Diagnosis Of Acute Diverticulitis Research Articles

Diverticulitis in the Under-40 Population.

As obesity and lifestyle factors become more prevalent in younger populations, we are diagnosing and treating diverticulitis in younger patients. In this study, the demographics, risk factors for the development, and treatment of acute diverticulitis were assessed focusing on patients under the age of 40. A retrospective review of the electronic medical records of a cohort of subjects diagnosed with diverticulitis was performed. Inclusion criteria included patients aged 18-40 who were treated for acute diverticulitis with or without any complications. Of the 109 patients, 40 patients required surgery, and 69 patients were managed conservatively. Analysis showed that the Hinchey classification (p<0.001) was the strongest predictor of treatment modality. As the incidence of diverticulitis has increased in recent decades, so too has the frequency with which elective surgical procedures are performed as treatment. While these procedures are vital components in the management of diverticulitis, the majority of research comparing conservative versus surgical treatments has been done in patients over 50 years old. Although diverticulitis has been classically thought of as a disease of the elderly, it has become more prevalent in younger populations due to the rise of obesity and lifestyle modification in the under-40 population. Although the prevalence of treatment and diagnosis of acute diverticulitis in younger patients has risen, there is a paucity of data surrounding treatment protocols for diverticulitis in association with patient symptoms for patients under the age of 40 years old. Our study has found that there is a higher incidence of complications in diverticulitis inpatients under the age of 40.Additionally, when considering the pattern of complication presentation in younger patients with complicated diverticulitis, surgical intervention might not be appropriate. The current treatment algorithm relates diverticulitis complications with surgical interventions. However, our data suggest that patients under the age of 40 presenting with abscesses or strictures may not need surgical intervention. This information could be particularly helpful in guiding physicians and younger patients in selecting the best choice of care and minimizing complications.Additionally, further research should help guide treatment protocol in this specific population of patients, as there is a lack of established guidelines pertaining to diverticulitis surrounding younger patients.

Enfermedad diverticular

Diverticula are sac-like protrusions that appear in the weak points of the colon wall. They are usually asymptomatic. Diverticular disease develops when symptoms appear. Its etiopathogenesis is likely multifactorial, although it is not fully known. Complicated diverticulosis includes acute diverticulitis, which is the most frequent complication and one of the most common reasons for consultation in emergency departments, and diverticular hemorrhage, one of the most frequent causes of lower gastrointestinal bleeding in our setting. A diagnosis of acute diverticulitis is established through an abdominal computed tomography scan. A diagnosis of hemorrhage is established by performing a full colonoscopy, for which adequate prior preparation of the patient by means of taking an oral laxative solution is recommended. The treatment of acute diverticulitis has classically been based on the use of antibiotics, although current evidence supports a decrease in the use of antibiotic treatment in patients with uncomplicated acute diverticulitis. In this disease, antibiotics must target a polymicrobial etiology consisting mainly of gram-negative and anaerobic bacilli.

Risk factors for readmission in patients with acute diverticulitis: a retrospective study at Auckland City Hospital.

Approximately one in five patients with acute diverticulitis (AD) will experience a recurrence. This study aimed to investigate the factors at AD admission that correlate with recurrence and test the proposed risk of recurrence-score according to Sallinen et al. method: This retrospective study followed patients for five years who were admitted with operatively or computed tomography (CT)-verified AD at Auckland City Hospital from January 2012-June 2013. Demographic, laboratory, radiological and patient-related factors at initial admission were analysed in relation to readmission with recurrent AD and to test a risk score presented by Sallinen et al. results: In the adjusted analyses, previous diagnosis of AD (OR, 7.3; 95% CI, 3.1-16.9), Māori ethnicity (OR, 5.7; 95% CI, 1.4-22.7) and complicated AD at index admission (OR, 2.5; 95% CI, 1.0-6.2), were all independent factors associated with readmission with recurrence. High-risk versus low-risk groups, according to the risk score, showed 71.4% and 18.6% recurrence rates, respectively. History of diverticulitis and complicated AD are risk factors for recurrence. The finding of higher recurrence rate in Māori requires further investigation utilising appropriate research methodologies. The risk score presented by Sallinen et al. may be a useful predictor of recurrent AD.

