Diverticulosis and Diverticulitis

  • Binda Gian AndreaEmail author
  • Cassini Diletta
  • Gianandrea Baldazzi
  • Nascimbeni Riccardo


Diverticular disease and related complications place a significant burden on health-care services. Their incidence increases with age even if the rate of hospitalization is rising mostly in young patients. The current clinical policy of elective and emergent treatment of diverticular disease is towards a more conservative approach either in the use of antibiotics, in the need of hospitalization, in the indication to surgery or the need of resection. Advanced age is not an independent determinant of clinical decision making; however, age-related aspects, such as chronic symptoms, diverticulitis-free intervals, severity of complications and comorbidities, are relevant in order to choose the most appropriate treatment option in the elderly patient with diverticular disease.


Diverticulosis Diverticular disease Complicated diverticular disease Abdominal abscess Peritonitis Colorectal resection Laparoscopic surgery Damage control surgery 


  1. 1.
    Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: result of a consensus development conference. The scientific Committee of the European Association for endoscopic surgery. Surg Endosc. 1999;13:430–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Liu CK, Hsu HH, Cheng SM. Colonic diverticulitis in the elderly. Int J Gerontol. 2009;3:9–15.CrossRefGoogle Scholar
  3. 3.
    Petruzziello L, Iacopini F, Bulajic M, et al. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther. 2006;23:1379–91.PubMedCrossRefGoogle Scholar
  4. 4.
    De Cecco CN, Ciolina M, Annibale B, Rengo M, Bellini D, Muscogiuri G, Maruotti A, Saba L, Iafrate F, Laghi A. Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC). Eur Radiol. 2016;26:639–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Wheat CL, Strate LL. Trends in hospitalization for diverticulitis and diverticular bleeding in the United States from 2000 to 2010. Clin Gastroenterol Hepatol. 2016;14:96–103.PubMedCrossRefGoogle Scholar
  6. 6.
    Bharucha AE, Parthasarathy G, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, Yawn BP, Melton LJ, Schleck C, Zinsmeister AR. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol. 2015;110:1589–96.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Cuomo R, Barbara G, Pace F, et al. Italian consensus conference for colonic diverticulosis and diverticular disease. United Eur Gastroenterol J. 2014;2:413–42.CrossRefGoogle Scholar
  8. 8.
    Etzioni DA, Mack TM, Beart RWJ, et al. Diverticulitis in the United States: 1998–2005: changing patterns of dis- ease and treatment. Ann Surg. 2009;249:210–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Nguyen GC, Steinhart AH. Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality. Inflamm Bowel Dis. 2008;14:1688–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Monk BA, George SJ. The effect of ageing on vascular smooth muscle cell behaviour—a mini-review. Gerontology. 2015;61:416–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Reichert MC, Lammert F. The genetic epidemiology of diverticulosis and diverticular disease: emerging evidence. United European Gastroenterol J. 2015;3:409–18.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Isbit J. Why diverticulosis haunts the western world. Tech Coloproctol. 2016;20:267–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Humes DJ, Ludvigsson JF, Jarvholm B. Smoking and the risk of hospitalization for symptomatic diverticular disease: a population cohort study from Sweden. Dis Colon Rectum. 2016;59:110–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Aldoori WH, Giovannucci EL, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Wing AL, Trichopoulos DV, Willett WC. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut. 1995;36:276–82.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Williams PT. Incident diverticular disease is inversely related to vigorous physical activity. Med Sci Sports Exerc. 2009;41:1042–7.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136:115–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Rosemar A, Angerås U, Rosengren A. Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum. 2008;51:450–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Cirocchi R, Grassi V, Cavaliere D, Renzi C, Tabola R, Poli G, Avenia S, Farinella E, Arezzo A, Vettoretto N, D’Andrea V, Binda GA, Fingerhut A. New trends in acute management of colonic diverticular bleeding: a systematic review. Medicine (Baltimore). 2015;94:e1710. Scholar
  19. 19.
    Kvasnovsky CL, Papagrigoriadis S, Bjarnason I. Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Color Dis. 2014;16:189–96.CrossRefGoogle Scholar
  20. 20.
    Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther. 2003;18(Suppl 3):71.PubMedCrossRefGoogle Scholar
  21. 21.
    Jeyarajah S, Faiz O, Bottle A, Aylin P, Bjarnason I, Tekkis PP, Papagrigoriadis S. Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions. Aliment Pharmacol Ther. 2009;30:1171–82.PubMedCrossRefGoogle Scholar
  22. 22.
