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Ono F, Takahashi Y, Shimada S, Mizumoto S, Miyata S, Nitahara-Kasahara Y, Yamada S, Okada T, Kosho T, Yoshizawa T. Carbohydrate sulfotransferase 14 gene deletion induces dermatan sulfate deficiency and affects collagen structure and bowel contraction. PLoS One 2025; 20:e0320943. [PMID: 40327642 PMCID: PMC12054877 DOI: 10.1371/journal.pone.0320943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 02/26/2025] [Indexed: 05/08/2025] Open
Abstract
Dermatan sulfate (DS) is a type of glycosaminoglycan present in the extracellular matrix, and which is related to tissue strength, structure, and healing. Dermatan 4-O-sulfotransferase 1 (D4ST1) is an enzyme that catalyzes the transfer of a sulfate group to the N-acetylgalactosamine residue of dermatan, resulting in mature DS. Biallelic loss-of-function variants in the carbohydrate sulfotransferase 14 (CHST14) gene encoding D4ST1, induce defective DS biosynthesis. DS deficiency causes severe connective tissue fragility and deformities in humans (musculocontractural Ehlers-Danlos Syndrome [mcEDS]) and mice (Chst14 gene knockout [Chst14-/-] mice). Many patients with mcEDS experience gastrointestinal symptoms such as constipation, diverticula, diverticulitis, and perforation. However, pathogenesis of these symptoms has not been systematically investigated. Therefore, we sought to determine the effects of DS deficiency on the colon using Chst14-/- mice. We found that collagen fibrils were abnormally arranged in the submucosa of the colon. The mice also exhibited accelerated colonic contraction. Unexpectedly, no significant aggravation of dextran sulfate sodium-induced colitis was observed in Chst14-/- mice compared with wild-type mice. These findings suggest a physiological role of DS in the colon and may shed light on the potential mechanisms underlying the gastrointestinal symptoms of mcEDS.
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Affiliation(s)
- Fumiko Ono
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuki Takahashi
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shin Shimada
- Division of Animal Research, Research Center for Advanced Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
| | - Shuji Mizumoto
- Department of Pathobiochemistry, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Shinji Miyata
- Graduate School of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Yuko Nitahara-Kasahara
- Division of Molecular and Medical Genetics, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Shuhei Yamada
- Department of Pathobiochemistry, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Takashi Okada
- Division of Molecular and Medical Genetics, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Research Center for Advanced Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
- BioBank Shinshu, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Takahiro Yoshizawa
- Division of Animal Research, Research Center for Advanced Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
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Hsieh SL, Grabill N, Louis M, Kuhn B. Complicated diverticulitis: Diagnostic precision and surgical solutions in a patient with chronic kidney disease. Radiol Case Rep 2025; 20:346-351. [PMID: 39525910 PMCID: PMC11550676 DOI: 10.1016/j.radcr.2024.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Diverticulitis, an inflammation of diverticula in the colon, can lead to severe complications such as perforation and abscess formation. A 42-year-old female with polycystic kidney disease and chronic kidney disease stage III presented with severe abdominal pain, fever, and inability to tolerate oral intake. The patient was a previous smoker who smoked 0.5 packs per day for 25 years. Initial evaluation revealed leukocytosis and elevated creatinine. A CT scan identified pneumoperitoneum and mild sigmoid diverticulitis, suggesting a perforated viscus. She underwent urgent exploratory laparotomy, which confirmed the CT findings and resulted in an appendectomy, sigmoid colon resection, and ostomy creation. Postoperatively, the patient faced complications, including recurrent pneumoperitoneum and subcutaneous emphysema, detected through follow-up CT scans, leading to further surgical interventions. CT imaging was pivotal in diagnosing, monitoring, and guiding treatment, with noncontrast CT being beneficial given her renal impairment. Early diagnosis and CT imaging are crucial in managing complicated diverticulitis. Postoperative monitoring with CT scans is essential for detecting complications. Follow-up care should include regular colonoscopies to assess diverticular disease and dietary modifications to prevent recurrence. Combining clinical, surgical, and radiologic data ensures effective management and improves patient outcomes.
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Affiliation(s)
- Sharon L. Hsieh
- Northeast Georgia Health System, Northeast Georgia Medical Center, Transitional Year GME Program, 743 Spring Street NE Gainesville, GA 30501
| | - Nathaniel Grabill
- Northeast Georgia Health System, Northeast Georgia Medical Center, General Surgery Department, 743 Spring Street NE Gainesville, GA 30501
| | - Mena Louis
- Northeast Georgia Health System, Northeast Georgia Medical Center, Trauma and Acute Care Surgery Department, 743 Spring Street NE Gainesville, GA 30501
| | - Bradley Kuhn
- Northeast Georgia Health System, Northeast Georgia Medical Center, Trauma and Acute Care Surgery Department, 743 Spring Street NE Gainesville, GA 30501
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3
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Wu S, Al Khaldi M, Richard CS, Dagbert F. Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence. Clin Colon Rectal Surg 2024; 37:359-367. [PMID: 39399131 PMCID: PMC11466519 DOI: 10.1055/s-0043-1777439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Acute diverticulitis represents a common colorectal emergency seen in the Western world. Over time, management of this condition has evolved. This review aims to highlight recent evidence and update current recommendations. Notable evidence has emerged in certain aspects of diverticulitis. This includes disease pathogenesis, as emerging data suggest a potentially greater role for the microbiome and genetic predisposition than previously thought. Acute management has also seen major shifts, where traditional antibiotic treatment may no longer be necessary for acute uncomplicated diverticulitis. Following successful medical management of acute diverticulitis, indications for elective sigmoidectomy have decreased. The benefit of emergency surgery remains for peritonitis, sepsis, obstruction, and acute diverticulitis in certain immunocompromised patients. Routine colonoscopy, once recommended after all acute diverticulitis episodes, has been shown to be beneficial for cancer exclusion in a distinct patient population. Despite advances in research, certain entities remain poorly understood, such as smoldering diverticulitis and symptomatic uncomplicated diverticular disease. As research in the field expands, paradigm shifts will shape our understanding of diverticulitis, influencing how clinicians approach management and educate patients.
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Affiliation(s)
- Sonia Wu
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada
| | - Maher Al Khaldi
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada
| | - Carole S. Richard
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada
| | - François Dagbert
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, QC, Canada
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Luvsandagva B, Bai T, Hou X. The Association of the Presence of Esophageal and Colonic Diverticula with Hiatal Hernia: A Cross-sectional Study. Niger J Clin Pract 2024; 27:1235-1238. [PMID: 39627662 DOI: 10.4103/njcp.njcp_690_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/26/2024] [Indexed: 12/06/2024]
Abstract
OBJECTIVE This study investigates the association between the presence of diverticula in the colon and esophagus and the occurrence of hiatal hernia, seeking to understand potential shared pathophysiological underpinnings and risk factors. METHODS A cross-sectional study was conducted at a tertiary care center, including patients aged ≥18 years who underwent both gastroscopy and colonoscopy over 2 years. Exclusion criteria were prior gastrectomy or colectomy, incomplete medical records, and non-consent. The presence of hiatal hernia, colonic, and esophageal diverticulosis was identified via endoscopy. Logistic regression analysis assessed the associations, adjusting for age and sex. RESULTS Among 3563 participants, males showed a higher prevalence of hiatal hernias compared to females (76.1% vs. 23.9%, P < 0.001). Hiatal hernia patients had a mean age of 51.28 years, slightly higher than those without (49.62 years, P = 0.034). A significant association was found between hiatal hernias and colonic diverticulosis (11.8% vs. 1.8%, P < 0.001), as well as between hiatal hernias and esophageal diverticulosis (2.4% vs. 0.3%, P < 0.001). Adjusted logistic regression revealed a 5-7 times higher likelihood of colonic diverticulosis in patients with hiatal hernias (odds ratio = 5.64, 95% confidence interval: 3.60-8.83; P < 0.001). CONCLUSION The study demonstrates a notable association between hiatal hernias and the presence of both colonic and esophageal diverticula, suggesting common pathophysiological processes. These findings highlight the need for further research into shared risk factors and mechanisms underlying these conditions, potentially guiding improved management strategies for affected patients.
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Affiliation(s)
- B Luvsandagva
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Schena CA, Covino M, Laterza V, Quero G, La Greca A, Cina C, de'Angelis N, Marchegiani F, Sganga G, Gasbarrini A, Franceschi F, Longo F, Alfieri S, Rosa F. The role of procalcitonin as a risk stratification tool of severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis. Surgery 2024; 176:162-171. [PMID: 38594101 DOI: 10.1016/j.surg.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Imaging-based classifications do not always reflect the clinical severity and prognosis of acute left-sided colonic diverticulitis. This study aims to investigate the role of an early procalcitonin assessment in the emergency department as a risk stratification tool for severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis. METHODS In this retrospective cohort study, all adult patients consecutively admitted from January 2015 to September 2020 for acute left-sided colonic diverticulitis and having a procalcitonin determination at admission were enrolled. The following data were collected: age, sex, comorbidities, laboratory parameters, level of urgency, clinical presentation, type of treatment, complications, and post-management outcomes. The association between the procalcitonin value at admission and the following endpoints was analyzed: type of treatment, classification of acute left-sided colonic diverticulitis, mortality, and type of surgery. RESULTS A total of 503 consecutive patients were enrolled. Procalcitonin >0.5 ng/mL emerged as an independent risk factor for complicated acute left-sided colonic diverticulitis (P = .007). Procalcitonin >0.5 ng/mL (P = .033), together with a history of complicated acute left-sided colonic diverticulitis (P < .001), abdominal pain (P = .04), bowel perforation (P < .001), and peritonitis (P < .001), was a significant risk factor for surgery. Procalcitonin >0.5 ng/mL (P = .007) and peritonitis (P = .03) emerged as independent risk factors for sigmoidectomy without colorectal anastomosis. Procalcitonin >0.5 ng/mL (P = .004), a higher level of urgency at admission (P = .005), Hartmann's procedure (P = .002), and the necessity of mechanical ventilation (P = .004) emerged as independent risk factors for mortality. CONCLUSION Procalcitonin >0.05 ng/mL at emergency department admission is a useful risk stratification tool for severity, prognosis, and need for surgical treatment in patients with acute left-sided colonic diverticulitis.