How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques

IntroductionThe choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists’ preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. MethodsAn online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents’ working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. ResultsA total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with >500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. ConclusionsThe radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists’ opinions, and actual clinical practice.

NLR AND PLR: NEW PREDICTORS OF COMPLICATED DIVERTICULITIS AND THE NEED FOR INTERVENTION

Abstract Introduction The most commonly used analytical parameters to predict severity (CRP, PCT, leukocyte count, % neutrophils…) are well known, whereas biomarkers such as the neutrophil-lymphocyte index (NLR) and the platelet-lymphocyte index (PLR) are less known and have utility during the diagnosis of acute diverticulitis (AD). Methods Retrospective study of 176 patients diagnosed with AD during 2019. The association between multiple acute phase reactants (PLRs) and the presence of complication of AD was studied. Results The mean age was 62.8 years, being more frequent in women (59.7%). According to the Hinchey classification 46 (26.1%) AD were complicated; Hinchey Ib: 32 (18.2%), Hinchey II: 10 (5.7%), Hinchey III: 3 (1.7%) and Hinchey IV: 1 (0.6%). Of all of them, 14 patients required surgery. A statistically significant increase in all RFA was observed in complicated AD and in cases of invasive treatment. It was shown that CRP has greater discriminative power to detect complicated AD with ROC curves (AUC: 76.6% (95% CI: 0.676–0.856)). However, regarding the need for invasive treatment, the NLR (AUC 77.8%; 95% CI: 0.648–0.908) was found to be more accurate. For the classification of uncomplicated vs. complicated AD, the cut-off points were CRP (9.05), NLR (6.23) and PLR (141.93), with CRP being the most accurate. Conclusions The NLR and PLR are easy and inexpensive indices to obtain to diagnose AD and their accuracy is comparable to that of other RFA commonly used in diagnosis.

Accuracy of Prediction Models in Diagnosis of Acute Diverticulitis.

The diagnostic score models (DMs) for patients with acute diverticulitis (AcDi) have been rarely evaluated. Therefore, we tried to develop diagnostic models (DMs) to enhance the diagnostic accuracy (DA) of AcDi. In this AAP (acute abdominal pain) cohort, 30 AcDi patients were compared to 1,303 non-AcDi patients, with regard to their i) clinical symptoms (n=22), ii) signs and tests (n=14) as well as iii) laboratory analyses (n=3). The triage was performed at patient arrival to the emergency department (ED) (triage I) and at follow-up (triage II) before final decision. The triage included a suggested diagnosis of the AAP patient. Bivariate random effects meta-analysis was performed separately for 1) the pooled symptoms (n=22), 2) signs & tests (n=17) as well as 3) pooled DMs (I-V) with different cut-offs (with or without triage) to assess the diagnostic accuracy (DA) in detection of AcDi by HSROC (hierarchical summary receiver operating characteristic) curves. In the conventional receiver operating characteristic (ROC) analysis (for test optimization and finding optimal cut-off points), the area under curve (AUC) reached the following values for AcDi: i) DM without triage, AUC=0.843, ii) DM with triage I, AUC=0.866 and iii) DM with triage I and II, AUC=0.926. In the HSROC analysis, the AUC values for detection of AcDi were as follows; i) pooled clinical symptoms, AUC=0.540, ii) pooled clinical signs & tests, AUC=0.556 and iii) pooled DMs globally, AUC=0.853. In roccomp analysis for differences in AUC values: i) and iii) p<0.0001; between ii) and iii) p<0.0001. As confirmed by ROC and HSROC analysis, the new DMs with triage mode proved to be far superior in their DA for AcDi as compared to both symptoms and signs & tests. In the lack of earlier studies, these data report the first evidence that the DM including triage at an ED could improve the detection of AcDi.

