Abstract

Diverticular disease is one of the most common problems encountered by general surgeons and gastroenterologists. The term refers to complications that occur from colonic diverticulosis. In diverticular colonic disease the sigmoid colon is usually the most commonly involved, while right acute colonic diverticulitis is rarer. In establishing the diagnosis of ALCD, objective clinical examination plays an important role in addition to biological paraclinical examinations (C-reactive protein - CRP and increased leukocyte count) and radiological paraclinical examinations: CT abdomen. CRP is a useful tool in predicting the clinical severity of acute diverticulitis. The treatment applied to patients with uncomplicated colonic diverticular disease can be represented by antibiotic therapy, water regime, hydro-electrolytic rebalancing. In patients with multiple comorbidities, hemodynamic instability, the Hartmann procedure is recommended for the treatment of acute peritonitis caused by perforated colonic diverticulitis and in hemodynamically stable patients without comorbidities, colonic resection with primary anastomosis with or without stoma is suggested.

Highlights

  • Diverticular disease is one of the most common problems encountered by general surgeons and gastroenterologists

  • In establishing the diagnosis of acute left colonic diverticulitis (ALCD), objective clinical examination plays an important role in addition to biological paraclinical examinations (C-reactive protein - CRP and increased leukocyte count) and radiological paraclinical examinations: computed tomography (CT) abdomen

  • The authors concluded that CRP is a useful tool in predicting the clinical severity of acute diverticulitis

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Summary

Introduction

Diverticular disease is one of the most common problems encountered by general surgeons and gastroenterologists. The term refers to complications that occur from colonic diverticulosis, including lower gastrointestinal bleeding, inflammation, pain, abscess formation, fistula, strictures, perforation, and death [1]. It is an important cause of morbidity and a significant economic burden [1, 2]. Left colonic diverticulosis remains more common in elderly patients, a dramatic increase in its incidence has been observed in younger age groups in recent years [2]. Uncomplicated acute diverticulitis can be managed on an outpatient basis in selected patients who do not have comorbidities (including the immunocompromised state) and can tolerate a liquid diet in the absence of fever, significant leukocytosis, or evidence of complicated imaging disease. Recurrent diverticulitis or diverticulitis complications, including abscess, perforation, fistulizing disease (Figure 1), and strictures/obstruction usually require surgery

Classification of colonic diverticular disease
Generalized fecal peritonitis
Establishing the diagnosis of acute diverticulitis
ALCD in immunocompromised patients
Antibiotic treatment in patients with uncomplicated acute colonic diverticulitis
Treatment of patients with uncomplicated ALCD
Treatment in patients with acute diverticulitis discovered on CT by the presence of gas around the colon
Follow-up of patients treated for colonic diverticular abscess
Treatment of patients with acute peritonitis caused by perforated colonic diverticulitis
Therapeutic strategy in diffuse acute peritonitis produced by acute perforated diverticulitis
4.11 Principles of treatment of right acute colonic diverticulitis (ARCD)
Findings
Conclusions
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