AIM： To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis. METHODS： The study, a non-randomized comparison of the two app...AIM： To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis. METHODS： The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis （Hinchey classification I - II ） at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies. RESULTS： The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher （80% vs 75%）. Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elec- tive resection （9296 ± 694 vs 8423 ± 968 ; P = 0.001）. Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages.展开更多
BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diver...BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diverticulitis(CD)mostly requires hospitalization and can be treated within a spectrum from observation to surgery.Treatment choice is formed depending on the patient’s general condition,the presence of diffuse peritonitis,the localization of diverticulitis,Hinchey stage,and responsiveness to the prior treatment.Clinical disparities regarding right and LCD also led to the differences in the incidences of both emergency surgery and future elective surgery.AIM To evaluate the clinical features of CD,display the differences according to colonic localizations,and present treatment approaches.METHODS This was a retrospective study from a single centre analysing data from a prospective database.The 253 patients with history of hospitalization for CD were included and divided into two groups:RCD and LCD.To compare the differences between the two groups,the Student’s t-test was used when the parametric test prerequisites were fulfilled,and the Mann-Whitney U test was used when such requirements were not fulfilled.RESULTS The 208(82.2%)patients were found to have LCD,and 45(17.8%)had RCD.The majority of the patients had Hinchey 1A diverticulitis(49.8%).Male gender was significantly more common in patients who underwent surgery for LCD.While persistent abdominal pain was the main prior finding in the conservative treatment of both localizations,surgery was most performed due to abscess in RCD and perforation in LCD.The presence of an accompanying malignancy during colonoscopy was significantly more common in LCD cases who underwent surgery.Hartmann’s procedure was the most performed technique in emergency settings(56.3%),while laparoscopic colectomy with anastomosis was in elective settings(53.9%).In addition,surgery was found to prolong the mean length of hospital stay in LCD patients.CONCLUSION Although diverticulitis is a benign condition,the need for an individualized and evidence-based approach makes management challenging.Localization of the disease has an important role in determining the appropriate treatment.展开更多
Diverticulitis is an infection of the diverticular sacs protruding from the intestinal wall.It typically presents as elevated inflammatory markers and left lower quadrant abdominal pain.Although clinical symptoms and ...Diverticulitis is an infection of the diverticular sacs protruding from the intestinal wall.It typically presents as elevated inflammatory markers and left lower quadrant abdominal pain.Although clinical symptoms and biomarkers are essential for diagnosis,imaging methods,particularly computed tomography(CT),are critical due to the inability to perform endoscopic procedures in the acute phase because of the risk of perforation.Various classification systems that include imaging findings have been developed.The most recent and widely accepted system is the Sartelli classification,which is endorsed by the World Society of Emergency Surgery.This classification describes stages of diverticulitis ranging from edematous bowel wall thickening and phlegmon in the adjacent mesentery to microperforation,localized or distant abscess formation,and generalized peritonitis with free fluid and air.Imaging findings are also pivotal in diagnosing and managing complications such as abscesses,pylephlebitis,fistulas,and gastrointestinal bleeding.Moreover,imaging can differentiate diverticulitis from infectious colitis,epiploic appendagitis,ischemic colitis,colorectal carcinoma,and inflammatory bowel disease.This review focuses on the radiological findings of diverticulitis.We specifically discuss CT imaging and emphasize its clinical manifestations,significant complications,and differential diagnosis.展开更多
Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden.This review article analyzes the current data regarding management of sigmoid diverticulitis in its ...Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden.This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations.Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis.Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended.Rather,a more individualized approach,taking into account frequency,severity of the attacks and their impact on quality of life,should guide the indication for surgery.On the other hand,complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal perforation.Laparoscopic surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized peritonitis.There is not sufficient evidence supporting any changes in the approach to management in younger patients.Conversely,the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals.Uncommon clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.展开更多
文摘AIM： To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis. METHODS： The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis （Hinchey classification I - II ） at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies. RESULTS： The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher （80% vs 75%）. Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elec- tive resection （9296 ± 694 vs 8423 ± 968 ; P = 0.001）. Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages.
文摘BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diverticulitis(CD)mostly requires hospitalization and can be treated within a spectrum from observation to surgery.Treatment choice is formed depending on the patient’s general condition,the presence of diffuse peritonitis,the localization of diverticulitis,Hinchey stage,and responsiveness to the prior treatment.Clinical disparities regarding right and LCD also led to the differences in the incidences of both emergency surgery and future elective surgery.AIM To evaluate the clinical features of CD,display the differences according to colonic localizations,and present treatment approaches.METHODS This was a retrospective study from a single centre analysing data from a prospective database.The 253 patients with history of hospitalization for CD were included and divided into two groups:RCD and LCD.To compare the differences between the two groups,the Student’s t-test was used when the parametric test prerequisites were fulfilled,and the Mann-Whitney U test was used when such requirements were not fulfilled.RESULTS The 208(82.2%)patients were found to have LCD,and 45(17.8%)had RCD.The majority of the patients had Hinchey 1A diverticulitis(49.8%).Male gender was significantly more common in patients who underwent surgery for LCD.While persistent abdominal pain was the main prior finding in the conservative treatment of both localizations,surgery was most performed due to abscess in RCD and perforation in LCD.The presence of an accompanying malignancy during colonoscopy was significantly more common in LCD cases who underwent surgery.Hartmann’s procedure was the most performed technique in emergency settings(56.3%),while laparoscopic colectomy with anastomosis was in elective settings(53.9%).In addition,surgery was found to prolong the mean length of hospital stay in LCD patients.CONCLUSION Although diverticulitis is a benign condition,the need for an individualized and evidence-based approach makes management challenging.Localization of the disease has an important role in determining the appropriate treatment.
文摘Diverticulitis is an infection of the diverticular sacs protruding from the intestinal wall.It typically presents as elevated inflammatory markers and left lower quadrant abdominal pain.Although clinical symptoms and biomarkers are essential for diagnosis,imaging methods,particularly computed tomography(CT),are critical due to the inability to perform endoscopic procedures in the acute phase because of the risk of perforation.Various classification systems that include imaging findings have been developed.The most recent and widely accepted system is the Sartelli classification,which is endorsed by the World Society of Emergency Surgery.This classification describes stages of diverticulitis ranging from edematous bowel wall thickening and phlegmon in the adjacent mesentery to microperforation,localized or distant abscess formation,and generalized peritonitis with free fluid and air.Imaging findings are also pivotal in diagnosing and managing complications such as abscesses,pylephlebitis,fistulas,and gastrointestinal bleeding.Moreover,imaging can differentiate diverticulitis from infectious colitis,epiploic appendagitis,ischemic colitis,colorectal carcinoma,and inflammatory bowel disease.This review focuses on the radiological findings of diverticulitis.We specifically discuss CT imaging and emphasize its clinical manifestations,significant complications,and differential diagnosis.
文摘Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden.This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations.Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis.Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended.Rather,a more individualized approach,taking into account frequency,severity of the attacks and their impact on quality of life,should guide the indication for surgery.On the other hand,complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal perforation.Laparoscopic surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized peritonitis.There is not sufficient evidence supporting any changes in the approach to management in younger patients.Conversely,the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals.Uncommon clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.
