Evidence-based treatment strategies for acute diverticulitis
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REVIEW
Evidence-based treatment strategies for acute diverticulitis Alexandra M. Zaborowski 1 & Des C. Winter 1 Accepted: 21 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a spectrum of pathological processes with varying clinical manifestations. The purpose of this review was to update the reader on modern evidence-based treatment strategies for acute diverticulitis. Methods A literature search of the PUBMED database was performed using the keywords ‘diverticulosis’, ‘diverticular disease’ and ‘diverticulitis’. Only articles published in the English language were included. Results Evidence-based treatment strategies for acute diverticulitis have evolved over time. Data have questioned the need for antibiotic therapy for Hinchey I disease and the role of percutaneous abscess drainage for Hinchey II. Clinical trials have demonstrated laparoscopic lavage is an appropriate option for select patients with Hinchey III disease and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease. Conclusion Risk-adapted treatment strategies and operative decision-making for acute diverticulitis are increasingly based on a combination of patient and disease factors. Keywords Diverticular disease . Diverticulitis . Laparoscopic surgery . Sigmoidectomy
Background
Epidemiology
Diverticular disease is a commonly acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity and adverse impact on quality of life. The term encompasses a spectrum of pathological processes with varying clinical manifestations. Pathologically, colonic diverticulosis is characterized by the presence of diverticula, sac-like herniations of mucosa and submucosa that protrude through the muscularis layer of the bowel wall at the sites of penetration of the vasa recta. As they do not involve all the layers of the colonic wall, they are considered false diverticula. Although diverticula any develop in any part of the colon, the sigmoid colon is most commonly affected.
Historically, much of the epidemiological data on diverticulosis came from post-mortem studies conducted in the early twentieth century [1, 2]. Seminal series by Parks et al. reported a prevalence of 37% in 300 cadaveric dissections and suggested that between 10 and 25% of patients with diverticular disease develop diverticulitis [3–5]. Since then populationbased studies have estimated a prevalence of 50% over 60 years of age and 70% over 80 years [6]. In a retrospective study of 2222 patients with endoscopic evidence of diverticulosis, only 4% developed diverticulitis after an 11-year follow-up period suggesting initial reports were gross over estimations [7].
Aetiology and pathogenesis * Des C. Winter [email protected] Alexandra M. Zaborowski [email protected] 1
Centre for Colorectal Disease
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