints was analyzed: type of treatment, classification of acute left-sided colonic diverticulitis, mortality, and type of surgery. RESULTS: A total of 503 consecutive patients were enrolled. Procalcitonin >0.5 ng/mL emerged as an independent risk factor for complicated acute left-sided colonic diverticulitis (P = .007). Procalcitonin >0.5 ng/mL (P = .033), together with a history of complicated acute left-sided colonic diverticulitis (P < .001), abdominal pain (P = .04), bowel perforation (P < .001), and peritonitis (P < .001), was a significant risk factor for surgery. Procalcitonin >0.5 ng/mL (P = .007) and peritonitis (P = .03) emerged as independent risk factors for sigmoidectomy without colorectal anastomosis. Procalcitonin >0.5 ng/mL (P = .004), a higher level of urgency at admission (P = .005), Hartmann's procedure (P = .002), and the necessity of mechanical ventilation (P = .004) emerged as independent risk factors for mortality. CONCLUSION: Procalcitonin >0.05 ng/mL at emergency department admission is a useful risk stratification tool for severity, prognosis, and need for surgical treatment in patients with acute left-sided colonic diverticulitis.
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Doença Diverticular do Colo , Pró-Calcitonina , Índice de Gravidade de Doença , Humanos , Masculino , Feminino , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/sangue , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/complicações , Pró-Calcitonina/sangue , Estudos Retrospectivos , Pessoa de Meia-Idade , Medição de Risco/métodos , Prognóstico , Idoso , Biomarcadores/sangue , Adulto , Doença Aguda , Fatores de Risco , Serviço Hospitalar de Emergência/estatística & dados numéricosRESUMO
PURPOSE: Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia. METHODS: This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021. RESULTS: Forty patients were included in our study. The mean age was 42 years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5 ± 3 days). Follow-up showed no recurrences. CONCLUSION: Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.
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Colectomia , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Tunísia/epidemiologia , Colectomia/métodos , Doença Aguda , Idoso , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/complicações , Resultado do Tratamento , Adulto Jovem , População do Norte da ÁfricaRESUMO
BACKGROUND: Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure. METHODS: A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission. RESULTS: Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002). CONCLUSIONS: Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.
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Tratamento Conservador , Falha de Tratamento , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Aguda , Tratamento Conservador/métodos , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/complicações , Drenagem/métodos , Estudos Retrospectivos , Fatores de RiscoRESUMO
ABSTRACT: Acute colonic diverticulitis is a common disease treated by acute care surgeons. Acute uncomplicated colonic diverticulitis involves thickening of the colon wall with inflammatory changes and less commonly requires the expertise of a surgeon; many cases may be treated as an outpatient with or without antibiotics. Complicated diverticulitis involves phlegmon, abscess, peritonitis, obstruction, stricture, and/or fistula and usually requires inpatient hospital admission, treatment with antibiotics, and consideration for intervention including operative management. This review will discuss what the acute care surgeon needs to know about diagnosis and management of acute colonic diverticulitis.
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Antibacterianos , Doença Diverticular do Colo , Humanos , Doença Diverticular do Colo/terapia , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/complicações , Doença Aguda , Antibacterianos/uso terapêuticoRESUMO
Acute colonic diverticulitis is a gastrointestinal condition that is frequently encountered by primary care and emergency department practitioners, hospitalists, surgeons, and gastroenterologists. Clinical presentation ranges from mild abdominal pain to peritonitis with sepsis. It is often diagnosed on the basis of clinical features alone, but imaging is necessary in more severe presentations to rule out such complications as abscess and perforation. Treatment depends on the severity of the presentation, the presence of complications, and underlying comorbid conditions. Medical and surgical treatment algorithms are evolving. This article provides an evidence-based, clinically relevant overview of the epidemiology, diagnosis, and treatment of acute diverticulitis.