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Affiliation(s)
- Carlo Alberto Schena
- Department of Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Marcello Covino
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vito Laterza
- Department of Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, France.
| | - Giuseppe Quero
- Department of Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio La Greca
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Caterina Cina
- Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Gabriele Sganga
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Fabio Longo
- Department of Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Sergio Alfieri
- Department of Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fausto Rosa
- School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Kodadek LM, Davis KA. Current diagnosis and management of acute colonic diverticulitis: What you need to know. J Trauma Acute Care Surg 2024; 97:1-10. [PMID: 38509056 DOI: 10.1097/ta.0000000000004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
ABSTRACT Acute colonic diverticulitis is a common disease treated by acute care surgeons. Acute uncomplicated colonic diverticulitis involves thickening of the colon wall with inflammatory changes and less commonly requires the expertise of a surgeon; many cases may be treated as an outpatient with or without antibiotics. Complicated diverticulitis involves phlegmon, abscess, peritonitis, obstruction, stricture, and/or fistula and usually requires inpatient hospital admission, treatment with antibiotics, and consideration for intervention including operative management. This review will discuss what the acute care surgeon needs to know about diagnosis and management of acute colonic diverticulitis.
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Affiliation(s)
- Lisa M Kodadek
- From the Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Sugiura K, Miyake H, Nagai H, Yoshioka Y, Shibata K, Yuasa N, Fujino M. Clinical features and risk factors for appendiceal diverticulitis: a comparative study with acute appendicitis. Surg Today 2024; 54:551-564. [PMID: 37987838 DOI: 10.1007/s00595-023-02766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/16/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Despite their similar clinical characteristics, appendiceal diverticulitis (AD) and acute appendicitis (AA) are pathologically distinct. This study compared the clinical features of AD and AA and identified relevant risk factors. METHODS Patients who underwent appendectomy with a preoperative diagnosis of either AD or AA were categorized based on histopathological findings. The two groups were compared in terms of various clinical factors. RESULTS Among the 854 patients included in the study, a histopathological evaluation revealed 49 and 805 cases of AD and AA, respectively. A univariate analysis demonstrated that AD was more prevalent than AA among older, taller, and heavier males. A multivariate analysis revealed that male sex, a white blood cell (WBC) count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a mean corpuscular volume (MCV) ≥ 91.6 fL were significant factors differentiating AD from AA. In addition, pathological AD emerged as an independent risk factor for abscess and/or perforation. CONCLUSIONS AD was associated with an older age, robust physique, and significant risk of abscess and/or perforation despite a low WBC count. In addition to imaging modalities, the preoperative factors of male sex, a WBC count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a MCV ≥ 91.6 fL may be useful for distinguishing AD from AA.
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Affiliation(s)
- Kota Sugiura
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Koji Shibata
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospita, l3-35, Michishita-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan.
| | - Masahiko Fujino
- Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
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Taha M, Fakieh AT, Alhazmi AM, Khiami AJ, Alasmari EA, Alharbi SS, Almajnoni MH. The Assessment of Knowledge, Awareness and Practice Regarding Diverticulitis and Its Risk Factors Among the Population of Saudi Arabia. Cureus 2024; 16:e60124. [PMID: 38864053 PMCID: PMC11165291 DOI: 10.7759/cureus.60124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Background The term "diverticula" refers to the existence of diverticula in the gastrointestinal tract but is mainly located in the sigmoid colon and is used to describe colonic diverticulosis. Diverticula, which are sac-like protrusions in the wall of the large bowel, are becoming more prevalent globally, in both developed and developing nations. This increase in occurrence is primarily attributed to changes in dietary and lifestyle patterns. Raising public awareness can potentially contribute to a decrease in the incidence of the disease and its associated complications. Aim This study aims to assess knowledge and awareness levels among the Saudi Arabian population regarding diverticulitis and its risk factors. Methods A descriptive cross-sectional study was conducted in Saudi Arabia between 1st January 2024 to 1st April 2024 using an online questionnaire for data collection. The target population consists of individuals who are between 18 years and 45, in Saudi Arabia without a history of diverticulitis. The study questionnaire covered participants' demographic (Western, Central, Southern, Eastern, Northern) regions, knowledge, awareness and practice of diverticulitis. Results A total of 548 eligible participants completed the study questionnaire, most of them (80.3%; 395) were from the Western region including Mecca, Medina and Jeddah. Participants' ages ranged from 18 to more than 40 years with a mean age of 30.5 ± 11.9 years old. A greater percentage (72.3%) of the participants were males compared to the percentage of females, which was 27.7%. The vast majority of the study participants had an inadequate knowledge level about diverticulitis (85.9%; 471) while only 31 (5.7%) had adequate knowledge and awareness about the disease. The most reported sources of information included study courses (6.4%), media (5.3%), and physicians (4.7%) while most respondents (83.6%) had no source. Conclusion In conclusion, aside from preventive strategies, the current study found that the public knew very little about diverticulitis, including its risk factors, clinical presentation, and diagnostic process. The two significant predictors of public awareness level were age and doctors as information sources.
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Affiliation(s)
- Medhat Taha
- Department of Anatomy, Umm Al-Qura University, Al-Qunfudhah, SAU
| | - Anas T Fakieh
- College of Medicine, Umm Al-Qura University, Al-Qunfudhah, SAU
| | | | | | - Emad A Alasmari
- College of Medicine, Umm Al-Qura University, Al-Qunfudhah, SAU
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McClintock S, Stupart D, Hoh SM, Redden AM, Schultz B, Robertson A, Moore E, Pollard J, Guest G, Watters D. Oral versus intravenous antibiotics in the treatment of uncomplicated colonic diverticulitis: results of a randomized non-inferiority control trial. ANZ J Surg 2024; 94:397-403. [PMID: 37962086 DOI: 10.1111/ans.18768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Colonic diverticular disease is common and its incidence increases with age, with uncomplicated diverticulitis being the most common acute presentation (1). This typically results in inpatient admission, placing a significant burden on healthcare services (2). We aimed to determine the safety and effectiveness of using intravenous or oral antibiotics in the treatment of uncomplicated diverticulitis on 30-day unplanned admissions, c-reactive protein (CRP), White Cell Count (WCC), pain resolution, cessation of pain medication, return to normal nutrition, and return to normal bowel function. METHODS This single centre, 2-arm, parallel, 1:1, unblinded non-inferiority randomized controlled trial compared the safety and efficacy of oral antibiotics versus intravenous antibiotics in the outpatient treatment of uncomplicated colonic diverticulitis. Inclusion criteria were patients older than 18 years of age with CT proven acute uncomplicated colonic diverticulitis (Modified Hinchey Classification Stage 0-1a). Patients were randomly allocated receive either intravenous or oral antibiotics, both groups being treated in the outpatient setting with a Hospital in the Home (HITH) service. The primary outcome was the 30-day unplanned admission rate, secondary outcomes were biochemical markers, time to pain resolution, time to cessation of pain medication, time to return to normal function and time to return to normal bowel function. RESULTS In total 118 patients who presented with uncomplicated colonic diverticulitis were recruited into the trial. Fifty-eight participants were treated with IV antibiotics, and 60 were given oral antibiotics. We found there was no significant difference between groups with regards to 30-day unplanned admissions or inflammatory markers. There was also no significant difference with regards to time to pain resolution, cessation of pain medication use, return to normal nutrition, or return to normal bowel function. CONCLUSION Outpatient management of uncomplicated diverticulitis with oral antibiotics proved equally as safe and efficacious as intravenous antibiotic treatment in this randomized non-inferiority control trial.
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Affiliation(s)
- Sam McClintock
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Douglas Stupart
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Su Mei Hoh
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Ann-Maree Redden
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Belinda Schultz
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Amy Robertson
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Eileen Moore
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - James Pollard
- Hospital in the Home (HITH), University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Glenn Guest
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - David Watters
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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Ferent IC, Lauro A, Rinaldi V, Frattaroli S, Varanese M, Saullo P, Caronna R. Treating a Bypass with Bypass Surgery: Repair of a Duodeno-sigmoid Fistula Complicating Acute Diverticulitis. Dig Dis Sci 2024; 69:683-688. [PMID: 38217679 DOI: 10.1007/s10620-023-08200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
Diverticular disease is common in Western countries; one-third of patients with diverticular disease develop diverticulitis during their lifetime of whom 5% may experience serious complications. We describe a rare complication of diverticulitis: a duodeno-colic fistula in a patient with an elongated sigmoid colon (dolicosigma). The patient complained of abdominal pain, diarrhea, weight loss, and feculent vomiting. Radiological studies and gastroscopy demonstrated a fistula between the second portion of the duodenum and the sigmoid colon. Curative surgery cured the fistula and completely resolved its associated signs and symptoms.
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Affiliation(s)
| | - Augusto Lauro
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Valerio Rinaldi
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | - Marzia Varanese
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Paolina Saullo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Roberto Caronna
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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11
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Li JJ, Boivin Z, Bhalodkar S, Liu R. Point of Care Abdominal Ultrasound. Semin Ultrasound CT MR 2024; 45:11-21. [PMID: 38056783 DOI: 10.1053/j.sult.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Abdominal pain is a common emergency department complaint, and point-of-care ultrasound (POCUS) of the abdomen is increasingly being utilized to evaluate clinical manifestations. It aids in accurate diagnoses and assists in procedures, particularly in emergency and critical care settings. Imaging is often required to confirm the etiology of abdominal pain. POCUS provides the benefit of avoiding radiation exposure and enables quicker diagnosis compared to computed tomography scans. There is growing evidence of the diagnostic accuracy for numerous abdominal POCUS applications, including appendicitis, intussusception, diverticulitis, gastric ultrasound and contrast-enhanced ultrasound.