¿Cómo diagnosticamos la diverticulitis aguda? Resultados de una encuesta nacional sobre el papel de las técnicas de imagen

IntroductionThe choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists’ preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. MethodsAn online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents’ working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. ResultsA total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with>500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. ConclusionsThe radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists’ opinions, and actual clinical practice.

CURRENT MODE OF TREATMENT IN ACUTE DIVERTICULITIS

Purpose: The purpose of our study is to determine whether patients with acute uncomplicated diverticulitis with micro-perforation should really be treated as patients without perforation and to identify differences in recurrence rates, complications and mode of treatment Material and Methods: A total of 47 patients with a diagnosis of acute diverticulitis were admitted to the hospital for a three-year period from 01.01.2018 to 01.01.2020 in the Department of General, Visceral and Emergency Surgery at UMHATEM "Pirogov". Of those hospitalized, women were 21 (44.68%), men 26 (55.32%). The age in this retrospective analysis varied from 27 to 81 years (average 51.3 years). Results: All patients had leukocytosis, abdominal pain, and tenderness. From the group of 47 patients hospitalized with acute diverticulitis, twenty-five (53.19%) were diagnosed with micro-perforation by pneumoperitoneum data from X-ray and CT or free intraperitoneal fluid from ultrasound. The other three (6.38%) were identified intraoperatively (by laparoscopy or laparotomy) based on an indication of peritoneal irritation. The remaining 19 (40.43%) with mild symptoms for conservative management (38.89%) - through physical examination, laboratory data and imaging diagnostic methods (X-ray, ultrasound and CT). Of the 28 operated, 13 patients had laparoscopy performed lavage and drainage, with the remaining 15 (with laparotomy) - had Hartmann's procedure. Conclusion: Acute diverticulitis with micro-perforation showed no significant differences in the complications and course of antibiotic therapy compared to the group of acute diverticulitis without micro-perforation. Neither group required surgery after one-month discharge. Accordingly, to these outcomes, the mode of treatment should be identical.

Predictors of Clinical Course and Outcomes of Acute Diverticulitis: The Role of Age and Ethnicity

Background and Objectives: Acute diverticulitis (AD) is the leading and most burdensome complication of colonic diverticulosis. However, risk factors for its development and predictors of its course are still poorly defined. In this regard, the association of a young age with a complicated course and worse outcome are still controversial. Moreover, little research has addressed the effect of ethnicity on the course of AD. The current study aimed to evaluate the impact of these variables on AD’s course and outcome in the diverse and unique ethnic landscape of Israel. Materials and Methods: We performed a retrospective review of the charts of patients with a radiologically confirmed diagnosis of AD. Patients’ outcomes and disease course, including hospitalization duration, complications, and recurrent episodes, were documented and compared among different age and ethnic groups. Multivariate analysis was performed to identify predictors of complicated AD. Results: Overall, 637 patients with AD were included, the majority (95%) had distal colon AD, and almost one quarter of them were aged less than 50 years. The majority of patients in the young age (<50) group were males (69.7%). Nonetheless, the rate of recurrent episodes (35.3% vs. 37.3%, p = 0.19), hospitalization duration (5 ± 4.7 vs. 6 ± 3.2, p = 0.09) and complications rate (17.3% vs. 13.7%; p = 0.16) were similar for both age groups. In the ethnicity group analysis, Arab minority patients had a first episode of AD at a significantly younger age compared to their Jewish counterparts (51.8 vs. 59.4 years, p < 0.001). However, factors such as a complicated course (16% vs. 15%; p = 0.08) and relapsing episode rates (33% vs. 38%; p = 0.36) did not differ significantly between groups. None of the variables, including young age and ethnic group, were predictors of complicated AD course in the multivariate analysis. Conclusion: AD is increasingly encountered in young patients, especially in ethnic minority groups, but neither ethnicity nor young age was associated with worse outcomes.

The Impact of Obesity on Mortality and Clinical Outcomes in Patients with Acute Diverticulitis in the United States.