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Doença Diverticular do Colo , Diverticulite , Peritonite , Humanos , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/epidemiologia , Tomografia Computadorizada por Raios X , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Dor Abdominal/etiologia , Doença AgudaRESUMO
AIM: We aimed to investigate the short and the long-term outcomes and 2-year Quality of Life (QoL) of patients with right-sided colonic diverticulitis (RCD) surgically managed. METHOD: We conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1-year post surgery. The enrolled patients completed the EuroQoL (EQ-5D-3L) during a regular follow-up visit at 12 and 24 months after surgery. RESULTS: Three hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non-operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo-caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien-Dindo as grade I-II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24-month follow-up. A statistically significant difference between preoperative and 24-month QoL index values (median 0.72; IQR = 0.57-0.8 vs. median 0.9; IQR = 0.82-1; p = 0.0003) was observed. CONCLUSIONS: The study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery.
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Doença Diverticular do Colo , Diverticulite , Humanos , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/cirurgia , Qualidade de Vida , Estudos de Coortes , Recidiva , Resultado do Tratamento , Estudos RetrospectivosRESUMO
BACKGROUND: Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke. METHODS: In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings. RESULTS: The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12-1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30-39 years. CONCLUSIONS: Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30-39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients.
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Doença Diverticular do Colo , AVC Isquêmico , Humanos , Masculino , Feminino , Taiwan/epidemiologia , AVC Isquêmico/epidemiologia , AVC Isquêmico/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto , Doença Diverticular do Colo/epidemiologia , Doença Diverticular do Colo/complicações , Idoso , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos de Casos e Controles , Estudos de CoortesRESUMO
BACKGROUND: In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS: All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS: In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS: This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION: Comité National Information et Liberté (CNIL) (n°920361).
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Doença Diverticular do Colo , Diverticulite , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos de Coortes , Colo Sigmoide/cirurgia , Diverticulite/cirurgia , Diverticulite/complicações , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , IdosoAssuntos
Doença Diverticular do Colo , Verde de Indocianina , Fístula Intestinal , Humanos , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Fístula Intestinal/cirurgia , Fístula Intestinal/etiologia , Fístula Intestinal/diagnóstico por imagem , Cateteres Urinários , Colo Sigmoide/cirurgia , Colo Sigmoide/irrigação sanguínea , Colo Sigmoide/diagnóstico por imagem , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/diagnóstico por imagem , Masculino , Ureter/cirurgia , Ureter/diagnóstico por imagem , Corantes , Feminino , Cirurgia Assistida por Computador/métodos , Fluxo Sanguíneo RegionalRESUMO
INTRODUCTION: The recurrence of acute diverticulitis (AD) of the colon is frequent and leads to hospital readmissions and the need for elective surgery in selected cases. It is important to individualize risk factors and develop predictive tools for their identification. MATERIALS AND METHODS: This prospective observational study included 368 patients who were diagnosed with AD between 2016 and 2021 in a tertiary general university hospital during their first episode and who had a good response to antibiotic, percutaneous, or peritoneal lavage treatment. Univariate and multivariate Cox regression analyses of the variables associated with recurrence were performed. Subsequently, a predictive risk score was developed and validated through survival studies. RESULTS: After a median follow-up of 50 months, there were 71 (19.3%) cases of recurrence out of a total of 368 patients. The mean time of recurrence was 15 months, and 73.3% of cases of recurrence occurred before 2 years of follow-up. Recurrence was independently associated with presentation with colonic perforation in the antimesenteric location (HR 3.67 95% CI [1.59-8.4]) and a CRP level greater than 100 mg/dl (HR 1.69 95% CI [1.04-2.77). A score with 5 variables was created that differentiated two risk groups: intermediate risk (0-3 points), with 19% recurrence and high risk (more than 3 points), with 42% recurrence. CONCLUSIONS: The risk of recurrence after the first episode of diverticulitis can be estimated using predictive scores. The detection of high-risk patients facilitates the individualization of follow-up and treatment.