A complicated acute sigmoid diverticulitis
Maggiori, Léon
A complicated acute sigmoid diverticulitis - 2022.
37
Colonic diverticulosis, anatomically defined by the presence of one or more diverticula and comprising a mucosal and sub-mucosal hernia through the colonic muscular layer, is extremely frequent in industrialized countries. Its prevalence increases with age, but its occurrence remains asymptomatic. However, in 30% of cases, the occurrence of infectious or hemorrhagic complications will be responsible for causing diverticular disease, which is one of the most frequent gastrointestinal emergencies and can lead to life-threatening situations. Infectious complications are the most frequent, and computed tomography is the cornerstone of their diagnosis, allowing clinicians to distinguish between non-complicated diverticulitis, whose treatment will be symptomatic and ambulatory, and complicated diverticulitis with perforation, abscess, or fistula, which will require hospitalization. In the acute phase, indications of emergency surgery are scarce and mainly limited to patients with peritonitis. Finally, in 2017 the Haute Autorité de Santé (French National Health Authority) published practice guidelines to clearly define the indications of prophylactic surgery following an acute flare-up. Although these indications are less frequent than they have been in previous decades, prophylactic surgery is nevertheless still frequently required and significantly reduces recurrence risk as well as improving the quality of life of these patients.
A complicated acute sigmoid diverticulitis - 2022.
37
Colonic diverticulosis, anatomically defined by the presence of one or more diverticula and comprising a mucosal and sub-mucosal hernia through the colonic muscular layer, is extremely frequent in industrialized countries. Its prevalence increases with age, but its occurrence remains asymptomatic. However, in 30% of cases, the occurrence of infectious or hemorrhagic complications will be responsible for causing diverticular disease, which is one of the most frequent gastrointestinal emergencies and can lead to life-threatening situations. Infectious complications are the most frequent, and computed tomography is the cornerstone of their diagnosis, allowing clinicians to distinguish between non-complicated diverticulitis, whose treatment will be symptomatic and ambulatory, and complicated diverticulitis with perforation, abscess, or fistula, which will require hospitalization. In the acute phase, indications of emergency surgery are scarce and mainly limited to patients with peritonitis. Finally, in 2017 the Haute Autorité de Santé (French National Health Authority) published practice guidelines to clearly define the indications of prophylactic surgery following an acute flare-up. Although these indications are less frequent than they have been in previous decades, prophylactic surgery is nevertheless still frequently required and significantly reduces recurrence risk as well as improving the quality of life of these patients.
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