Diverticular disease represents a leading cause of gastrointestinal-related hospitalizations. We sought to identify the adverse consequences of obesity on acute diverticulitis (AD) hospital admissions. By age 85, approximately two-thirds of individuals will develop diverticular disease and up to 25% will develop AD. Generally, obesity confers an increased risk of morbidity and mortality; however, its impact on hospitalized patients with AD are lacking. Utilizing ICD-9-CM codes from the National Inpatient Sample (January 2012 - October 2015) we identified patients with a primary discharge diagnosis of AD including 660,820 hospitalizations and 115,785 with obesity. Primary outcomes were mortality, length of stay, and hospitalization cost. Secondary outcomes were AD complications and the need for surgical interventions. On multivariate analysis, obesity was not associated with an increased risk of mortality (OR=1.1, 95%CI: 0.87-1.41; p= 0.43). However, morbid obesity (BMI > 40 kg/m2) showed a significant increased risk of mortality (OR=1.69, 95%CI: 1.23-2.31; p<0.001). Obesity was associated with prolonged hospitalizations length of stay by 0.61 days (0.55-0.68; p <10-6), higher hospital charges $6,320 ($ 5,500-7,140; p<10-6), increased complicated diverticulitis 1.05 (1.01-1.1; p < 0.010) and required more surgical interventions for diverticulitis (OR=1.19, 95%CI: 1.15-1.23; p<10-6). Morbid obesity increases risk for mortality while obesity leads to longer hospitalization stays and greater healthcare cost as well as adverse clinical outcomes and more surgical interventions. Further interventions are required to address obesity and weight loss for patients with diverticulitis to improve clinical outcomes.

Neutrophil-to-lymphocyte ratio as a predictor of complicated acute diverticulitis: A retrospective cohort study

IntroductionCurrently, the debate on the usefulness of Neutrophil to Lymphocyte Ratio (NLR) as a predictor of complications in acute diverticulitis (AD) remains open, especially, the relation to the severity of the disease, the clinical impact, and the necessity of minimally invasive or emergency surgical procedures. On the other hand, its diagnostic efficacy has not been studied even in our field. The objective of the present study was to determine the utility and diagnostic precision of NLR in complicated acute diverticulitis (cAD). MethodsDescriptive, retrospective cohort and analytical study. Patients older than 18 years with a diagnosis of AD were included, from 2013 to 2018. Demographic variables, days of hospitalization, leukocyte count, neutrophils, lymphocytes, ESR, CRP, and NLR were analyzed. The sensitivity and specificity for the diagnosis of cAD were determined using ROC curves. Results325 patients were included. Of these 196 (60%) were men. The median age was 52 years. A total of 30 (9%) were categorized as cAD. The patients with cAD presented mean values in the leukocyte count (14.02 ± 4.49 × 109/l; p < 0.01), CRP (119.60 ± 87.67; p < 0.01) and NLR (7.61 ± 4.03; p < 0.01). An NLR cutoff value ≥ 4.2 was identified as the most appropriate to distinguish cAD, with a sensitivity of 80%, a specificity of 64%, NPV of 96%, and PPV of 18%. ConclusionNLR is a predictive marker of cAD, with a cut-off point of 4.2 being the best diagnostic approach.

Interval colonoscopy following acute diverticulitis should not be discouraged yet: results from a retrospective cohort.

Although included in some guidelines, the recommendation of interval colonoscopy after an acute diverticulitis (AD) episode has recently been questioned. In this study, we evaluated the incidence of colon cancer during the follow-up of an episode of AD. A retrospective review was carried out of patients with conservatively treated AD at our Institution (January 2011 to December 2018) with or without endoscopic study. Patients who had no colonoscopy performed were followed for two years. The demographic, clinical, radiological, follow-up and anatomopathological records were analysed. We determined CT scan validity for the differential diagnosis of CC and AD; sensibility, specificity, predictive values and likelihood ratios were calculated. Patients lost to follow-up and patients who had had colonoscopy in the previous three years were excluded. This study included 285 patients with a mean age of 59 years. A total of 225 interval colonoscopies were performed and 60 patients without colonoscopy were followed up. There were 19 CC (6.7%) diagnosed, 14 with interval colonoscopy and 5 during follow-up; 8 (42.1%) happened in patients who had had an episode of uncomplicated AD. Although CT scan accuracy is high, 87.7%, positive and negative likelihood ratios were low, 4.67 and 0.64, respectively. Interval colonoscopy should still be advisable after an episode of AD. The rationale for this statement is based on a non-negligible rate of hidden CC and an important uncertainty in the differential diagnosis.