    McGillicuddy EA, Schuster KM, Davis KA, Longo WA. Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg. 2009;144:1157–62.PubMedCrossRefGoogle Scholar
  23. 23.
    Modini C, Romagnoli F, De Milito R, Romeo V, Petroni R, La Torre F, Catani M. Octogenarians: an increasing challenge for acute care and colorectal surgeons. An outcomes analysis of emergency colorectal surgery in the elderly. Colorect Dis. 2012;14:e312–8.CrossRefGoogle Scholar
  24. 24.
    Wong WD, Wexner SD, Lowry A, et al. Standards task force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. Dis Colon Rectum. 2000;43:290–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Anaya DA, et al. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surgery. 2005;140:681–5.CrossRefGoogle Scholar
  26. 26.
    Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum. 2009;52:1558–63.PubMedCrossRefGoogle Scholar
  27. 27.
    Morris CR, Harvey IM, Stebbings WS, et al. Epidemiology of perforated colonic diverticular disease. Postgrad Med J. 2002;78:654–8.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Chapman J, Davies M, Wolff B, et al. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005;242:576–81.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Rafferty J, Shellito P, Hyman NH, et al. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49:939–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Simianu VV, Fichera A, Bastawrous AL, Davidson GH, Florence MG, Thirlby RC, Flum DR. Number of diverticulitis episodes before resection and factors associated with earlier interventions. JAMA Surg. 2016;151:604–10.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Simianu VV, Strate LL, Billingham RP, et al. The impact of elective colon resection on rates of emergency surgery for diverticulitis. Ann Surg. 2016;263:123–9.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57:284–94.PubMedCrossRefGoogle Scholar
  33. 33.
    Fozard JBJ, Armitage NC, Schofield JB, Jones OM. ACPGBI position statement on elective resection for diverticulitis. Colorectal Dis. 2011;13(Suppl 3):1–11.CrossRefPubMedGoogle Scholar
  34. 34.
    Binda GA, Cuomo R, Laghi A, Nascimbeni R, Serventi A, Bellini D, Gervaz P, Annibale B. Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines. Tech Coloproctol. 2015;19:615–26.CrossRefPubMedGoogle Scholar
  35. 35.
    Makela JT, Kiviniemi H, Laitinen S. Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg. 2005;22:100–6.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Kwon S, Billingham R, Farrokhi E, et al. Surgical care and outcomes assessment program (SCOAP) collaborative. Adoption of laparoscopy for elective colorectal resection: a report from the surgical care and outcomes assessment program. J Am Coll Surg. 2012;214:909–18.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Kehlet H, Büchler MW, Beart RW Jr, Billingham RP, Williamson R. Care after colonic operation: is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg. 2006;202:45–54.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Colorectal Writing Group for the SCOAP-CERTAIN Collaborative. The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate. Am J Surg. 2015;209:913–8.CrossRefGoogle Scholar
  39. 39.
    Lidor AO, Segal JB, Wu AW, Yu Q, Feinberg R, Schneider EB. Older patients with diverticulitis have low recurrence rates and rarely need surgery. Surgery. 2011;150:146–53.CrossRefPubMedGoogle Scholar
  40. 40.
    Klarenbeek BR, Veenhof A, De Lange E, Bemelman WA, Bergamaschi R, Heres P, Lacy AM, Van den Broek WT, Van der Peet DL, Cuesta MA. The sigma-trial protocol: a prospective double-blind multi-centre comparison of laparoscopic versus open elective sigmoid resection in patients with symptomatic diverticulitis. BMC Surg. 2007;7:16.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Reissfelder C, Burh HJ, Ritz JP. What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection? Dis Colon Rectum. 2006;49:1842–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Zingg U, Pasternak I, Guertler L, Dietrich M, Wohlwend K-A, Metzger U. Early vs, delayed elective laparoscopic-assisted colectomy in sigmoid diverticulitis: timing of surgery in relation to the acute attack. Dis Colon Rectum. 2007;50:1911–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Benn PL, Wolff BG, Ilstrup DM. Level of anastomosis and recurrent colonic diverticulitis. Am J Surg. 1986;151:269–71.PubMedCrossRefGoogle Scholar
  44. 44.
