Classification Of Diverticulitis Research Articles

Pathophysiology, Symptoms and Evolving Treatment for Colonic Diverticular Disease: A Review

The review on diverticulitis disease, is the most prevalent non-cancerous pathology of the colon is diverticular disease and diverticulitis. It has long been thought to be a disease of the elderly, linked to cultural and dietary patterns. Our understanding of this condition, as well as the therapy protocols, has progressed. To give an updated assessment of the epidemiology, pathophysiology, and classification of diverticulitis, as well as to highlight developments in medicinal and surgical management. Treatment of Diverticular Disease represented an important challenge in clinical practice, especially concerning the management of symptomatic uncomplicated diverticular disease (SUDD) and the primary and secondary prevention of acute diverticular disease (AD). Antibiotics and supportive treatments are the mainstays of non-operative treatment, while antibiotics may be skipped in moderate cases. Acute surgery is required for the most severe and refractory cases, whereas elective resections should be considered for chronic, smoldering, or recurrent forms, as well as their associated complications (stricture, fistula, etc.) and patients with factors that are highly predictive of recurrent attacks. Diverticulitis isn't just a condition that affects the elderly. Our growing understanding of diverticulitis as a clinical entity has resulted in a more nuanced approach to its medicinal and surgical therapy. For more than 70% of patients, non-surgical care is still the best option. In the acute, chronic, or elective-prophylactic environment, a segmental colectomy remains the most effective surgical treatment for those with non-relenting, persistent, or recurrent symptoms, as well as those with severe disease and sequelae.

Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography.

To prospectively assess the diagnostic value of intestinal ultrasound (US) compared to computerized tomography (CT) in differentiating uncomplicated and complicated acute colonic diverticulitis (ACD). During a period of 14months patients referred to the department of Radiology with clinical suspicion of ACD underwent an US examination. All confirmed US ACD diagnosis were included and subsequently underwent an emergency abdominal CT, used as gold standard. The WSES (World Society for Emergent Surgery) classification of diverticulitis was used. Diverticulitis was prospectively classified as either uncomplicated or complicated. Sensitivity, specificity, positive predictive value, and negative predictive values of US were evaluated. Before CT scan, the radiologist indicated whether they would have required or not a complementary CT scan, based on US findings. Of the 240 patients included in our study, 71 (29.6%) were Stage 0, 127 (53%) Stage 1A, and 42 (17.5%) were moderate-severe ACD (stages 1B, 2A, 2B, 3 and 4). The sensitivity of US for diagnosing complicated ACD was 84% and specificity of 95.8%. Most patients (24 of 27) misclassified by US as uncomplicated diverticulitis were classified on CT as stage 1A. From the 148 cases in which the radiologist considered CT unnecessary, only 3 of these revealed signs of complicated ACD on CT; none of them required emergency surgery. US is an effective technique to differentiate complicated from uncomplicated ACD. Our results suggest that US, may be a valuable alternative to CT for the initial radiologic evaluation in patients with clinical suspicion of ACD.

Prediction and management of recurrent right colon diverticulitis

While the incidence of right colonic diverticulitis (RCD) is rare in Western countries, the right colon is the most common site of diverticulitis in Asian countries. However, its recurrent pattern and management were rarely studied. This study was designed to elucidate the pattern of recurrence in RCD. Of the 154 patients admitted as right colonic diverticulitis between February 2004 and March 2012, 104 patients were enrolled, prospectively. The recurrence rate, size, multiplicity, location, diagnostic criteria score, and predisposing factors were evaluated based on Hinchey's classification of diverticulitis. There were 104 patients with right colonic diverticulitis in this study, and 20 patients (19.2 %) recurred after medical treatment. When the diverticula were not located in the right colon, the recurrence rate was significantly higher than the diverticula located only in the right colon (p = 0.004). The recurrence rate of diverticulitis for a single diverticulum was significantly lower than that for multiple diverticula (p = 0.02). Of the 20 patients with recurrence, 1 (5 %) patient underwent laparoscopic diverticulectomy due to a misdiagnosis of diverticulitis as appendicitis. The remaining 19 patients (95 %) received nonoperative management and recovered without any sequelae. The recurrence rate was 19.2 %, and the predisposing factors were the location of diverticula and the multiplicity of primary diverticula. The re-recurrence rate of recurred patients was 26.3 %. The recurred lesions were controlled simply by nonoperative management. Elective surgery was also a treatment option.

Prophylaxe und konservative Therapie der Divertikelkrankheit

Diverticulosis and diverticular disease are a common problem in daily practice and one third of the patients with diverticulosis develop symptoms. Patients with uncomplicated diverticulitis are very often treated with antibiotics. There is growing evidence that antibiotics are not necessary in uncomplicated cases. One problem is the different classification of diverticulitis and diverticular disease. Therefore, it is not easy to compare different studies. The evidence for therapy with antibiotics, mesalamine, probiotics and fibers are initially discussed and secondly therapeutic recommendations are given for the various stages of diverticular disease.