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2015 ; 7
(11
): 313-8
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Natural history of uncomplicated sigmoid diverticulitis
#MMPMID26649154
Buchs NC
; Mortensen NJ
; Ris F
; Morel P
; Gervaz P
World J Gastrointest Surg
2015[Nov]; 7
(11
): 313-8
PMID26649154
show ga
While diverticular disease is extremely common, the natural history (NH) of its
most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated.
Relevant information is mostly restricted to population-based or retrospective
studies. This comprehensive review aimed to evaluate the NH of simple sigmoid
diverticulitis. While there is a clear lack of uniformity in terminology, which
results in difficulties interpreting and comparing findings between studies, this
review demonstrates the benign nature of simple sigmoid diverticulitis. The
overall recurrence rate is relatively low, ranging from 13% to 47%, depending on
the definition used by the authors. Among different risk factors for recurrence,
patients with C-reactive protein > 240 mg/L are three times more likely to recur.
Other risk factors include: Young age, a history of several episodes of acute
diverticulitis, medical vs surgical management, male patients, radiological signs
of complicated first episode, higher comorbidity index, family history of
diverticulitis, and length of involved colon > 5 cm. The risk of developing a
complicated second episode (and its corollary to require an emergency operation)
is less than 2%-5%. In fact, the old rationale for elective surgery as a
preventive treatment, based mainly on concerns that recurrence would result in a
progressively increased risk of sepsis or the need for a colostomy, is not upheld
by the current evidence.
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