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Affiliation(s)
- Jia J Li
- Yale New-Haven Hospital, New Haven, CT.
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Mahmood MW, Schmidt PT, Olén O, Hellsing C, Hjern F, Abraham-Nordling M. Identification of diverticular disease in Swedish healthcare registers: a validation study. Scand J Gastroenterol 2024; 59:176-182. [PMID: 37936435 DOI: 10.1080/00365521.2023.2278422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE The Swedish National Patient Register (SNPR) is frequently used in studies of colonic diverticular disease (DD). Despite this, the validity of the coding for this specific disease in the register has not been studied. METHODS From SNPR, 650 admissions were randomly identified encoded with ICD 10, K572-K579. From the years 2002 and 2010, 323 and 327 patients respectively were included in the validation study. Patients were excluded prior to, or up to 2 years after a diagnosis with IBD, Celiac disease, IBS, all forms of colorectal cancer (primary and secondary), and anal cancer. Medical records were collected and data on clinical findings with assessments, X-ray examinations, endoscopies and laboratory results were reviewed. The basis of coding was compared with internationally accepted definitions for colonic diverticular disease. Positive predictive values (PPV) were calculated. RESULTS The overall PPV for all diagnoses and both years was 95% (95% CI: 93-96). The PPV for the year 2010 was slightly higher 98% (95% CI: 95-99) than in the year 2002, 91% (95% CI: (87-94) which may be due to the increasing use of computed tomography (CT). CONCLUSION The validity of DD in SNPR is high, making the SNPR a good source for population-based studies on DD.
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Affiliation(s)
- Mahmood Wael Mahmood
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter T Schmidt
- Department of Medical Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Christine Hellsing
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Hjern
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mirna Abraham-Nordling
- Department of Pelvic Cancer, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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13
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Ariam E, Richter V, Bermont A, Sandler Y, Cohen DL, Shirin H. Prior abdominal surgery as a potential risk factor for colonic diverticulosis or diverticulitis. World J Clin Cases 2023; 11:8320-8329. [PMID: 38130607 PMCID: PMC10731208 DOI: 10.12998/wjcc.v11.i35.8320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Abnormal colonic pressure profiles have been associated with an increased risk of colonic diverticulosis. A surgical history is a known risk factor for abdominal adhesions and these may lead to increased intraluminal colonic pressure. AIM To assess whether previous abdominal surgery is associated with colonic diverticulosis or diverticulitis. METHODS We analyzed data from a study of patients undergoing colonoscopy for different indications from 2020 through 2021. Patients completed a structured questionnaire concerning previous abdominal surgeries, dietary and lifestyle exposures including smoking, alcohol use and co-morbidities. RESULTS Three hundred and fifty-nine patients were included in the study. The mean age was 67.6 and 46% were females. Diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, chronic renal failure, and body mass index were similar in the diverticulosis and control groups. The overall prevalence of colonic diverticulosis was 25% (91/359) and 48% of the patients had previous abdominal surgery. As expected, the prevalence of diverticulosis increased with age. There was no difference in the rate of previous abdominal surgery between patients with or without diverticulosis (49% vs 47%, P = 0.78). In regards to specific surgeries, inguinal hernia repair was significantly associated with diverticulosis (52% vs 20%, P = 0.001), but not diverticulitis. In contrast, appendectomy was not associated with diverticulosis (6% vs 14%, P = 0.048). CONCLUSION These findings suggest that post-operative abdominal adhesions inducing high colonic intraluminal pressures do not appear to be the mechanism for diverticula formation. Rather, inguinal hernia and diverticulosis may share similar connective tissue pathologies with no causative relationship between them.
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Affiliation(s)
- Eran Ariam
- Department of Gastroenterology, Kaplan Medical Center, Rehovot 76100, Israel
| | - Vered Richter
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anton Bermont
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sandler
- Department of Surgery Division, Shamir Medical Center, Zerifin 70300, Israel
| | - Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Shirin
- The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Stapler SJ, Colom SM, Rajkumar D, Cleary RK. Early Urinary Catheter Removal After Colectomy for Colovesical Fistula is Not Associated With Increased Postoperative Complications. Am Surg 2023; 89:6091-6097. [PMID: 37482697 DOI: 10.1177/00031348231191179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Management of the bladder defect during colectomy for colovesical fistula (CVF) and recommendations for duration of urinary catheter drainage are inconsistent. This study aimed to determine if urinary catheter drainage duration was associated with postoperative complications. METHODS Retrospective single institution cohort study of patients undergoing resection for diverticular CVF from 2015 through 2021. Urinary catheter drainage was defined as Early (≤7 days postoperative and then subdivided into 1-2 days, 3-5 days, 6-7 days), and Late (>7 days postoperative). Primary outcome was a composite measure of postoperative bladder leak, surgical site infection-III, sepsis, reoperation, and postoperative length-of-stay ≥7 days. RESULTS There were 73 patients-64 Early group and 9 Late group. Composite measure between groups (Early 25% vs Late 33.33%, P = .688) was not significantly different. The Late group had more patients with large bladder defects (33.3% vs 7.8%, P = .054), significantly more patients who underwent suture repair (55.6% vs 14.1%, P = .01), and significantly more patients that had an intraoperative pelvic drain (66.7% vs 15.6%, P = .003). After propensity score inverse weighting, the Late group had significantly more cystogram-detected postoperative bladder leaks (P = .002) and ileus (P = .042) than the Early group. There were no bladder leaks or ileus in those who had urinary catheter removal on postoperative days 1-2. CONCLUSIONS Early urinary catheter removal was associated with no increase in bladder leaks and fewer postoperative complications after definitive management of CVF. Further investigation is required to determine if intraoperative bladder leak testing and postoperative cystograms are useful adjuncts in decision making.
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Affiliation(s)
| | - Sara M Colom
- Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA
| | - Dixy Rajkumar
- Department of Academic Research, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
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15
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Kodadek LM, Moore MS, Canner JK, Schneider EB. Diverticulitis in Older Adults: Is Cognitive Impairment Associated With Outcomes? J Surg Res 2023; 291:359-366. [PMID: 37506436 DOI: 10.1016/j.jss.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Older age is associated with increased prevalence of both diverticulitis and cognitive impairment. The association between cognitive impairment and outcomes among older adults presenting to the emergency department (ED) for diverticulitis is unknown. METHODS Adults aged ≥65 y presenting to an ED with a primary diagnosis of colonic diverticulitis were identified using the Nationwide Emergency Department Sample (2016-2019) and stratified by cognitive impairment status in this retrospective cohort study. Multivariable Poisson regression models adjusted for patient age, sex, Elixhauser Comorbidity Index, primary payer status, and presence of complicated diverticulitis quantified relative risk of a) inpatient admission, b) operative intervention, and c) in-hospital mortality comparing patients with or without a diagnosis code suggestive of cognitive impairment. RESULTS Among 683,444 older adults with an ED encounter for diverticulitis from 2016 to 2019, there were 468,226 patients with isolated colonic diverticulitis and 26,388 (5.6%) with comorbid cognitive impairment. After adjustment, the risk of inpatient admission for those with cognitive impairment was 18% higher than for those without cognitive impairment (adjusted relative risks [aRR]: 1.18, 95% confidence interval [CI]: 1.17-1.20). Those with cognitive impairment were 34% more likely to undergo colectomy than those without cognitive impairment (aRR: 1.34, 95% CI: 1.24-1.44). Older adults with cognitive impairment had a 32% greater mortality than those without cognitive impairment (aRR: 1.32, 95% CI: 1.05-1.67). CONCLUSIONS Among older adults presenting for ED care with a primary diagnosis of colonic diverticulitis, individuals with cognitive impairment had higher rates of hospitalization, operative intervention, and in-hospital mortality than those without cognitive impairment.
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Affiliation(s)
- Lisa M Kodadek
- Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - Miranda S Moore
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
| | - Joseph K Canner
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
| | - Eric B Schneider
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
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Soliman MG, Mansour HA, Hassan WA, Shawky E. Impact of Oral Probiotics in Amelioration of Immunological and Inflammatory Responses on Experimentally Induced Acute Diverticulitis. Probiotics Antimicrob Proteins 2023; 15:1113-1123. [PMID: 35838945 PMCID: PMC10491525 DOI: 10.1007/s12602-022-09969-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/17/2022]
Abstract
Acute diverticulitis is inflammation of a colon diverticulum; it represents a major cause of morbidity and mortality. The alteration of gut microbiota contributes to the promotion of inflammation and the development of acute diverticulitis disease. Probiotics can modify the gut microbiota, so they are considered a promising option for managing diverticulitis disease. This study aimed to investigate the potential protective effect of probiotics, alone or in combination with amoxicillin, on the experimentally induced model of acute diverticulitis disease. Forty-two rats were divided into seven groups as follows: control group: received water and food only; DSS group: received 3% dextran sulfate sodium (DSS) daily for 7 days; LPS group: injected with lipopolysaccharide (LPS) enema at the dose of (4 mg/kg); probiotics group: treated with probiotics (Lactobacillus acidophilus and Bifidobacterium lactis) each of which (4 × 108 CFU suspended in 2 ml distilled water) orally for 7 days; DSS/LPS group: received DSS and LPS; DSS/LPS treated with probiotics group; DSS/LPS treated with probiotics and amoxicillin group. The results revealed that both treatments (probiotics and probiotics-amoxicillin) attenuated DSS/LPS-induced diverticulitis, by restoring the colonic antioxidant status, ameliorating inflammation (significantly reduced TNF-α, interleukins, interferon-γ, myeloperoxidase activity, and C-reactive protein), decreasing apoptosis (through downregulating caspase-3), and reduction of the colon aerobic bacterial count. These probiotic strains were effective in preventing the development of the experimentally induced acute diverticulitis through the anti-inflammatory and immunomodulatory effects and have affected gut microbiota, so they can be considered a potential option in treating acute diverticulitis disease.