    Lehmann RK, Brounts LR, Johnson EK, Rizzo JA, Steele SR. Does sacrifice of the inferior mesenteric artery or superior rectal artery affect anastomotic leak following sigmoidectomy for diverticulitis? A retrospective review. Am J Surg. 2011;201:623–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Cirocchi R, Trastulli S, Farinella E, Desiderio J, Listorti C, Parisi A, et al. Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials. Color Dis. 2012;14:e521–9.CrossRefGoogle Scholar
  46. 46.
    Masoni L, Mari FS, Nigri G, Favi F, Gasparrini M, Dall’Oglio A, et al. Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc. 2013;27:199–206.PubMedCrossRefGoogle Scholar
  47. 47.
    Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G, Tagliacozzo S. Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg. 2001;182:162–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Stevenson AR, Stitz RW, Lumley JW, Fielding GA. Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg. 1998;227:335–42.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, et al. Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the sigma trial. Ann Surg. 2009;249:39–44.PubMedCrossRefGoogle Scholar
  50. 50.
    Gervaz P, Inan I, Perneger T, Schiffer E, Morel P. A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg. 2010;252:3–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK. Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg. 2010;200:144–61.PubMedCrossRefGoogle Scholar
  52. 52.
    Jones OM, Stevenson AR, Clark D, Stitz RW, Lumley JW. Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg. 2008;248:1092–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA. Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review. Color Dis. 2012;14:671–83.CrossRefGoogle Scholar
  54. 54.
    Mbadiwe T, Obirieze AC, Cornwell EE 3rd, Turner P, Fullum TM. Surgical management of complicated diverticulitis: a comparison of the laparoscopic and open approaches. J Am Coll Surg. 2013;216:782–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Aalbers AG, Biere SS, van Berge Henegouwen MI, Bemelman WA. Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis. Surg Endosc. 2008;22:1769–80.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Lee SW, Yoo J, Dujovny N, Sonoda T, Milsom JW. Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum. 2006;49:464–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Anderson J, Luchtefeld M, Dujovny N, Hoedema R, Kim D, Butcher J. A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease. Am J Surg. 2007;193:400–3.PubMedCrossRefGoogle Scholar
  58. 58.
    Kang JC, Chung MH, Chao PC, et al. Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc. 2004;18:577–81.PubMedCrossRefGoogle Scholar
  59. 59.
    Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP. Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum. 2011;54:183–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Vestweber B, Alfes A, Paul C, Haaf F, Vestweber KH. Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc. 2010;24:3225–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Ragupathi M, Ramos-Valdez DI. Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and review of literature. Surg Endosc. 2011;25:199–206.PubMedCrossRefGoogle Scholar
  62. 62.
    Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum. 2004;47:1680–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Maciel V, Lujan HJ, Plasencia G, Zeichen M, Mata W, Jorge I, Lee D, Viamonte M 3rd, Hartmann RF. Diverticular disease complicated with colovesical fistula: laparoscopic versus robotic management. Int Surg. 2014;99:203–10.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol. 2011;17:1600–5.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Alonso S, Pera M, Parés D, Pascual M, Gil MJ, Courtier R, et al. Outpatient treatment of patients with uncomplicated acute diverticulitis. Color Dis. 2009;12:278–82.CrossRefGoogle Scholar
  66. 66.
    Comparato G, Pilotto A, Franzè A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis. 2007;25:151–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Rodríguez-Cerrillo M, Poza-Montoro A, Fernandez-Diaz A, Matesanz-David M, Iñurrieta Romero A. Treatment of elderly patients with uncomplicated diverticulitis, even with comorbidity, at home. Eur J Int Med. 2013;24:430–2.CrossRefGoogle Scholar
  68. 68.
    van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, Bossuyt PM, Stoker J, Boermeester MA, OPTIMA Study Group. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011;21:1535–45.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management – a prospective study of 542 patients. Eur Radiol. 2002;12:1145–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Ukkonen M, Karlsson S, Laukkarinen J, Rantanen T, Paajanen H, Finnsepsis Study Group. Severe sepsis in elderly patients undergoing gastrointestinal surgery-a prospective multicenter follow-up study of finish intensive care units. J Gastrointest Surg. 2016;20:1028–33.PubMedCrossRefGoogle Scholar
  71. 71.
    Lamb MN, Kaiser AM. Elective resection versus observation after nonoperative management of complicated diverticulitis with abscess: a systematic review and meta-analysis. Dis Colon Rectum. 2014;57:1430–40.PubMedCrossRefGoogle Scholar
  72. 72.
