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2014 ; 76
(6
): 429-35
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Management of acute diverticulitis and its complications
#MMPMID25614717
Welbourn HL
; Hartley JE
Indian J Surg
2014[Dec]; 76
(6
): 429-35
PMID25614717
show ga
Colonic diverticular disease is a common condition, and around a quarter of
people affected by it will experience acute symptoms at some time. The most
common presentation is uncomplicated acute diverticulitis that can be managed
conservatively with bowel rest and antibiotics. However, some patients will
present with diverticular abscesses or purulent or faeculent peritonitis due to
perforated diverticular disease. Whilst most mesocolic abscesses can be managed
with percutaneous drainage alone, pelvic abscesses are associated with a higher
rate of future complications and usually require percutaneous drainage followed
by interval sigmoid resection. Patients who require emergency surgery for
complicated acute diverticulitis most commonly undergo a Hartmann's procedure,
although resection with primary anastomosis and laparoscopic peritoneal lavage
have emerged as alternative treatment options for patients with purulent
peritonitis in recent years. However, robust evidence from randomized trials is
lacking for these alternative procedures, and the studies that have reported good
outcomes from them have included carefully selected patient groups. There has
been a move away from recommending elective prophylactic colectomy after two
episodes of acute diverticulitis in the light of evidence that most patients will
not experience a significant recurrence of their symptoms; elective surgery is
indicated for those with ongoing symptoms, pelvic abscesses, complications-such
as fistulating disease, strictures or recurrent diverticular bleeding-and those
who are at high risk of perforation during future episodes, for example, due to
immunosuppression, chronic renal failure or collagen-vascular diseases.