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Affiliation(s)
- Maha G Soliman
- Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Hanaa A Mansour
- Department of Pharmacology, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
| | - Wedad A Hassan
- Department of Pharmacology, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
| | - Eman Shawky
- Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt.
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Cameron R, Walker MM, Jones M, Eslick GD, Keely S, Pockney P, Cosentino CC, Talley NJ. Increased mucosal eosinophils in colonic diverticulosis and diverticular disease. J Gastroenterol Hepatol 2023; 38:1355-1364. [PMID: 37415341 PMCID: PMC10946982 DOI: 10.1111/jgh.16278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
AIMS Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula. METHODS Hematoxylin and eosin stained sections from colonic surgical resections (n = 82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications. RESULTS Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = <0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P = <0.001) and neck (P = 0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups. CONCLUSION Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.
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Affiliation(s)
- Raquel Cameron
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Marjorie M. Walker
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
| | - Michael Jones
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Department of PsychologyMacquarie UniversityNorth RydeAustralia
| | - Guy D. Eslick
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Peter Pockney
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | | | - Nicholas J. Talley
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
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Gonzalez Gonzalez JA, Lombana LJ, Rugeles SJ, Zuñiga MI, Velez AM, Gomez M. Divertículo gigante verdadero del colon izquierdo. Reporte de caso. REVISTA COLOMBIANA DE GASTROENTEROLOGÍA 2023; 38:206-210. [DOI: 10.22516/25007440.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Se presenta el caso clínico de un paciente masculino, con clínica y hallazgos tomográficos de masa abdominal en colon descendente. Se describe proceso diagnostico y tratamiento. Se realiza revisión de la literatura, estableciendo su definición e indicaciones quirúrgicas, teniendo en cuenta que el divertículo gigante verdadero del colon se una entidad rara, con menos de 200 casos reportados en la literatura.
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Valvano M, Vezzaro V, Fabiani S, Capannolo A, Sgamma E, Cesaro N, Valerii G, Longo S, Barbera C, Lombardi L, Viscido A, Necozione S, Latella G. The connection between diverticulosis and colonic superficial neoplastic lesions in patients who underwent screening colonoscopy. Int J Colorectal Dis 2023; 38:107. [PMID: 37081187 PMCID: PMC10119047 DOI: 10.1007/s00384-023-04399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE If could be a potential pathophysiological connection between colonic diverticula and colonic superficial neoplastic lesions, beyond the shared risk factors, has been a subject of debate in the last years. This study tries to evaluate the association between diverticulosis and colonic neoplastic lesions. METHODS This is a cross-sectional study including asymptomatic patients who underwent a screening colonoscopy (patients with a positive fecal occult blood test under the regional program of colorectal cancer (CRC) screening), surveillance after polypectomy resection, or familiarity (first-degree relatives) between 2020 and 2021 to evaluate the association between diverticula and colonic polyps. A multivariate analysis with multiple logistic regression and odds ratio (OR) to study the independent association between adenomas and adenocarcinomas was performed. RESULTS One thousand five hundred one patients were included. A statistically significant association between adenomas or CRC alone and colonic diverticula was found (p = 0.045). On a multivariate analysis of demographic (age, gender) and clinical parameters (familiarity for diverticula and adenoma/CRC), only age was significantly associated with the development of colorectal adenomas or cancer (OR 1.05, 95% CI 1.03-1.07, p < 0.0001). CONCLUSIONS This study showed a statistically significant association between diverticula and colonic adenomas. However, it is impossible to establish a cause-effect relationship due to the intrinsic characteristics of this study design. A study with a prospective design including both patients with diverticulosis and without colonic diverticula aimed at establishing the incidence of adenoma and CRC could help to answer this relevant clinical question, since a potential association could indicate the need for closer endoscopic surveillance.
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Affiliation(s)
- M Valvano
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - V Vezzaro
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - S Fabiani
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - A Capannolo
- Diagnostic and Surgical Endoscopy Unit, San Salvatore Academic Hospital, L'Aquila, Italy
| | - E Sgamma
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - N Cesaro
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - G Valerii
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, 64100, Teramo, Italy
| | - S Longo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - C Barbera
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, 64100, Teramo, Italy
| | - L Lombardi
- Diagnostic and Surgical Endoscopy Unit, San Salvatore Academic Hospital, L'Aquila, Italy
| | - A Viscido
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - S Necozione
- Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Latella
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy.
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ANDREJEVIC P, PORTELLI M, SCHEMBRI HIGGANS J. Diverticulitis in the frail elderly patient. Chirurgia (Bucur) 2023; 36. [DOI: 10.23736/s0394-9508.22.05488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Chang CY, Hsu TY, He GY, Shih HM, Wu SH, Huang FW, Chen PC, Tsai WC. Utility of monocyte distribution width in the differential diagnosis between simple and complicated diverticulitis: a retrospective cohort study. BMC Gastroenterol 2023; 23:96. [PMID: 36977993 PMCID: PMC10047462 DOI: 10.1186/s12876-023-02736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis. METHODS This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher's exact test. The Mann-Whitney U test was used for continuous variables. Multivariable regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases. RESULTS Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784-0.956); CRP, 0.800 (95% CI, 0.707-0.892); NLR, 0.724 (95% CI, 0.616-0.832); PLR, 0.662 (95% CI, 0.525-0.798); and WBC, 0.679 (95% CI, 0.563-0.795). When the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively. CONCLUSIONS A large MDW was a significant and independent predictor of complicated diverticulitis. The optimal cutoff value for MDW is 20.38 as it exhibits maximum sensitivity and specificity for distinguishing between simple and complicated diverticulitis The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.
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Affiliation(s)
- Chang-Yuan Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tai-Yi Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Guan-Yi He
- Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Mo Shih
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Shih-Hao Wu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Fen-Wei Huang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan.
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Ivashkin V, Shifrin O, Maslennikov R, Poluektova E, Korolev A, Kudryavtseva A, Krasnov G, Benuni N, Barbara G. Eubiotic effect of rifaximin is associated with decreasing abdominal pain in symptomatic uncomplicated diverticular disease: results from an observational cohort study. BMC Gastroenterol 2023; 23:82. [PMID: 36959568 PMCID: PMC10037807 DOI: 10.1186/s12876-023-02690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Rifaximin effectively treats symptomatic uncomplicated diverticular disease (SUDD) and has shown eubiotic potential (i.e., an increase in resident microbial elements with potential beneficial effects) in other diseases. This study investigated changes in the fecal microbiome of patients with SUDD after repeated monthly treatment with rifaximin and the association of these changes with the severity of abdominal pain. METHODS This was a single-center, prospective, observational, uncontrolled cohort study. Patients received rifaximin 400 mg twice a day for 7 days per month for 6 months. Abdominal pain (assessed on a 4-point scale from 0 [no pain] to 3 [severe pain]) and fecal microbiome (assessed using 16 S rRNA gene sequencing) were assessed at inclusion (baseline) and 3 and 6 months. The Spearman's rank test analyzed the relationship between changes in the gut microbiome and the severity of abdominal pain. A p-value ≤ 0.05 was considered statistically significant. RESULTS Of the 23 patients enrolled, 12 patients completed the study and were included in the analysis. Baseline abdominal pain levels decreased significantly after 3 (p = 0.036) and 6 (p = 0.008) months of treatment with rifaximin. The abundance of Akkermansia in the fecal microbiome was significantly higher at 3 (p = 0.017) and 6 (p = 0.015) months versus baseline. The abundance of Ruminococcaceae (p = 0.034), Veillonellaceae (p = 0.028), and Dialister (p = 0.036) were significantly increased at 6 months versus baseline, whereas Anaerostipes (p = 0.049) was significantly decreased. The severity of abdominal pain was negatively correlated with the abundance of Akkermansia (r=-0.482; p = 0.003) and Ruminococcaceae (r=-0.371; p = 0.026) but not with Veillonellaceae, Dialister, or Anaerostipes. After 3 months of rifaximin, abdominal pain was significantly less in patients with Akkermansia in their fecal microbiome than in patients without Akkermansia (p = 0.022). CONCLUSION The eubiotic effect of rifaximin was associated with decreased abdominal pain in patients with SUDD.
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Affiliation(s)
- Vladimir Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for the Human Microbiome Research, Moscow, Russian Federation
| | - Oleg Shifrin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Roman Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for the Human Microbiome Research, Moscow, Russian Federation
| | - Elena Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for the Human Microbiome Research, Moscow, Russian Federation
| | - Alexander Korolev
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Anna Kudryavtseva
- Laboratory of Postgenomic Research, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - George Krasnov
- Laboratory of Postgenomic Research, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Nona Benuni
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
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Reitano E, Francone E, Bona E, Follenzi A, Gentilli S. Gut Microbiota Association with Diverticular Disease Pathogenesis and Progression: A Systematic Review. Dig Dis Sci 2023; 68:913-921. [PMID: 35796855 PMCID: PMC10011305 DOI: 10.1007/s10620-022-07600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/15/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Growing evidence supports the role of the intestinal microbiome in the development of different intestinal and extraintestinal diseases. Diverticular disease (DD) is one of the most common disorders in western countries. In the last years, different articles have suggested a possible role of the intestinal microbiome in DD pathogenesis and in the development of acute diverticulitis (AD). This systematic review aimed to clarify the current knowledge on the role of the intestinal microbiome in colonic diverticulitis in different stages according to the 2009 PRISMA guidelines. MATERIALS AND METHODS Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Patients with any stage of disease were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. RESULTS Overall, nine studies were included in the review. Only one article was focused on patients with AD, while all other articles only considered patients with DD without acute inflammation signs. Enterobacteriaceae seems to be the microbiota most associated with the disease, followed by Bifidobacteria. CONCLUSIONS All the included studies showed great heterogeneity in population characteristics and sampling methods. Therefore, given the high prevalence of colonic diverticulitis in the general population, further studies are needed to clarify the role of the intestinal microbiome, paving the way to new target therapies with important social implications.