    Devaraj B, Liu W, Tatum J, Cologne K, Kaiser AM. Medically treated diverticular abscess associated with high risk of recurrence and disease complications. Dis Colon Rectum. 2016;59:208–15.PubMedCrossRefGoogle Scholar
  73. 73.
    Brandt D, Gervaz P, Durmishi Y, et al. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon Rectum. 2006;49:1533–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. Am J Roentgenol. 2006;186:680–4.CrossRefGoogle Scholar
  75. 75.
    Kumar R, Kim JT, Haukoos JS, et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum. 2006;49:183–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum. 2005;48:787–91.PubMedCrossRefGoogle Scholar
  77. 77.
    Elagili F, Stocchi L, Ozuner G, Mody R, Baker ME, Kiran RP. Predictors of postoperative outcomes for patients with diverticular abscess initially treated with percutaneous drainage. Am J Surg. 2015;209:703–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Felder SI, Barmparas G, Lynn J, Murrell Z, Margulies DR, Fleshner P. Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted? Am Surg. 2013;79:1013–6.PubMedGoogle Scholar
  79. 79.
    Subhas G, Rana G, Bhullar J, Essad K, Mohey L, Mittal VK. Percutaneous drainage of a diverticular abscess should be limited to two attempts for a resilient diverticular abscess. Am Surg. 2014;80:635–9.PubMedGoogle Scholar
  80. 80.
    Gaertner WB, Willis DJ, Madoff RD, Rothenberger DA, Kwaan MR, Belzer GE, Melton GB. Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum. 2013;56:622–6.PubMedCrossRefGoogle Scholar
  81. 81.
    Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C. Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum. 2002;45:962–6.PubMedCrossRefGoogle Scholar
  82. 82.
    Nagorney DM, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum. 1985;28:71–5.PubMedCrossRefGoogle Scholar
  83. 83.
    Salem L, Anaya DA, Roberts KE, Flum DR. Hartmann’s colectomy and reversal in diverticulitis: a population-level assessment. Dis Colon Rectum. 2005;48:988–95.PubMedCrossRefGoogle Scholar
  84. 84.
    Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357:2057–66.PubMedCrossRefGoogle Scholar
  85. 85.
    Vermeulen J, Akkersdijk GP, Gosselink MP, Hop WC, Mannaerts GH, van der Harst E, Coene PP, Weidema WF, Lange JF. Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. Dig Surg. 2007;24:361–6.PubMedCrossRefGoogle Scholar
  86. 86.
    Janes SE, Meagher A, Frizelle F. Management of diverticulitis. BMJ. 2006;332:271–5.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Constantinides VA, Heriot A, Remzi F, Darzi A, Senapati A, Fazio VW, Tekkis PP. Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann’s procedures. Ann Surg. 2007;245:94–103.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C, Grieder F, Gelpke H, Decurtins M, Tempia-Caliera AA, Demartines N, Hahnloser D, Clavien PA, Breitenstein S. A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or Fecal peritonitis. Ann Surg. 2012;256:819–27.PubMedCrossRefGoogle Scholar
  89. 89.
    Binda GA, Karas JR, Serventi A, Sokmen S, Amato A, Hydo L, Bergamaschi R, for the Study Group on Diverticulitis. Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial. Color Dis. 2012;14:1403–10.CrossRefGoogle Scholar
  90. 90.
    Masoomi H, Stamos MJ, Carmichael JC, Nguyen B, Buchberg B, Mills S. Does primary anastomosis with diversion have any advantages over Hartmann’s procedure in acute diverticulitis? Dig Surg. 2012;29:315–20.PubMedCrossRefGoogle Scholar
  91. 91.
    Gawlick U, Nirula R. Resection and primary anastomosis with proximal diversion instead of Hartmann’s: evolving the management of diverticulitis using NSQIP data. J Trauma Acute Care Surg. 2012;72:807–14.PubMedCrossRefGoogle Scholar
  92. 92.
    Jiménez Fuertes M, Costa Navarro D. Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure? World J Surg. 2012;36:1148–53.PubMedCrossRefGoogle Scholar
  93. 93.
    Trenti L, Biondo S, Golda T, Monica M, Kreisler E, Fraccalvieri D, Frago R, Jaurrieta E. Generalized peritonitis due to perforated diverticulitis: Hartmann’s procedure or primary anastomosis? Int J Color Dis. 2011;26:377–84.CrossRefGoogle Scholar
  94. 94.
