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Diverticulitis: Incidence and Initial Management

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Multidisciplinary Approaches to Common Surgical Problems

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Abstract

The understanding of and medical treatment for diverticulitis has evolved significantly in recent years. The progression from asymptomatic diverticulosis to diverticulitis is less than was previously thought. Emerging evidence suggests uncomplicated diverticulitis may not require antibiotics. Despite these changes, the central tenet in the treatment of sigmoid diverticulitis remains unchanged, with a focus on the patient’s clinical status. This is paramount as laboratory and radiographic findings may not predict clinical course. To this end, diverticulitis should be approached in an algorithmic manner and individualized based on the patient’s presentation.

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References

  1. Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971;2(5759):450–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Shahedi K, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol. 2013;11(12):1609–13.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Warner E, et al. Fourteen-year study of hospital admissions for diverticular disease in Ontario. Can J Gastroenterol. 2007;21(2):97–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kang JY, Melville D, Maxwell JD. Epidemiology and management of diverticular disease of the colon. Drugs Aging. 2004;21(4):211–28.

    Article  PubMed  Google Scholar 

  5. Heise CP. Epidemiology and pathogenesis of diverticular disease. J Gastrointest Surg. 2008;12(8):1309–11.

    Article  PubMed  Google Scholar 

  6. Salem TA, Molloy RG, O’Dwyer PJ. Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. Dis Colon Rectum. 2007;50(9):1460–4.

    Article  PubMed  Google Scholar 

  7. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4(1):53–69.

    CAS  PubMed  Google Scholar 

  8. Peery AF, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149(7):1731–41 e3.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Peery AF, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179–87 e1–3.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Iyer R, et al. Acute colonic diverticulitis: diagnostic evidence, demographic and clinical features in three practice settings. J Gastrointestin Liver Dis. 2014;23(4):379–86.

    PubMed  Google Scholar 

  11. Sugihara K. Diverticular disease of the colon in Japan. Ann Acad Med Singap. 1987;16(3):504–8.

    CAS  PubMed  Google Scholar 

  12. Markham NI, Li AK. Diverticulitis of the right colon–experience from Hong Kong. Gut. 1992;33(4):547–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631–9.

    Article  PubMed  Google Scholar 

  14. Parks TG. Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J. 1969;4(5684):639–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bahadursingh AM, et al. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg. 2003;186(6):696–701.

    Article  PubMed  Google Scholar 

  16. Beckham H, Whitlow CB. The medical and nonoperative treatment of diverticulitis. Clin Colon Rectal Surg. 2009;22(3):156–60.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Woods RJ, et al. Internal fistulas in diverticular disease. Dis Colon Rectum. 1988;31(8):591–6.

    Article  CAS  PubMed  Google Scholar 

  18. Makela J, Kiviniemi H, Laitinen S. Prevalence of perforated sigmoid diverticulitis is increasing. Dis Colon Rectum. 2002;45(7):955–61.

    Article  PubMed  Google Scholar 

  19. Nagorney DM, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum. 1985;28(2):71–5.

    Article  CAS  PubMed  Google Scholar 

  20. Feingold D, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284–94.

    Article  PubMed  Google Scholar 

  21. Makela JT, et al. The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit. Scand J Gastroenterol. 2015;50(5):536–41.

    Article  PubMed  CAS  Google Scholar 

  22. Makela JT, Klintrup K, Rautio T. The role of low CRP values in the prediction of the development of acute diverticulitis. Int J Color Dis. 2016;31(1):23–7.

    Article  Google Scholar 

  23. Kechagias A, Rautio T, Makela J. The early C-reactive protein trend does not have a role in monitoring acute diverticulitis progression. Chirurgia (Bucur). 2016;111(1):43–7.

    Google Scholar 

  24. Lameris W, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18(11):2498–511.

    Article  PubMed  Google Scholar 

  25. Ambrosetti P, et al. Computed tomography in acute left colonic diverticulitis. Br J Surg. 1997;84(4):532–4.

    Article  CAS  PubMed  Google Scholar 

  26. Morris J, et al. The utility of computed tomography in colonic diverticulitis. Ann Surg. 1986;204(2):128–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85–109.

    CAS  PubMed  Google Scholar 

  28. Sher ME, et al. Laparoscopic surgery for diverticulitis. Surg Endosc. 1997;11(3):264–7.

    Article  CAS  PubMed  Google Scholar 

  29. Wasvary H, et al. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65(7):632–5; discussion 636.

    CAS  PubMed  Google Scholar 

  30. Heverhagen JT, et al. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum. 2008;51(12):1810–5.

    Article  PubMed  Google Scholar 

  31. Vennix S, et al. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Color Dis. 2014;16(11):866–78.

    Article  CAS  Google Scholar 

  32. Alonso S, et al. Outpatient treatment of patients with uncomplicated acute diverticulitis. Colorectal Dis. 2010;12(10 Online):e278–82.