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Affiliation(s)
- Elisa Reitano
- grid.16563.370000000121663741Department of Translational Medicine, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Elisa Francone
- grid.16563.370000000121663741Division of General Surgery, Department of Health Sciences, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
- Department of Surgery, IRCCS Ospedale San Martino, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Elisa Bona
- grid.16563.370000000121663741Department of Science and Innovation in Technologies, University of Eastern Piedmont, Piazza San Eusebio 5, 13100 Vercelli, Italy
| | - Antonia Follenzi
- grid.16563.370000000121663741Department of Translational Medicine, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Sergio Gentilli
- grid.16563.370000000121663741Division of General Surgery, Department of Health Sciences, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
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Ojemolon PE, Shaka H, Kwei-Nsoro R, Kanemo P, Shah M, Abusalim AI, Attar B. Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis. Cureus 2023; 15:e36843. [PMID: 37123665 PMCID: PMC10141331 DOI: 10.7759/cureus.36843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Objective We aimed to describe epidemiologic trends in outcomes of colonic diverticular disease (CDD) hospitalizations in morbidly obese patients. Methods We searched the United States National Inpatient Sample databases from 2010 through 2019, obtained the incidence rate of morbid obesity (MO) among CDD hospitalizations, and used Joinpoint analysis to obtain trends in these rates adjusted for age and sex. Hospitalizations involving patients less than 18 years of age were excluded. Trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge were analyzed. Multivariate regression analysis was used to obtain trends in adjusted mortality, mean LOS, and mean total hospital charge. Results We found an average annual percent change of 7.5% (CI = 5.5-9.4%, p < 0.01) in the adjusted incidence of MO among hospitalizations for CDD over the study period. We noted a 7.2% decline in mortality (p = 0.011) and a 0.1 days reduction in adjusted LOS (p < 0.001) over the study period. Hospitalizations among the middle-aged and elderly had adjusted odds ratios of 7.18 (95% CI = 2.2-23.3, p = 0.001) and 24.8 (95% CI = 7.9-77.9, p < 0.001), respectively, for mortality compared to those in young adults. The mean LOS was 0.29 days higher in females compared to males (p < 0.001). Conclusion The incidence of MO increased among CDD hospitalizations while mortality and mean LOS reduced over the study period. Outcomes were worse in older patients, with an increased mean LOS in females compared to males.
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Affiliation(s)
- Pius E Ojemolon
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Hafeez Shaka
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Robert Kwei-Nsoro
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Philip Kanemo
- Internal Medicine, Rapides Regional Medical Center, Alexandria, USA
- Internal Medicine, Englewood Hospital, New Jersey, USA
| | - Mihir Shah
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Bashar Attar
- Gastroenterology and Hepatology, Rush University Medical Center, Chicago, USA
- Gastroenterology and Hepatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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25
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Laursen ASD, Jensen BW, Strate LL, Sørensen TIA, Baker JL, Sørensen HT. Birth weight, childhood body mass index, and risk of diverticular disease in adulthood. Int J Obes (Lond) 2023; 47:207-214. [PMID: 36698028 DOI: 10.1038/s41366-023-01259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Adult overweight is associated with increased risk of diverticular disease (DD). We investigated associations between birthweight and childhood body mass index (BMI) and DD. METHODS Cohort study of 346,586 persons born during 1930-1996 with records in the Copenhagen School Health Records Register. Data included birthweight, and height and weight from ages 7 through 13. We used Cox proportional hazard regression to examine associations between birthweight and BMI z-scores and DD registered in the Danish National Patient Registry. Due to non-proportionality, we followed participants from age 18-49 and from age 50. RESULTS During follow-up, 5459 (3.2%) women and 4429 (2.5%) men had DD. For low and high BMI in childhood, we observed a higher risk of DD before age 50. Among women with z-scores <0 at age 13, the hazard ratio (HR) was 1.16 [95% confidence interval (CI): 0.98-1.39] per one-point lower z-score. For z-scores ≥0 at age 13, the HR was 1.30 (95% CI: 1.11-1.51) per one-point higher z-score. Among men with z-scores <0 at age 13, the HR was 1.02 (95% CI: 0.85-1.22). For z-scores ≥0 at age 13, the HR was 1.54 (95% CI: 1.34-1.78). Z-scores ≥0 were not associated with DD after age 50. Among women only, birthweight was inversely associated with DD before age 50 [HR = 0.90 (95% CI: 0.83-0.99) per 500 g higher birthweight]. CONCLUSION BMI z-scores below and above zero in childhood were associated with higher risk of DD before age 50. In addition, we observed lower risk of DD among women, the higher their birthweight.
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Affiliation(s)
- Anne Sofie D Laursen
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Britt W Jensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lisa L Strate
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA
| | - Thorkild I A Sørensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Genomic Physiology and Translation Program, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Protective effects of amoxicillin and probiotics on colon disorders in an experimental model of acute diverticulitis disease. Inflammopharmacology 2022; 30:2153-2165. [PMID: 36318434 DOI: 10.1007/s10787-022-01093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
AbstractAcute diverticulitis disease is associated with inflammation and infection in the colon diverticula and may lead to severe morbidity. This study aimed to evaluate and compare the protective effects of amoxicillin antibiotic, either alone or in combination with probiotics (Lactobacillus acidophilus and Bifidobacterium lactis), in a rat model of acute diverticulitis disease. Acute diverticulitis was induced, in albino rats, by adding 3% weight/volume of dextran sulfate sodium (DSS) to the rats’ drinking water; daily for 7 days, in addition to injecting lipopolysaccharide (LPS) enema (4 mg/kg). The impact of treatments was assessed by measuring the physiological and immunological parameters and evaluating colon macroscopic and microscopic lesions. The results showed that both treatments (especially probiotics with amoxicillin) alleviated the adverse effects of DSS and LPS. This was obvious through the modulation of the rats’ body weight and the colon weight-to-length ratio. Also, there was a significant (p < 0.001) decrease in the colon macroscopic lesion score. The pro-inflammatory cytokines [(TNF)-α, (IL)-1β, (IFN)-γ, and (IL)-18]; in the colon tissue; were significantly (p < 0.001) decreased. Also, both treatments significantly ameliorated the elevation of myeloperoxidase activity and C-reactive protein levels, in addition to improving the histopathological alterations in the colon tissue. In conclusion, amoxicillin and probiotics–amoxicillin were effective in preventing the development of experimentally induced acute diverticulitis, through their anti-inflammatory and immunomodulatory effects. Furthermore, this study has explored the role of probiotics in preventing DSS/LPS-induced acute diverticulitis, so it can be applied as a promising treatment option for acute diverticulitis disease.
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Time Trend and Association of Early-Onset Colorectal Cancer with Diverticular Disease in the United States: 2010-2021. Cancers (Basel) 2022; 14:cancers14194948. [PMID: 36230874 PMCID: PMC9563394 DOI: 10.3390/cancers14194948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: To examine time trends of incidence rates of EOCRC from 2010 to 2021 among patients with and without diverticular disease and to examine whether diverticular disease is associated with increased risk of EOCRC. Methods: This is a retrospective cohort study of 46,179,351 young adults aged 20−49, including 298,117 with diverticular disease. We examined yearly incidence rate of first diagnosis of EOCRC from 2010 through 2021 among patients with and without diverticular disease. The 5-year risk of EOCRC among patients with pre-existing diverticular disease was compared to propensity-matched patients without diverticular disease and EOCRC and odds ratio (OR) and 95% confidence interval (CI) were calculated. Results: The yearly incidence rate of new diagnosis of EOCRC (measured as new cases per 100,000 people per year) in young adults with pre-existing diverticular disease increased from 100 in 2010 to 402 in 2021, 4−6 times higher than in those without diverticular disease (24 in 2010 to 77 in 2021) (p < 0.001). Patients with diverticular disease were at higher risk for EOCRC than those without (OR: 1.76, 95% CI: 1.40−2.32). Conclusion: The incidence of EOCRC continuously increased from 2010 through 2021 in patients with and without diverticular disease and was 4−6 times higher among patients with diverticular disease. Patients with pre-existing diverticular disease were at a significantly increased risk for EOCRC.
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28
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A. Vaz A, Odriozola-Serrano I, Oms-Oliu G, Martín-Belloso O. Physicochemical Properties and Bioaccessibility of Phenolic Compounds of Dietary Fibre Concentrates from Vegetable By-Products. Foods 2022; 11:2578. [PMID: 36076764 PMCID: PMC9455628 DOI: 10.3390/foods11172578] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022] Open
Abstract
The agro-food industry generates a large volume of by-products, whose revaluation is essential for the circular economy. From these by-products, dietary fibre concentrates (DFCs) can be obtained. Therefore, the objective of this study was to characterise (a) the proximal composition by analysing soluble, insoluble and total Dietary Fibre (DF), (b) the physicochemical properties, and (c) the phenolic profile of artichoke, red pepper, carrot, and cucumber DFCs. In addition, the bioaccessibility of phenolic compounds was also evaluated after in vitro gastrointestinal and colonic digestions. The results showed that the DFCs had more than 30 g/100 g dw. The water holding and retention capacity of the DFCs ranges from 9.4 to 18.7 g of water/g. Artichoke DFC presented high concentration of phenolic compounds (8340.7 mg/kg) compared to the red pepper (304.4 mg/kg), carrot (217.4 mg/kg) and cucumber DFCs (195.7 mg/kg). During in vitro gastrointestinal digestion, soluble phenolic compounds were released from the food matrix, chlorogenic acid, the principal compound in artichoke and carrot DFCs, and hesperetin-7-rutinoside in red pepper cucumber DFCs. Total phenolic content decreased after in vitro colonic digestion hence the chemical transformation of the phenolic compounds by gut microbiota. Based on the results, DFCs could be good functional ingredients to develop DF-enriched food, reducing food waste.