Differentiating Colorectal Carcinoma From Diverticulitis With Computerised Tomography: Does Every Patient Need Follow-Up Colonoscopy After an Episode of Acute Diverticulitis?

PurposeTo correlate computerised tomography (CT) and endoscopic follow-up (FU) in differentiating presentations of acute diverticulitis (AD) and colorectal carcinoma (CRC).MethodsPatient’s discharge summaries between April 2018 and September 2019, stating AD under-diagnosis were retrieved. Admission details, CT reports, endoscopic findings and histopathology results were retrospectively collected from prospectively maintained data.ResultsIn our study period of 17 months, we identified 150 patients with an admission diagnosis of AD. In total, 134 patients had a CT confirmed diagnosis of AD; 61% had uncomplicated acute diverticulitis (UAD) and 39% complicated acute diverticulitis (CAD). The mean age of the patients was 64 years, and 59% were female. Of the 134, 15 patients were excluded, and 119 with AD were discharged with a plan to have FU endoscopy. Overall, 75% of the patients managed to undergo complete endoscopic investigation, 4% had incomplete endoscopy, and 21% failed to attend endoscopy. Follow-up (FU) endoscopic investigation found polyps in 20 patients; seven were reported as tubular adenomas with low-grade dysplasia and 10 as non-concerning hyperplastic or sessile polyps. One was inflammatory, and two were malignant. CT scans for two patients with malignant polyps were reported as CAD with suspicion of sigmoid cancer in one and right-sided perforated diverticulitis in the other. Both patients were female aged over 60 years.ConclusionsThis study demonstrates that a selective approach is more appropriate for endoscopic FU after an episode of AD. Risk stratification is required to allocate FU endoscopic investigation for patients at high risk for CRC.

144 An “Ultrasound-First” Protocol in Patients With Suspected Acute Diverticulitis Is Associated With Reduction in Time and CT Utilization

Although CT scans are highly accurate in diagnosing diverticulitis, they are costly, prolong ED length of stay, and expose patients to ionizing radiation. The objective of this study was to investigate the potential time-saving effect and reduction in CT scan utilization when point-of-care ultrasound (POCUS) was employed as a first-line imaging modality in the diagnosis of acute diverticulitis. This was a prospective observational study in patients with suspected diverticulitis who underwent both POCUS and CT in their ED visits. To estimate the impact on CT scan utilization, negative CT scans and those with simple diverticulitis (Hinchey “0”) were considered avoidable. To determine the potential CT reduction associated with an ultrasound-first protocol in ED patients with uncomplicated diverticulitis, we applied the findings from our study to institutional medical records of ED visits for diverticulitis over a period of 3.5 years. To estimate the time-savings of an ultrasound-first protocol, we compared the arrival time to the time in which the CT read was available as compared to the completion of POCUS. 72 patients in our study had both POCUS and CT scans. In 35% (25/72), both POCUS and CT showed simple uncomplicated diverticulitis. In 35% (25/72) both POCUS and CT were negative. In 30% (22/72), the CT scan showed complicated diverticulitis, identified an alternative diagnosis or changed management. Overall, CT scans could have been avoided in 70% (50/72) of the cases. When this rate of 70% is applied to the number of patients who had a CT scan for diverticulitis in the ED over a period of 3.5 years, approximately 959 CT scans (70% of 1,370 CT scans), or 274 CT scans annually could have been avoided if POCUS was used as the first-line diagnostic tool. As for the time-saving impact, the average time from arrival to completion of CT and POCUS scans were 5.3 hours (95% CI 4.9-5.7) and 1.1 hours (95% CI 1.0-1.3), respectively. A mean difference of 4.2 hours (95% CI 3.9- 4.5) reflects the potential decrease in length of stay for patients in the ED. In ED patients with uncomplicated diverticulitis, using POCUS as a first-line imaging can substantially reduce the number of CT scans and time to diagnosis. There could be substantial implications and reduction on patient length of stay, radiation, and cost.

