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Contemporary review of risk-stratified management in acute uncomplicated and complicated diverticulitis

Boermeester, Marja A.; Humes, David; Velmahos, George C.; Søreide, Kjetil

Authors

Marja A. Boermeester

DAVID HUMES david.humes@nottingham.ac.uk
Clinical Associate Professor

George C. Velmahos

Kjetil Søreide



Abstract

BACKGROUND: Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis.

METHODS: We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/) were searched for ongoing, recruiting, or closed trials not yet published.

RESULTS: Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients.

CONCLUSIONS: A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

Journal Article Type Article
Journal World Journal of Surgery
Print ISSN 0364-2313
Electronic ISSN 1432-2323
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 40
Issue 10
APA6 Citation Boermeester, M. A., Humes, D., Velmahos, G. C., & Søreide, K. (in press). Contemporary review of risk-stratified management in acute uncomplicated and complicated diverticulitis. World Journal of Surgery, 40(10), https://doi.org/10.1007/s00268-016-3560-8
DOI https://doi.org/10.1007/s00268-016-3560-8
Publisher URL http://link.springer.com/article/10.1007%2Fs00268-016-3560-8
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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