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Affiliation(s)
| | | | | | - Olga Martín-Belloso
- Department of Food Technology, University of Lleida—Agrotecnio CERCA Center, Av. Alcalde Rovira Roure191, 25198 Lleida, Spain
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29
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Donovan E, Rizzolo D. Managing a patient with acute colonic diverticulitis. JAAPA 2022; 35:23-30. [PMID: 35762951 DOI: 10.1097/01.jaa.0000832644.97318.f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical presentation and treatment options vary considerably, leaving uncertainty about optimal management. Traditionally, surgery was recommended to prevent complications, persistent symptoms, and recurrent episodes. Improvements in the understanding of the disease's natural history, diagnostic imaging, and long-term outcomes have prompted changes to diagnosis and treatment guidelines.
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Affiliation(s)
- Elizabeth Donovan
- Elizabeth Donovan practices in general surgery at Chevy Chase Surgical Associates in Chevy Chase, Md. Denise Rizzolo is an assistant clinical professor in the Pace Completion Program in the Department of Physician Assistant Studies in New York City and an assessment specialist at the Physician Assistant Education Association. The authors have disclosed no potential conflicts of interest, financial or otherwise
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30
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Mari A, Khoury T, Pellicano R. The Impact of Bariatric Surgery on Diverticulitis Outcomes: Another Reason to Lose Weight. Obes Surg 2022; 32:2076-2077. [PMID: 35314947 DOI: 10.1007/s11695-022-06026-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Amir Mari
- Gastroenterology and Endoscopy Unit, The Nazareth Hospital, EMMS, Nazareth, Israel
- Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
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31
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Impact of diverticular disease on prostate cancer risk among hypertensive men. Prostate Cancer Prostatic Dis 2022; 25:700-706. [PMID: 34621012 DOI: 10.1038/s41391-021-00454-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Prostate cancer (PCa) is a heterogenous disease with multiple etiological factors playing a role in its development. Recently, chronic and systemic inflammatory conditions such as inflammatory bowel disease were identified as key risk factors influencing its development. The study aimed to evaluate the relationship between diverticular disease (DD) (local and acute inflammation) and PCa. METHODS Hypertensive patients with DD and hypertensive controls were identified between 1995 and 2010 from the Statewide Planning and Research Cooperative System database. Cohorts were queried for PCa incidence through 2015. Univariable and multivariable logistic regression analyses were used for determining independent predictors of PCa diagnosis. RESULTS A total of 51,353 patients with DD and 111,541 controls were identified. In all, 6.26% of DD developed PCa, and 3.71% of controls developed PCa (p < 0.01). DD was a significant risk factor for PCa (OR: 1.27 CI: 1.19-1.34, p < 0.01). On subgroup analysis, the patients diagnosed with DD <50 years old had an OR of 3.39 for PCa (CI: 2.52-4.56, p < 0.01), age 50-59 had an OR of 2.12 (CI: 1.86-2.15, p < 0.01), and age 60-69 had an OR of 1.20 (CI: 1.10-1.31, p < 0.01). Finally, age and race stratification showed that white patients <50 had an OR of 2.56 (CI: 1.75-3.76, p < 0.01), while black patients <50 had an OR of 3.98 (CI: 2.61-6.07, p < 0.01). The trend in differing odds between these populations was the same for age groups 50-59 and 60-69. CONCLUSION Our analysis shows that DD is associated with diagnosis of PCa in hypertensive men. Importantly, the earlier the diagnosis of DD, the higher the odds for development of PCa, particularly in black men.
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Turner GA, O'Grady MJ, Purcell RV, Frizelle FA. Acute Diverticulitis in Young Patients: A Review of the Changing Epidemiology and Etiology. Dig Dis Sci 2022; 67:1156-1162. [PMID: 33786702 DOI: 10.1007/s10620-021-06956-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years, especially in patients under 50 years old. Historically, acute diverticulitis in younger patients was felt to represent a separate entity, being more virulent and associated with a higher rate of recurrence. Accordingly, young patients were often managed differently to older counterparts. Our understanding of the natural history of this condition has evolved, and current clinical practice guidelines suggest age should not alter management. The purpose of this review is to evaluate the changing epidemiology of acute diverticulitis, consider potential explanations for the observed increased incidence in younger patients, as well as review the natural history of acute diverticulitis in the younger population.
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Affiliation(s)
- Greg A Turner
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Michael J O'Grady
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Rachel V Purcell
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Frank A Frizelle
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
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The Coexistence of Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus. J Clin Med 2022; 11:jcm11051375. [PMID: 35268466 PMCID: PMC8910939 DOI: 10.3390/jcm11051375] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
The incidence of nonalcoholic fatty liver disease (NAFLD) is growing worldwide. Epidemiological data suggest a strong relationship between NAFLD and T2DM. This is associated with common risk factors and pathogenesis, where obesity, insulin resistance and dyslipidemia play pivotal roles. Expanding knowledge on the coexistence of NAFLD and T2DM could not only protect against liver damage and glucotoxicity, but may also theoretically prevent the subsequent occurrence of other diseases, such as cancer and cardiovascular disorders, as well as influence morbidity and mortality rates. In everyday clinical practice, underestimation of this problem is still observed. NAFLD is not looked for in T2DM patients; on the contrary, diagnosis for glucose metabolism disturbances is usually not performed in patients with NAFLD. However, simple and cost-effective methods of detection of fatty liver in T2DM patients are still needed, especially in outpatient settings. The treatment of NAFLD, especially where it coexists with T2DM, consists mainly of lifestyle modification. It is also suggested that some drugs, including hypoglycemic agents, may be used to treat NAFLD. Therefore, the aim of this review is to detail current knowledge of NAFLD and T2DM comorbidity, its prevalence, common pathogenesis, diagnostic procedures, complications and treatment, with special attention to outpatient clinics.
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Educational Case: Diverticulosis. Acad Pathol 2022; 9:100014. [PMID: 35600744 PMCID: PMC9115725 DOI: 10.1016/j.acpath.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
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Piccioni A, Franza L, Vaccaro V, Saviano A, Zanza C, Candelli M, Covino M, Franceschi F, Ojetti V. Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:802. [PMID: 34441008 PMCID: PMC8398895 DOI: 10.3390/medicina57080802] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023]
Abstract
The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as "diverticulitis", "Limosilactobacillus reuteri", "human health and disease", "probiotics". We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.
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Affiliation(s)
- Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Vanessa Vaccaro
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Angela Saviano
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Christian Zanza
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Veronica Ojetti
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
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Vayzband V, Ashraf H, Esparragoza P. Surgically Managed Perforated Jejunal Diverticulitis. Cureus 2021; 13:e15930. [PMID: 34336432 PMCID: PMC8313005 DOI: 10.7759/cureus.15930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
A 71-year-old male with a past medical history significant for chronic constipation presented to the emergency department for acute onset of severe abdominal pain. On presentation, the patient appeared to be in distress, exemplifying signs of peritonitis despite vital signs being grossly benign. CT scan established the diagnosis of a perforated jejunal diverticulitis. Initially, the patient was managed conservatively with IV fluids, antibiotics, and pain control medications. Diagnostic imaging in tandem with the patient's failure to improve incited surgical intervention with a jejunal resection and establishment of a primary anastomosis. This case illustrates additional differential diagnoses necessary for consideration in an elderly patient presenting with an acute abdomen.
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Affiliation(s)
- Vlad Vayzband
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Hamza Ashraf
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Paola Esparragoza
- Gastroenterology and Hepatology, Saint Peter's University Hospital, New Brunswick, USA
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Spangler R, Manning S. Disaster Diagnoses in Geriatric Patients with Abdominal Pain. Emerg Med Clin North Am 2021; 39:347-360. [PMID: 33863464 DOI: 10.1016/j.emc.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Care of geriatric patients with abdominal pain can pose significant diagnostic and therapeutic challenges to emergency physicians. Older adults rarely present with classic signs, symptoms, and laboratory abnormalities. The incidence of life-threatening emergencies, including abdominal aortic aneurysm, mesenteric ischemia, perforated viscus, and other surgical emergencies, is high. This article explores the evaluation and management of several important causes of abdominal pain in geriatric patients with an emphasis on high-risk presentations.
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Affiliation(s)
- Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Sara Manning
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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Sartelli M, Ansaloni L, Bartoletti M, Catena F, Cardi M, Cortese F, Di Marzo F, Pea F, Plebani M, Rossolini GM, Sganga G, Viaggi B, Viale P. The role of procalcitonin in reducing antibiotics across the surgical pathway. World J Emerg Surg 2021; 16:15. [PMID: 33761972 PMCID: PMC7988639 DOI: 10.1186/s13017-021-00357-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/26/2021] [Indexed: 12/29/2022] Open
Abstract
Procalcitonin (PCT) is widely considered as a highly sensitive biomarker of bacterial infection, offering general and emergency surgeons a key tool in the management of surgical infections. A multidisciplinary task force of experts met in Bologna, Italy, on April 4, 2019, to clarify the key issues in the use of PCT across the surgical pathway. The panelists presented the statements developed for each of the main questions regarding the use of PCT across the surgical pathway. An agreement on the statements was reached by the Delphi method, and this document reports the executive summary of the final recommendations approved by the expert panel.
