Predictive risk model of recurrence of acute diverticulitis after the first episode.

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.

[Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care]. / Estudio prospectivo para evaluar la precisión diagnóstica en enfermedad anal benigna en atención primaria.

OBJECTIVE: To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases. DESIGN: Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery. SETTING: Department of General Surgery and Digestive Diseases. Castellon General Hospital. PARTICIPANTS: Patients diagnosed with a benign anal disease in PC and referred to our department. MEASUREMENTS: The sensitivity, specificity and kappa index was calculated for each disease. RESULTS: A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results. CONCLUSIONS: The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.

[Ileal pouch-anal anastomosis for Crohn's disease. Current status]. / Anastomosis ileoanal con reservorio en pacientes con enfermedad de Crohn. Estado actual.

Ileal pouch-anal anastomosis has become the standard surgical procedure for the treatment of ulcerative colitis and familial polyposis of the colon. Nevertheless, its use in Crohn's disease patients remains controversial. A review was carried out in order to determine the present scientific evidence on the usefulness of ileal pouch-anal anastomosis in Crohn's disease patients. There are no clinical trials analysing this issue. Scientific evidence is based on case series and retrospective studies. Most authors agree that Crohn's disease remains a contraindication for ileal pouch-anal anastomosis, due to the high rate of complications and pouch failure. Nevertheless, a small group of authors consider ileal pouch-anal anastomosis as a good alternative for selected Crohn's disease patients. Both groups agree that if the pouch can be preserved, functional results are good. According to our review, current scientific evidence does not recommend ileal pouch-anal anastomosis for Crohn's disease patients.