    Zingg U, Pasternak I, Dietrich M, Seifert B, Oertli D, Metzger U. Primary anastomosis vs Hartmann’s procedure in patients undergoing emergency left colectomy for perforated diverticulitis. Color Dis. 2010;12:54–60.CrossRefGoogle Scholar
  95. 95.
    Vermeulen J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH, Weidema WF, Lange JF. Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann’s procedure be considered a one-stage procedure? Color Dis. 2009;11:619–24.CrossRefGoogle Scholar
  96. 96.
    Richter S, Lindemann W, Kollmar O, Pistorius GA, Maurer CA, Schilling MK. One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV). World J Surg. 2006;30:1027–32.PubMedCrossRefGoogle Scholar
  97. 97.
    Regenet N, Pessaux P, Hennekinne S, Lermite E, Tuech JJ, Brehant O, Arnaud JP. Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J. Color Dis. 2003;18:503–7.CrossRefGoogle Scholar
  98. 98.
    Schilling MK, Maurer CA, Kollmar O, Büchler 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.PubMedCrossRefGoogle Scholar
  99. 99.
    Gooszen AW, Gooszen HG, Veerman W, Van Dongen VM, Hermans J, Klien Kranenbarg E, Tollenaar RA. Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection. Eur J Surg. 2001;167:35–9.PubMedCrossRefGoogle Scholar
  100. 100.
    Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH, Fazio VW, Aydin N, Darzi A, Senapati A. Primary resection with anastomosis vs. Hartmann’s procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum. 2006;49:966–81.PubMedCrossRefGoogle Scholar
  101. 101.
    Abbas S. Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Color Dis. 2007;22:351–7.CrossRefGoogle Scholar
  102. 102.
    Salem L, Flum DR. Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum. 2004;47:1953–64.PubMedCrossRefGoogle Scholar
  103. 103.
    Constantinides VA, Aydin HN, Tekkis PP, Fazio VW, Heriot AG, Remzi FH. Long-term, health-related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease. Color Dis. 2006;8:663–71.CrossRefGoogle Scholar
  104. 104.
    de Korte N, Klarenbeek BR, Kuyvenhoven JP, Roumen RM, Cuesta MA, Stockmann HB. Management of diverticulitis: results of a survey among gastroenterologists and surgeons. Color Dis. 2011;13:e411–7.CrossRefGoogle Scholar
  105. 105.
    Aydin HN, Tekkis PP, Remzi FH, Constantinides V, Fazio VW. Evaluation of the risk of a nonrestorative resection for the treatment of diverticular disease: the Cleveland Clinic diverticular disease propensity score. Dis Colon Rectum. 2006;49:629–39.PubMedCrossRefGoogle Scholar
  106. 106.
    Jafferji MS, Hyman N. Surgeon, not disease severity, often determines the operation for acute complicated diverticulitis. J Am Coll Surg. 2014;218:1156–61.PubMedCrossRefGoogle Scholar
  107. 107.
    O’Sullivan GC, Murphy D, O’Brien MG, Ireland A. Laparoscopic management of generalized peritonitis due to per- forated colonic diverticula. Am J Surg. 1996;171:432–4.PubMedCrossRefGoogle Scholar
  108. 108.
    Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg. 2008;95:97–101.PubMedCrossRefGoogle Scholar
  109. 109.
    Toorenvliet BR, Swank H, Schoones JW, Hamming JF, Bemelman WA. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Color Dis. 2010;12:862–7.CrossRefGoogle Scholar
  110. 110.
    Vennix S, Musters GD, Mulder IM, et al. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015;386:1269–77.PubMedCrossRefGoogle Scholar
  111. 111.
    Angenete E, Thornell A, Burcharth J, et al. Laparoscopic lavage is feasible and safe for the treatment of perforated diverticulitis with purulent peritonitis: the first results from the randomized controlled trial DILALA. Ann Surg. 2016;263:117–22.PubMedCrossRefGoogle Scholar
  112. 112.
    Schultz JK, Yaqub S, Wallon C, et al. Laparoscopic lavage vs primary resection for acute perforated diverticulitis: the SCANDIV randomized clinical trial. JAMA. 2015;314:1364–75.PubMedCrossRefGoogle Scholar
  113. 113.
    Slim K. Role of peritoneal lavage for sigmoid perforation peritonitis surgery: what do the meta-analyses tell us? J Visc Surg. 2016;154:139. Scholar
  114. 114.