Hospital admission for complicated diverticulitis is increasing in Italy, especially in younger patients: a national database study

Epidemiological studies show an increasing trend of hospitalization for acute diverticulitis (AD), but data regarding the trend in hospitalization for complicated AD in Italy are scarce. The aim of this study was to analyze the Italian trend in hospitalization for complicated AD, from 2008 to 2015. Using the Italian Hospital Information System, we identified all patients with complicated colonic AD as a discharge diagnosis. Age- and sex-specific rates for AD as well as type of hospital admission (emergency/elective), type of complication (peritonitis, obstruction, bleeding, abscess, fistula, perforation, sepsis) and type of treatment (medical/surgical), were analyzed. A total of 41,622 patients with a discharge diagnosis of complicated AD were identified. Over the study period the admission rate grew from 8.8 to 11.8 per 100,000 inhabitants. The hospitalization rate was highest for patients ≥ 70years, but the increase in the admission rate was higher among patients aged ≤ 60years. There were more males in the group < 60years and more females in the group ≥ 60years old. The rate of emergency admissions associated with surgery showed a significant mean annual increase (+ 3.9% per year) in the rate of emergency admissions associated with surgery, whereas elective admissions for surgery remained stable. Peritonitis was the most frequent complication (35.5%). The rate of surgery increased in AD complicated by peritonitis (+ 5.1% per year), abscess (+ 5.8% per year) and decreased for obstruction (-1.8% per year). From 2008 to 2015, we documented an increasing rate of hospitalization for complicated AD, especially for younger patients, with an increase in surgery for peritonitis and abscess. Further studies are needed to clearly assess the risk factors for complications and risk of surgery.

The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.

Objectives:Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients.Methods:In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients’ sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed.Results:The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis.Conclusion:We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.

Clinical presentation and outcomes of acute diverticulitis in a Middle Eastern population

Background and study aimsThere is lack of literature describing the presentation of diverticulitis in the Middle East population. The aim of this study is to provide an analysis of the epidemiological indicators, patterns of presentation and outcomes of acute diverticulitis in a Middle Eastern population. Patients and methodsA retrospective review of all adult patients over the age of 17 who were admitted to the surgical service with a diagnosis of acute diverticulitis between January 2010 and May 2018 at a major university affiliated government hospital in the state of Kuwait. Data collected included patients’ demographics, clinical presentation, management and outcome. ResultsBetween January 2010 and May 2018 there were 132 patients admitted with a diagnosis of acute diverticulitis. The mean age was 49.2 [±14.3] years. There were 89 (67.4%) men and 43 (32.6%) women. One-hundred and fifteen patients (87.1%) were Arabs, of which Kuwaiti citizens represented 58.3%. Most patients (76.5%) presented with uncomplicated diverticulitis. One hundred and twelve patients (84.8%) had sigmoid colon diverticulitis. There were nine patients that were readmitted within thirty days. The mean length of hospital stay was 5.3 days [±4.5]. The median follow-up period was 15.6 weeks (IQR 1.8, 118.4), during which time recurrent attacks occurred in 25 patients (18.9%). ConclusionsIt appears that there is a low prevalence of acute diverticulitis in Arabs living in Kuwait, and that when they do present with acute diverticulitis the majority present at a relatively younger age with uncomplicated disease.

High Probability of an Underlying Colorectal Cancer Among Patients Treated for Acute Diverticulitis. A Population-Based Cohort Follow-Up Study.