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Affiliation(s)
| | | | - Michele Bartoletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Infectious Disease Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Maurizio Cardi
- Department of Surgery, “P. Valdoni” Sapienza University, Rome, Italy
| | - Francesco Cortese
- Department of Emergency Surgery, San Filippo Neri Hospital, Roma, Italy
| | | | - Federico Pea
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mario Plebani
- Department of Medicine, Laboratory Medicine, University of Padova, Padova, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Infectious Disease Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Skajaa N, Schønfeldt Troelsen F, Pedersen L, Ekholm O, Strate LL, Erichsen R, Sørensen HT. Statins and risk of diverticular disease: Nested case-control study. Pharmacoepidemiol Drug Saf 2021; 30:770-778. [PMID: 33583126 DOI: 10.1002/pds.5205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Statins exert pleiotropic anti-inflammatory effects and may prevent diverticular disease. However, the association remains poorly understood with previous studies obtaining conflicting results. AIMS To examine the effect of statin on the subsequent risk of diverticular disease. METHODS We conducted a nested case-control study in Denmark among respondents (>18 years) of the 2010 or the 2013 Danish National Health Survey. Among these, we identified 8809 cases of hospital-diagnosed diverticular disease and risk-set sampled population controls without diverticular disease. Using complete prescription and hospital records, we used conditional logistic regression to compute odds ratios (ORs) associating statin use with diverticular disease. In adjusted analyses, we controlled for hospital-based diagnoses, medication use other than statins, and lifestyle and socioeconomic factors. RESULTS The fully adjusted OR for diverticular disease associated with ever use (≥1 statin prescription filling) was 1.19 (95% CI: 1.12-1.27) compared with never use. However, we observed no dose-response relation. For example, among short-term users (<5 years), the OR was 1.18 (95% CI: 1.04-1.35) for low intensity users and 1.13 (95% CI: 1.01-1.26) for high intensity users. Among long-term users (≥5 years), the respective ORs were 1.25 (95% CI: 1.13-1.38) and 1.11 (95% CI: 0.98-1.24). In analyses restricting to cases and controls with a previous colonoscopy, associations were null (OR: 1.01 [95% CI: 0.85-1.20]). CONCLUSIONS The observed association of a higher risk of diverticular disease associated with statins could be explained by diagnostic bias. Our study did not support a protective nor harmful effect of statins on the risk of diverticular disease.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, Washington, USA
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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The Impact of the Aging Population on Surgical Diseases. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-020-00352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Duarte-Chavez R, Stoltzfus J, Yellapu V, Martins N, Nanda S, Longo S, Geme B, Schneider Y. Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis. Int J Colorectal Dis 2021; 36:83-91. [PMID: 32875377 DOI: 10.1007/s00384-020-03736-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are to clarify this association using a larger patient population and to identify risk factors in general to develop diverticular disease. METHODS The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the population with ADPKD compared with the general population without ADPKD. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease in the general population. RESULTS The prevalence of diverticulosis, diverticulitis, and diverticular bleeding were considerably increased in patients with ADPKD compared with the general population without ADPKD. The prevalence of colonic surgery was less in ADPKD patients with diverticulitis. In patients with kidney transplant, the prevalence of diverticulitis was increased in the ADPKD group, but colonic surgery was not significantly different between both groups. The prevalence of diverticular bleeding was slightly elevated in patients with ADPKD, but colonic surgery was significantly increased in patients with ADPKD. NSAID use, hypertension, constipation, and ADPKD had increased odds ratios for diverticular disease during multivariate analysis. CONCLUSION There is an increased prevalence of colonic diverticular disease in the population with ADPKD.
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Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Internal Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA.
| | - Jill Stoltzfus
- Department of Research, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Vikas Yellapu
- Department of Research, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Noel Martins
- Department of Internal Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Sudip Nanda
- Department of Internal Medicine, Division of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Berhanu Geme
- Department of Internal Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Yecheskel Schneider
- Department of Internal Medicine, Division of Gastroenterology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
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Meyer DC, Hill SS, Bebinger DM, McDade JA, Davids JS, Alavi K, Maykel JA. Resolution of multiply recurrent and multifocal diverticulitis after fecal microbiota transplantation. Tech Coloproctol 2020; 24:971-975. [PMID: 32601752 DOI: 10.1007/s10151-020-02275-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exact pathophysiology of diverticulitis is not well understood and may be multifactorial. Recent studies highlight dysbiosis as a plausible mechanism. FMT is a safe strategy to restore commensal colon microbiota and has proven to be an effective treatment for gastrointestinal dysbiosis such as Clostridium difficile infection (CDI). There have been no studies reporting the treatment of diverticulitis with FMT. Our aim was to describe the novel application of fecal microbiota transplantation (FMT) for the treatment of recurrent diverticulitis. CASE We report a case of a 63-year-old woman who had a 13-year history of multiply recurrent and multifocal diverticulitis previously treated with numerous short courses of intravenous and oral antibiotics for acute flares, two segmental colon resections, and suppressive antibiotic therapy for recurrent disease. Secondary to multiple courses of antibiotics , the patient developed CDI. She was treated with a single round of FMT and subsequently stopped all antibiotics at the time of FMT. RESULTS In 20 months of follow-up, the patient has had no further recurrence of diverticulitis or CDI. CONCLUSIONS FMT could prove to be a novel therapy for refractory diverticulitis but requires further investigation.
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Affiliation(s)
- D C Meyer
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA
| | - S S Hill
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA
| | - D M Bebinger
- Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - J A McDade
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA
| | - J S Davids
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA
| | - K Alavi
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA
| | - J A Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA.
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Storz C, Rospleszcz S, Askani E, Rothenbacher T, Linseisen J, Messmann H, De Cecco CN, Machann J, Kiefer LS, Elser S, Rathmann W, Peters A, Schlett CL, Bamberg F. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. ROFO-FORTSCHR RONTG 2020; 193:33-41. [PMID: 32785905 DOI: 10.1055/a-1212-5669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population. MATERIALS AND METHODS Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated. RESULTS A total of 371 subjects were included in the analysis (58.2 % male, 56.2 ± 9.2 years). Based on MRI, 154 participants (41.5 %) had diverticular disease with 62 cases (17 %) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9 ± 5.1 vs. 27.5 ± 4.6, p < 0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e. g. VAT: 6.0 ± 2.8 vs. 4.2 ± 2.6 and SAT: 9.2 ± 3.6 vs. 7.8 ± 3.6, all p < 0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p = 0.002). CONCLUSION Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development. KEY POINTS · Diverticular disease is associated with constitutional risk factors such as BMI.. · Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease.. · Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease.. · MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state.. CITATION FORMAT · Storz C, Rospleszcz S, Askani E et al. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2021; 193: 33 - 41.
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Affiliation(s)
- Corinna Storz
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Theresa Rothenbacher
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, Ludwig-Maximilians University of Munich, UNIKA-T Augsburg, Augsburg, Germany.,IRG Clinical Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Helmut Messmann
- Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Jürgen Machann
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tuebingen, Germany.,German Center for Diabetes Research (DZD), Tuebingen, Germany
| | - Lena Sophie Kiefer
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Elser
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Duesseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Munich, Germany.,Institute for Cardiovascular Prevention, Ludwig-Maximilians-University-Hospital, Munich, Germany.,Chair of Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Freiburg, Germany
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Montali F, Palmieri G, Casali L, Pagliai L, Costi R. Rapidly fatal outcome of Covid-19 after successful emergency surgery during pandemic outbreak in Northern Italy. Int J Surg Case Rep 2020; 73:9-12. [PMID: 32622186 PMCID: PMC7305717 DOI: 10.1016/j.ijscr.2020.06.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION A pandemic outbreak of novel coronavirus, named SARS-CoV-2 and responsible of Coronavirus Disease 2019 (COVID-19), has rapidly spread from China to Europe, being Northern Italy the first focus outside Asia. Little is known about the evolution of SARS-CoV-2 infection in patients undergoing surgery. PRESENTATION OF CASE Here we report the first confirmed case of early postoperative SARS-CoV-2 infection in a patient recovering after Hartmann's procedure for acute diverticulitis. After an otherwise unevenful postoperative course, on post-operative day 8, the patient suddenly presented hyperpyrexia and cough, rapidly evolving to respiratory failure and death 36 h after symptoms onset. CT-scan identified bilateral, diffuse, interstitial pneumonitis and oropharyngeal swab test confirmed the presence of SARS-CoV-2. A previous contact with the partner, developing the same symptoms, remained unrecognized until ICU admission. DISCUSSION During a pandemic outbreak, the early identification of SARS-CoV-2 infection of an inside patient initially considered to be infection-free has a pivotal importance not only for the prompt patient's management, but also to avoid infection spreading to other patients and hospital personnel.In the reported case, a more precise information to the patient regarding the imperative necessity to inform the medical personnel of any person of his entourage presenting, at any time, any tell-tale sign, symptom or examination which may be attributed to COVID-19, may have had allowed to anticipate patient's isolation and examinations and procedures aimed at identifying such an infection. CONCLUSION Persistent hyperleucocytosis and increased CRP serum level in spite of uneventful postoperative course were the only, aspecific markers of an ongoing SARS-CoV-2 infection before symptoms' onset, and should be considered in future clinical practice in order to adopt the prompt and appropriate patient management and limit COVID-19 contagion in surgical units.