    Ceresoli M, Coccolini F, Montori G, Catena F, Sartelli M, Ansaloni L. Laparoscopic lavage in perforated purulent diverticulitis-is it time for definitive conclusions? Int J Color Dis. 2016;32(1):159. Scholar
  115. 115.
    Angenete E, Bock D, Rosenberg J, Haglind E. Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis. Int J Color Dis. 2016;32(2):163–9. Scholar
  116. 116.
    Marshall JR, Buchwald PL, Gandhi J, et al. Laparoscopic lavage in the management of Hinchey grade III diverticulitis: a systematic review. Ann Surg. 2016;265(4):670–6. Scholar
  117. 117.
    Cirocchi R, Di Saverio S, Weber DG, et al. Laparoscopic lavage versus surgical resection for acute diverticulitis with generalized peritonitis: a systematic review and meta-analysis. Tech Coloproctol. 2017;21(2):93–110. Scholar
  118. 118.
    Tridente A, Clarke GM, Walden A, McKechnie S, Hutton P, Mills GH, Gordon AC, Holloway PA, Chiche JD, Bion J, Stuber F, Garrard C, Hinds CJ, GenOSept Investigators. Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Intensive Care Med. 2014;40:202–10.PubMedCrossRefGoogle Scholar
  119. 119.
    Rosenthal G, Kaboli P, Barnett M. Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc. 2002;50:1205–12.PubMedCrossRefGoogle Scholar
  120. 120.
    Van Den Noortgate N, Vogelaers D, Afschrift M, Colardyn F. Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing. 1999;28:253–6.CrossRefGoogle Scholar
  121. 121.
    Perathoner A, Klaus A, Muhlmann G, et al. Damage control with abdominal vacuum therapy (VAC) to manage perforated diverticulitis with advanced generalized peritonitis—a proof of concept. Int J Color Dis. 2010;25:767–74.CrossRefGoogle Scholar
  122. 122.
    Kafka-Ritsch R, Birkfellner F, Perathoner A, et al. Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV. J Gastrointest Surg. 2012;16:1915–22.PubMedCrossRefGoogle Scholar
  123. 123.
    Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology bleeding registry: preliminary findings. Am J Gastroenterol. 1997;92:924–8.PubMedPubMedCentralGoogle Scholar
  124. 124.
    Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92:419–24.PubMedPubMedCentralGoogle Scholar
  125. 125.
    McGuire HH Jr, Haynes BW Jr. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg. 1972;175:847–55.PubMedPubMedCentralCrossRefGoogle Scholar
  126. 126.
    Zuckerman GR, Prakash C. Acute lower intestinal bleeding. II. Etiology, therapy, and outcomes. Gastrointest Endosc. 1999;49:228–38.PubMedCrossRefGoogle Scholar
  127. 127.
    McGuire HH Jr. Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg. 1994;220:653–6.PubMedPubMedCentralCrossRefGoogle Scholar
  128. 128.
    Aytac E, Stocchi L, Gorgun E, Ozuner G. Risk of recurrence and long-term outcomes after colonic diverticular bleeding. Int J Color Dis. 2014;2:373–8.CrossRefGoogle Scholar
  129. 129.
    Lee KK, Shah SM, Moser MA. Risk factors predictive of severe diverticular hemorrhage. Int J Surg. 2011;9:83–5.PubMedCrossRefGoogle Scholar
  130. 130.
    Nagata N, Niikura R, Aoki T, Moriyasu S, Sakurai T, Shimbo T, Sekine K, Okubo H, Watanabe K, Yokoi C, Akiyama J, Yanase M, Mizokami M, Fujimoto K, Uemura N. Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage. World J Gastroenterol. 2015;21:10697–703.PubMedPubMedCentralCrossRefGoogle Scholar
  131. 131.
    Nakatsu S, Yasuda H, Maehata T, Nomoto M, Ohinata N, Hosoya K, Ishigooka S, Ozawa S, Ikeda Y, Sato Y, Suzuki M, Kiyokawa H, Yamamoto H, Itoh F. Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Intern Med. 2015;54:553–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Binda Gian Andrea
    • 1
    Email author
  • Cassini Diletta
    • 2
  • Gianandrea Baldazzi
    • 2
  • Nascimbeni Riccardo
    • 3
  1. 1.Department of SurgeryGalliera HospitalGenoaItaly
  2. 2.Department of General Minimally-invasive and Robotic SurgeryPoliclinic of Abano TermePaduaItaly
  3. 3.Department of Molecular & Translational MedicineUniversity of BresciaBresciaItaly

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