Patients treated conservatively for acute diverticulitis (AD) are recommended colonic assessment to rule out an underlying Colorectal cancer (CRC). This has been questioned in patients with a CT diagnosis of uncomplicated AD. We analyzed the frequency of CRC and compared the characteristics of the CRC patients with controls. A cohort of patients treated conservatively for AD during 2005-2011 was identified through an administrative database. Patients diagnosed with CRC within 1year after the index admission and four randomly selected controls were identified. The patients' files were reviewed to verify the diagnosis and obtain information about the clinical characteristics and the management. A blinded review was performed of CT examinations. The expected number of CRC was calculated from age, sex, and period-specific incidence data. The characteristics of the CRC patients were compared with the controls in a nested case-control study. 890 patients (298 men and 592 women) were treated conservatively for AD. 12 patients were diagnosed with CRC within 1year, and ten of them in the sigmoid, giving a Standardized Incidence Ratio of 20.0 (95% CI 10.2-35.7, p<0.001) for sigmoidal cancer. All CRC patients were aged over 70years. The cancer was missed in six CT scans at the primary reading and in five at the blinded review. Patients conservatively treated for AD are at high risk for an underlying CRC, especially if older than 70years, which motivates routine follow-up. A CT diagnosis of uncomplicated AD does not rule out CRC.

THE ROLE OF IMAGISTIC INVESTIGATIONS IN DIAGNOSING ACUTE COMPLICATED DIVERTICULITIS

Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. Contrast enhanced Computed Tomography (CT) has a high sensitivity and specificity, reaching a diagnostic accuracy over 95%. Although abdominal X-ray and ultrasonography are still used, their utility is limited in this pathology. Retrospective study including patients admitted for acute diverticulitis in the Surgery Clinic of Bucharest Clinical Emergency Hospital between January 2012 and July 2014. From the total number of 29508 admissions, 156 patients were diagnosed with acute diverticulitis staged Hinchey I to IV. The imagistic investigations on admission were plain abdominal X-ray (128 cases), which identified 6 cases of pneumoperitoneum; abdominal ultrasound (112 cases) which identified colonic wall thickening and/or free peritoneal fluid in 29.4% cases. Contrast enhanced CT was performed in 97 cases, successfully establishing the diagnostic in 80% of cases. The mean waiting time interval until CT scan was under 24 hours for the patients with acute complicated diverticulitis. Patients with acute diverticulitis staged Hinchey II-III needed CT reevaluation both for monitoring the response to conservative treatment and identification of postoperative complications. Due to its high diagnostic accuracy and short waiting interval, in the studied cohort, contrast enhanced CT represents the investigation of choice in diagnosing acute diverticulitis. Abdominal ultrasound remains an alternative only in cases where CT scan is unavailable or contraindicated, having a lower accuracy in diagnosis and evaluation of diverticular disease complications.

Diagnostic impact of routine colonoscopy following acute diverticulitis: A multicenter study in 808 patients and controls

The diagnosis of acute diverticulitis is mainly based on clinical, biological and computed tomography (CT)-scan findings. Elective colonoscopy is recommended after medical treatment, to rule out another diagnosis and to detect associated conditions; however, the relevance of this recommendation has been questioned. Between January 2005 and December 2011, we retrospectively identified in three referral centers the consecutive patients whom underwent a colonoscopy after the medical treatment of a CT scan-proven acute diverticulitis episode. We excluded from the analysis patients with haematochezia or recent change in bowel habits. Sex and age-matched asymptomatic patients undergoing a screening colonoscopy were chosen as a control group. We collected and compared the results of colonoscopy and histological findings in both groups. We matched 404 patients whom underwent a colonoscopy after an episode of acute diverticulitis with 404 control patients. Their mean age was 60.9 years, with 59% being women. Colorectal adenoma, advanced adenoma and cancer detection rates in acute diverticulitis patients were 12.1%, 2.7% and 0.25%, respectively; versus 14.6% (p = 0.35), 6.7% (p = 0.01) and 0.25% respectively, in control patients. Diagnosis rates for adenomas and for colorectal cancer during a colonoscopy scheduled after acute diverticulitis were similar than those of control patients undergoing a screening colonoscopy, while the detection rate of advanced adenomas was lower. We suggest that colonoscopy should be indicated only in selected patients, i.e. those presenting with reasonable doubt on initial CT-scan, those with alarm symptoms, and those with identified risk factors for colorectal cancer.