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Medicina
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New Trends in Acute Colonic Diverticulitis
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New Trends in Acute Colonic Diverticulitis

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 9453

Special Issue Editors

Dr. Roberto Cirocchi

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Guest Editor
Department of Medicine and Surgery, University of Perugia, 05100 Perugia, Italy
Interests: surgical anatomy; emergency surgery; trauma; diverticular diseases
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Riccardo Nascimbeni

E-Mail Website
Guest Editor
Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy
Interests: diverticular diseases; colorectal surgery; emergency surgery
Dr. Gian Andrea Binda

E-Mail Website
Guest Editor
General Surgery, Biomedical Institute, Genoa, Italy
Interests: diverticular diseases; colorectal surgery; emergency surgery; oncologic surgery

Special Issue Information

Dear Colleagues,

The rate of acute diverticulitis is continuously increasing in Western industrialized countries, so the estimated annual number of hospitalizations for acute episodes of diverticulitis will be significantly higher in the next decades. These data will be consequentially associated with an increase of financial resources needed to treat patients affected from acute episodes of AD.

As recent epidemiological studies have identified, an increased rate of hospitalization has been reported for patients less than 70 years old, especially those under 60. Differently, the hospitalization for elderly was higher but remained unchanged.

During this same period, an increase of hospitalization for complicated AD with a higher surgery rate for peritonitis and abscess was reported.

Focus on DD is increasing exponentially, as reflected also in the number of recent publications, guidelines, and position papers devoted to it.

This Special Issue on “New Trends on Acute Colonic Diverticulitis” is devoted to the development of an updated investigation and rationale on epidemiology, pathology, biomarkers, diagnostics, medical therapeutics, and surgical treatment.

Prof. Dr. Roberto Cirocchi
Prof. Dr. Riccardo Nascimbeni
Dr. Gian Andrea Binda
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute diverticulitis
  • diffuse peritonitis
  • diverticular disease
  • septic shock
  • Hartmann’s procedure
  • colon resection
  • complicated diverticulitis
  • emergency surgery
  • non-operative treatment
  • percutaneous drainage

Published Papers (4 papers)

