Abstract
Colonic diverticular disease is common but surprisingly poorly understood. Recent advances in the field continue to focus on the introduction of new technology. Diagnosis and assessment of the severity of acute diverticulitis is improved with CT scanning. A specialized bleeding team employing advanced endoscopic techniques can control diverticular bleeding so that emergency surgical resection may be avoided. Selected patients undergoing laparoscopic sigmoid resection may benefit from this approach. The vast majority of reports are from retrospective studies and include few randomized, controlled trials.
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References and Recommended Reading
Parks TG: Natural history of diverticular disease of the colon. Clin Gastroenterol 1975, 4:53–69.
Spivak H, Weinrauch S, Harvey JC, et al.: Acute colonic diverticulitis in the young. Dis Colon Rectum 1997, 40:570–574. This retrospective review contradicts the standard view that resection should be offered to young patients after a single episode of diverticulitis.
Chautems R, Ambrosetti P, Ludwig A, et al.: Long-term followup after first acute episode of sigmoid diverticulitis: is surgery mandatory? Dis Colon Rectum 2001, 44:A5-A26.
Miura S, Kodaira S, Shatari T, et al.: Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum 2000, 43:1383–1389.
Pradel JA, Adell JT, Taourel P, et al.: Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 1997, 205:503–512.
Hollerweger A, Rettenbacher T, Macheiner P, et al.: Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography. AJR Am J Roentgenol 2000, 175:1155–1160.
Ambrosetti P, Alexandra C, Becker F, et al.: Acute left colonic diverticulitis-compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 2000, 43:1363–1367. In this well-performed prospective study, two common imaging methods for diverticulitis were compared, using surgical specimens as the gold standard for establishing the correct diagnosis. CT was found to be more sensitive for making the diagnosis, and it additionally indicated the extent of extraluminal disease that could not be assessed by contrast enema.
Ambrossetti P, Grossholz M, Becker C, et al.: Computed tomography in acute left colonic diverticulitis. Br J Surg 1997, 84:532–534.
Rao PM, Rhea JT, Novelline RA, et al.: Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol 1998, 170:1445–1449. Administration of rectal contrast may avoid the risks of intravenous contrast and the delays inherent in administering oral contrast prior to CT.
Heverhagen JT, Ishaque N, Zielke A, et al.: Feasibility of MRI in the diagnosis of acute diverticulitis: initial results. MAGMA 2001, 12:4–9.
Jensen DM, Machicado GA, Jutabha R, Kovacs T: Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000, 342:78–82. This study reported the outcomes of aggressive endoscopic evaluation of diverticular bleeding, and treatment employing submucosal epinephrine injection or bipolar coagulation. The value of a specialized bleeding team in obtaining these outcomes is highlighted.
Wong WD, Wexner SD, Lowry A, et al.: Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000, 43:290–297. Guidelines for the management of sigmoid diverticulitis are presented in the context of supporting evidence from the literature.
Patient Care Committee of the Society for Surgery of the Alimentary Tract (SSAT): Surgical treatment of diverticulitis. J Gastrointest Surg 1999, 3:212–213.
Stollman NH, Raskin JB: Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999, 94:3110–3121. These are clear and thorough guidelines that also indicate areas of diagnosis and management that remain controversial.
Young-Fadok TM, Roberts PL, Spencer MP, Wolff BG: Colonic diverticular disease. Curr Probl Surg 2000, 37:457–514. A review of the pathophysiology, natural history, and therapy for diverticular disease with particular emphasis on details of appropriate surgical management.
Hackford AW, Schoetz DJ Jr, Coller JA, Veidenheimer MC: Surgical management of complicated diverticulitis: the Lahey Clinic experience, 1967–1982. Dis Colon Rectum 1985, 28:317–321.
Finlay IG, Carter DC: A comparison of emergency resection and staged management in perforated diverticular disease. Dis Colon Rectum 1987, 30:929–933.
Zeitoun G, Laurent A, Rouffet F, et al.: Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicated sigmoid diverticulitis. Peillon and the French Association for Surgical Research. Br J Surg 2000, 87:1366–1374. Although the three-stage procedure has already been abandoned in the United States, this study deserves notice for being one of the few in the surgical literature to employ a randomized, controlled trial to evaluate two alternative surgical approaches.
Lee EC, Murray JJ, Coller JA, et al.: Intraoperative colonic lavage in nonelective surgery for diverticular disease. Dis Colon Rectum 1997, 40:669–674. A retrospective evaluation of an extensive experience with intraoperative colonic lavage as a means of permitting a single-stage procedure and avoiding a stoma.
Schilling MK, Maurer CA, Kollmar O, Buchler MW: Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 2001, 44:699–703.
Gooszen AW, Gooszen HG, Veerman W, et al.: Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection. Eur J Surg 2001, 167:35–39.
Schneider C, Scheidbach H, Scheuerlein H, Kockerling F: Prospective multicenter study of laparoscopic colorectal surgery: quality assurance during introduction of new methods. Zentralbl Chir 2000, 125(suppl 2):164–168.
Kockerling F, Schneider C, Reymond MA, et al.: Laparoscopic resection of sigmoid diverticulitis: results of a multicenter study. Surg Endosc 1999, 13:567–571. A prospective multicenter database is employed to evaluate the outcomes of one of the largest series of laparoscopic operations for diverticulitis.
Vargas HD, Ramirez RT, Hoffman GC, et al.: Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis. Dis Colon Rectum 2000, 43:1726–1731.
Faynsod M, Stamos MJ, Arnell T, et al.: A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg, 2000, 66:841–843.
Bergamaschi R, Tuetch JJ, Pessaux P, Arnaud JP: Intracorporeal vs laparoscopic-assisted resection for uncomplicated diverticulitis of the sigmoid. Surg Endosc 2000,14:520–523.
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Cima, R.R., Young-Fadok, T.M. New developments in diverticular disease. Curr Gastroenterol Rep 3, 420–424 (2001). https://doi.org/10.1007/s11894-001-0085-5
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DOI: https://doi.org/10.1007/s11894-001-0085-5