    Article  CAS  PubMed  Google Scholar 

  33. Biondo S, et al. Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg. 2014;259(1):38–44.

    Article  PubMed  Google Scholar 

  34. Etzioni DA, et al. Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum. 2010;53(6):861–5.

    Article  PubMed  Google Scholar 

  35. Chabok A, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99(4):532–9.

    Article  CAS  PubMed  Google Scholar 

  36. Daniels L, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104(1):52–61.

    Article  CAS  PubMed  Google Scholar 

  37. Stollman N, et al. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015;149(7):1944–9.

    Article  PubMed  Google Scholar 

  38. Bolkenstein HE, et al. Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure. Int J Color Dis. 2018;33:863.

    Article  CAS  Google Scholar 

  39. Brook I, Frazier EH. Aerobic and anaerobic microbiology in intra-abdominal infections associated with diverticulitis. J Med Microbiol. 2000;49(9):827–30.

    Article  CAS  PubMed  Google Scholar 

  40. Solomkin JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133–64.

    Article  PubMed  CAS  Google Scholar 

  41. Ribas Y, et al. Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis. Int J Color Dis. 2010;25(11):1363–70.

    Article  Google Scholar 

  42. Ridgway PF, et al. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis. Color Dis. 2009;11(9):941–6.

    Article  CAS  Google Scholar 

  43. Schechter S, Mulvey J, Eisenstat TE. Management of uncomplicated acute diverticulitis: results of a survey. Dis Colon Rectum. 1999;42(4):470–5; discussion 475–6.

    Article  CAS  PubMed  Google Scholar 

  44. Schug-Pass C, et al. Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Color Dis. 2010;25(6):751–9.

    Article  Google Scholar 

  45. Johnson JR, et al. Intensity and mechanisms of fluoroquinolone resistance within the H30 and H30Rx subclones of Escherichia coli sequence type 131 compared with other fluoroquinolone-resistant E. coli. Antimicrob Agents Chemother. 2015;59(8):4471–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Dharmarajan S, et al. The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum. 2011;54(6):663–71.

    Article  PubMed  Google Scholar 

  47. Kumar RR, et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum. 2006;49(2):183–9.

    Article  PubMed  Google Scholar 

  48. Devaraj B, et al. Medically treated diverticular abscess associated with high risk of recurrence and disease complications. Dis Colon Rectum. 2016;59(3):208–15.

    Article  PubMed  Google Scholar 

  49. Brandt D, et al. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon Rectum. 2006;49(10):1533–8.

    Article  CAS  PubMed  Google Scholar 

  50. Durmishi Y, et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surg Endosc. 2006;20(7):1129–33.

    Article  CAS  PubMed  Google Scholar 

  51. Ambrosetti P, et al. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum. 2005;48(4):787–91.

    Article  PubMed  Google Scholar 

  52. Jaung R, et al. Uncomplicated acute diverticulitis: identifying risk factors for severe outcomes. World J Surg. 2017;41(9):2258–65.

    Article  PubMed  Google Scholar 

  53. Biondo S, et al. Recurrence and virulence of colonic diverticulitis in immunocompromised patients. Am J Surg. 2012;204(2):172–9.

    Article  PubMed  Google Scholar 

  54. Samdani T, et al. Colonic diverticulitis in chemotherapy patients: should operative indications change? A retrospective cohort study. Int J Surg. 2014;12(12):1489–94.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tan KK, Wong J, Sim R. Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients. Int J Color Dis. 2013;28(6):849–54.

    Article  Google Scholar 

  56. Schlussel AT, et al. Right-sided diverticulitis requiring colectomy: an evolving demographic? A review of surgical outcomes from the National Inpatient Sample Database. J Gastrointest Surg. 2016;20(11):1874–85.

    Article  PubMed  Google Scholar 

  57. Komuta K, et al. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004;187(2):233–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    Dominic M. Forte

  2. Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    Andrew T. Schlussel

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  1. Dominic M. Forte
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  2. Andrew T. Schlussel
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Correspondence to Andrew T. Schlussel .

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Editors and Affiliations

  1. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA

    Robert Lim

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Forte, D.M., Schlussel, A.T. (2019). Diverticulitis: Incidence and Initial Management. In: Lim, R. (eds) Multidisciplinary Approaches to Common Surgical Problems. Springer, Cham. https://doi.org/10.1007/978-3-030-12823-4_21

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  • DOI: https://doi.org/10.1007/978-3-030-12823-4_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12822-7

  • Online ISBN: 978-3-030-12823-4

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