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Research

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8 pages, 263 KiB  
Article
Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
by Gennaro Perrone, Mario Giuffrida, Elena Bonati, Gabriele Luciano Petracca, Antonio Tarasconi, Gianluca Baiocchi and Fausto Catena
Medicina 2022, 58(1), 29; https://doi.org/10.3390/medicina58010029 - 24 Dec 2021
Cited by 3 | Viewed by 2386
Abstract
Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials [...] Read more.
Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65–74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 ± 6.8 years (range 65–92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88%). Average white cells count was 10.04 ± 5.05 × 109/L in the early elderly group and 11.24 ± 7.89 in the late elderly group. CRP was elevated in 29 (78.3%) cases in early elderly and in 23 late elderly patients (67.6%). A CT scan of the abdomen was performed in every case (100%). Almost all patients were treated with bowel rest and antibiotics (95.7%). Average length of stay was 7.74 ± 7.1 days (range 1–48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 ± 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6%). New episodes of acute diverticulitis were reported in 20 patients (28.1%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities. Full article
(This article belongs to the Special Issue New Trends in Acute Colonic Diverticulitis)
8 pages, 489 KiB  
Article
Post-Diverticulitis Colonoscopy Was Not Associated with Higher Colonic Adenoma and Carcinoma: A Multicenter Case–Control Study
by Amir Mari, Tawfik Khoury and Wisam Sbeit
Medicina 2021, 57(7), 682; https://doi.org/10.3390/medicina57070682 - 02 Jul 2021
Cited by 3 | Viewed by 1969
Abstract
Background and Objectives: Colonoscopy following an episode of acute diverticulitis is currently recommended to rule out underlying colon cancer. However, a number of studies have debated this recommendation. We aimed to explore whether patients with colonic diverticulosis who experienced an episode of [...] Read more.
Background and Objectives: Colonoscopy following an episode of acute diverticulitis is currently recommended to rule out underlying colon cancer. However, a number of studies have debated this recommendation. We aimed to explore whether patients with colonic diverticulosis who experienced an episode of acute diverticulitis had higher prevalence colonic pathologies, essentially colonic adenomas and colorectal carcinoma (CRC) on a follow-up colonoscopy. Materials and Methods: We performed a multicenter retrospective study that included patients with a diagnosis diverticulosis as the control group and allocated patients after diverticulitis according to computed tomography (CT) scan and clinical presentation that had performed colonoscopy within 6 months from the acute diverticulitis episode. We compared the detection rate of colonic pathologic findings in both groups. Results: Overall, 367 patients were included. Of them, 134 patients experienced an episode of diverticulitis vs. 233 patients who did not have diverticulitis. On univariate analysis, there was no difference between all pathological findings (CRC, colonic adenomas; OR (odds ratio) 1.51, p = 0.085), and even for each pathological findings alone, there was no difference (for colonic adenomas, p = 0.07; for CRC, p = 0.87). Further sub-analysis revealed that only male gender (OR 4.03, p = 0.004) and smoking (OR 8.67, p < 0.0001) correlated with colonic adenomas and CRC, while moderate to severe disease was not correlated with colonic pathological findings (OR 0.86, 95% CI (confidence interval) 0.4–1.82, p = 0.68). Conclusions: Post-diverticulitis screening colonoscopy has not found a higher rate of colonic pathological findings, especially colonic neoplasia. Decision to perform colonoscopy after acute diverticulitis should be individualized based on risk stratification of colonic neoplasia. Full article
(This article belongs to the Special Issue New Trends in Acute Colonic Diverticulitis)
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7 pages, 279 KiB  
Article
Impact of Physical Activity on Disability Risk in Elderly Patients Hospitalized for Mild Acute Diverticulitis and Diverticular Bleeding Undergone Conservative Management
by Aldo Rocca, Maria Chiara Brunese, Micaela Cappuccio, Andrea Scacchi, Gennaro Martucci, Antonio Buondonno, Fabio Massimo Perrotta, Gennaro Quarto, Pasquale Avella and Bruno Amato
Medicina 2021, 57(4), 360; https://doi.org/10.3390/medicina57040360 - 08 Apr 2021
Cited by 15 | Viewed by 1906
Abstract
Background and Objectives: The role of physical activity (PA) in elderly patients admitted to surgical units for mild acute diverticulitis in the development of disability has not been clarified so far. Our aim is to demonstrate the relationship between physical activity and better [...] Read more.
Background and Objectives: The role of physical activity (PA) in elderly patients admitted to surgical units for mild acute diverticulitis in the development of disability has not been clarified so far. Our aim is to demonstrate the relationship between physical activity and better post-discharge outcomes on disability in elderly population affected by diverticular disease. Materials and Methods: We retrospectively reviewed data of 56 patients (32 Males-24 females) collected from October 2018 and March 2020 at Cardarelli Hospital in Campobasso. We included patients older than 65 yrs admitted for acute bleeding and acute diverticulitis stage ≤II, characterized by a good independence status, without cognitive impairment and low risk of immobilization, as evaluated by activity of daily living (ADL) and the instrumental activity of daily living (IADL) and Exton-Smith Scale. “Physical Activity Scale for the Elderly” (PASE) Score evaluated PA prior to admission and at first check up visit. Results: 30.4% of patients presented a good PA, 46.4% showed moderate PA and 23.2% a low PA score. A progressive reduction in ADL and IADL score was associated with lower physical activity (p value = 0.0038 and 0.0017). We consider cognitive performance reduction with a cut off of loss of more than 5 points in Short Port of ADL and IADL and a loss of more than 15 points on Exton-Smith Scale, (p-value 0.017 and 0.010). In the logistic regression analysis, which evaluated the independent role of PASE in disability development, statistical significance was not reached, showing an Odds Ratio of 0.51 95% CI 0.25–1.03 p value 0.062. Discussion: Reduced physical activity in everyday life in elderly is associated with increased post-hospitalization disability regarding independence, cognitive performance and immobilization. Conclusions: Poor physical performance diagnosis may allow to perform a standardized multidimensional protocol to improve PA to reduce disability incidence. Full article
(This article belongs to the Special Issue New Trends in Acute Colonic Diverticulitis)

Review

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12 pages, 553 KiB  
Review
The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review
by Roberto Cirocchi, Riccardo Nascimbeni, Gloria Burini, Carlo Boselli, Francesco Barberini, Justin Davies, Salomone Di Saverio, Diletta Cassini, Bruno Amato, Gian Andrea Binda and Gabrio Bassotti
Medicina 2021, 57(10), 1127; https://doi.org/10.3390/medicina57101127 - 18 Oct 2021
Cited by 8 | Viewed by 2316
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign [...] Read more.
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation. Full article
(This article belongs to the Special Issue New Trends in Acute Colonic Diverticulitis)
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