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Affiliation(s)
- Filippo Montali
- Unità Operativa di Chirurgia Generale, Ospedale di Vaio, Fidenza (Parma), Azienda Sanitaria Locale di Parma, Italy.
| | - Gerardo Palmieri
- Unità Operativa di Chirurgia Generale, Ospedale di Vaio, Fidenza (Parma), Azienda Sanitaria Locale di Parma, Italy
| | - Lorenzo Casali
- Unità Operativa di Chirurgia Generale, Ospedale di Vaio, Fidenza (Parma), Azienda Sanitaria Locale di Parma, Italy
| | - Lorenzo Pagliai
- Unità Operativa di Chirurgia Generale, Ospedale di Vaio, Fidenza (Parma), Azienda Sanitaria Locale di Parma, Italy
| | - Renato Costi
- Unità Operativa di Chirurgia Generale, Ospedale di Vaio, Fidenza (Parma), Azienda Sanitaria Locale di Parma, Italy; Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
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Sugi MD, Sun DC, Menias CO, Prabhu V, Choi HH. Acute diverticulitis: Key features for guiding clinical management. Eur J Radiol 2020; 128:109026. [PMID: 32422553 DOI: 10.1016/j.ejrad.2020.109026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
Diverticular disease of the colon and small bowel is an important cause of pathology leading to emergency department visits and urgent gastrointestinal surgery. CT is a highly sensitive and specific modality for the diagnosis of acute diverticulitis and its complications as well as for the exclusion of alternate causes of pathology. Ultrasound, MRI and virtual CT colonoscopy have important adjunct roles for screening and workup of complications in specific patient populations. While diverticular disease most commonly involves the descending and sigmoid colon, it can also affect the proximal colon and small bowel. Acute diverticulitis may be categorized as uncomplicated or complicated according to the degree of inflammatory changes and related complications it induces, although some degree of overlap exists in clinical practice. Uncomplicated diverticulitis is classically characterized by localized inflammation surrounding a diverticulum ranging from wall thickening and phlegmonous change to the development of small, localized pericolic abscesses. Complicated forms of disease manifest with larger pericolic and distant abscesses, fistulae to adjacent organs, perforation, and peritonitis. Recurrent episodes of diverticulitis may lead to muscular hypertrophy of the bowel wall and luminal narrowing, potentially leading to bowel obstruction. Several imaging features may help to differentiate diverticulitis from colonic malignancy, however this remains a diagnostic imaging challenge that often requires further evaluation with colonoscopy. In this review, we discuss the pathophysiology and key imaging features of acute diverticulitis and its complications. We explore both common and uncommon presentations of the disease involving the colon and small bowel, acute and chronic manifestations of disease, and pitfalls to recognize when imaging alone may be insufficient to distinguish benign from malignant.
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Affiliation(s)
- Mark D Sugi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | - Derek C Sun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Christine O Menias
- Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, AZ, United States
| | - Vinay Prabhu
- Department of Radiology, New York University Langone Health, New York, NY, United States
| | - Hailey H Choi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
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Alcantar D, Giron F, Al-Jaashaami L, Kumar R. Not Your Typical Mucocele: A Case Report of a Benign Sigmoidal Diverticular Mucocele. Cureus 2020; 12:e7743. [PMID: 32455062 PMCID: PMC7241229 DOI: 10.7759/cureus.7743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In recent literature, mucoceles have been discovered to be in the appendix vermiformis or in the nasal sinuses. Although rare, colonic mucoceles, as well as rectal mucoceles, have also been encountered. Furthermore, colonic mucoceles arising from a diverticulum is an even more unusual occurrence, and to date, there has been only one reported case. We present a 48-year-old male with a past medical history of multiple episodes of diverticulitis who presented to the emergency department complaining of bilateral lower quadrant abdominal pain for three days. Upon arrival to the emergency department, the patient had a CT scan of the abdomen and pelvis, which showed an annular constricting 65 mm mass in the proximal sigmoid causing large bowel obstruction. The patient underwent unsuccessful endoscopies and inevitably underwent a hand-assisted laparoscopic sigmoid resection. The following days, the biopsy returned and resulted to be a mucocele arising from a sigmoid diverticulum. We encountered the very first benign colonic mucocele arising from a sigmoid diverticulum.
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Affiliation(s)
| | - Fanny Giron
- Internal Medicine, MacNeal Hospital, Berwyn, USA
| | | | - Rashmi Kumar
- Gastroenterology, Banner University Medical Center, Phoenix, USA
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Marchante IS, Mohedas RC. Enfermedad diverticular del intestino grueso. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2020; 13:434-440. [DOI: 10.1016/j.med.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Gasser E, Alexander P, Reich-Weinberger S, Buchner S, Kogler P, Zitt M, Kafka-Ritsch R, Öfner D. Damage control surgery for perforated diverticulitis: a two center experience with two different abdominal negative pressure therapy devices. Acta Chir Belg 2019; 119:370-375. [PMID: 30388397 DOI: 10.1080/00015458.2018.1534397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The adoption of abdominal negative pressure therapy (NPT) during urgent laparotomy has shown to be helpful to control abdominal sepsis, improve morbidity and increase anastomosis rate. The aim of this study was to compare feasibility and outcome of two different abdominal negative pressure devices. Methods: The retrospective two-center study includes 78 consecutive patients with perforated sigmoid diverticulitis, who underwent urgent laparotomy using the ABThera™ (KCI, Wien, Austria) abdominal NPT device (Group A, n = 51) or the Suprasorb® CNP (Lohmann & Rauscher, Wien, Austria) abdominal NPT device (Group B, n = 27). Results: The mean length of abdominal NPT was 3.6 days in Group A and 2.8 days in Group B. Revisional surgery after closure of the abdomen was necessary due to surgical site infections, fascial dehiscence or anastomotic insufficiency in 25% and 29%, respectively. NPT-associated complications like fistula formation or acute bleeding were not observed. Mortality was 15% (Group A) and 7% (Group B). Conclusion: Despite the good feasibility and the well-known positive effect of abdominal NPT, perforated diverticulitis is still associated with high morbidity. However, the analysis did not show significant differences between the two abdominal NPT devices.
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Affiliation(s)
- Elisabeth Gasser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Perathoner Alexander
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Selina Buchner
- Department of Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Pamela Kogler
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Zitt
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
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Abstract
BACKGROUND Diverticular disease is the leading cause of colovaginal fistulas. Surgery is challenging given the inflammatory process that makes dissection difficult. To date, studies are small and include fistula secondary to multiple etiologies. OBJECTIVE The objectives of this study were to examine surgical outcomes of diverticular colovaginal fistulas and to identify variables associated with successful closure. DESIGN This was a retrospective study of a prospectively maintained clinical database. SETTINGS The study was conducted at a single tertiary referral center. PATIENTS Women with diverticular colovaginal fistulas, who underwent surgical repair with intent to close the fistula, were included. INTERVENTIONS Repair of colovaginal fistula through minimally invasive or open techniques was involved. MAIN OUTCOME MEASURES Successful closure of fistula, defined as resolution of symptoms and no stoma, was measured. RESULTS Fifty-two patients underwent surgical treatment of diverticular colovaginal fistula, 23 (44%) of whom underwent a minimally invasive approach (conversion rate of 22%). Ostomy construction and omental pedicle flaps were used in 28 (54%) and 38 patients (73%). Surgery was successful in 47 patients (90%). Accounting for secondary operations, ultimate success and failure rates were 49 (94.0%) and 3 (5.7%). There was no difference in postoperative morbidity between the 2 groups (5 patients with Clavien-Dindo III/IV complications in the success group versus 2 patients in the failure group; 10.6% vs 40.0%; p = 0.44). Failure to achieve fistula closure was not associated with perioperative variables, age, BMI, diabetes mellitus, ASA grade, steroid use, previous abdominal surgery or hysterectomy, use of omentoplasty, or ostomy. Patients who failed were more likely to be smokers (60.0% vs 12.8%; p = 0.03). LIMITATIONS Limitations include the retrospective design and lack of power. CONCLUSIONS Surgery is effective in achieving successful closure of diverticular colovaginal fistula. Smokers should be encouraged to stop before embarking on an elective repair. Although the use of fecal diversion and omental pedicle flaps did not correlate with success, they should be used when clinically appropriate. See Video Abstract at http://links.lww.com/DCR/A983. FÍSTULAS COLOVAGINALES DIVERTICULARES ¿QUÉ FACTORES CONTRIBUYEN AL ÉXITO DEL TRATAMIENTO QUIRÚRGICO?: La enfermedad diverticular es la causa principal de fístulas colovaginales. La cirugía es un reto dado el proceso inflamatorio que dificulta la disección. Hasta la fecha, los estudios son pequeños e incluyen fístulas secundarias a múltiples etiologías. OBJETIVO 1) Examinar los resultados quirúrgicos de las fístulas colovaginales diverticulares; 2) Identificar variables asociadas a un cierre exitoso. DISEÑO:: Estudio retrospectivo de una base de datos clínicos prospectivamente mantenida. CONFIGURACIÓN:: Centro de referencia superior. PACIENTES Mujeres con fístulas colovaginales diverticulares, que se sometieron a una reparación quirúrgica con la intención de cerrar la fístula. INTERVENCIONES Reparación de la fístula colovaginal mediante técnicas mínimamente invasivas o abiertas. MEDIDAS DE RESULTADOS PRINCIPALES Cierre exitoso de la fístula definida como resolución de los síntomas y sin estoma. RESULTADOS Cincuenta y dos pacientes se sometieron a tratamiento quirúrgico de la fístula colovaginal diverticular, 23 (44%) de los cuales se sometieron a un acceso mínimamente invasivo (tasa de conversión del 22%). La construcción de la ostomía y los pedículos omentales se utilizaron en 28 (54%) y 38 pacientes (73%), respectivamente. La cirugía fue exitosa en 47 pacientes (90%). Tomando en cuenta las operaciones secundarias, las tasas finales de éxito y fracaso fueron 49 (94.0%) y 3 (5.7%). No hubo diferencias en la morbilidad postoperatoria entre los dos grupos (5 pacientes con complicaciones de Clavien-Dindo III / IV en el grupo de éxito versus a 2 pacientes en el grupo de fracaso, 10.6% versus a 40.0%; p = 0.44). El fracaso para lograr el cierre de la fístula no se asoció con variables perioperatorios, edad, IMC, diabetes, grado ASA, uso de esteroides, cirugía abdominal previa o histerectomía, uso de omentoplastia u ostomía. Los pacientes que fracasaron eran más propensos a ser fumadores (60.0% versus a 12.8%; p = 0.03). LIMITACIONES Las limitaciones incluyen el diseño retrospectivo y la falta de poder. CONCLUSIONES La cirugía es efectiva para lograr el cierre exitoso de la fístula colovaginal diverticular. Se debe aconsejar a los fumadores a parar de fumar antes de embarcarse en una reparación electiva. Mientras el uso de desviación fecal y pedículos omentales no se correlacionó con el éxito, deberían utilizarse cuando sea clínicamente apropiado. Consulte el Video del Resumen en http://links.lww.com/DCR/A983.
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