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Emergency medicine updates: Acute diverticulitis

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Accuracy of TICS ultrasound protocol in detecting simple and complicated diverticulitis: A prospective cohort study

Hamid Shokoohi et al.

Summary: This study aimed to evaluate the accuracy of an ultrasound protocol (TICS) in diagnosing diverticulitis in the emergency department (ED) setting and assess its ability to distinguish between simple and complicated diverticulitis. The results showed that ultrasound demonstrated high accuracy in ruling out or diagnosing diverticulitis in ED patients with suspected diverticulitis, but its reliability in differentiating complicated from simple diverticulitis is unsatisfactory.

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Antibiotics vs observational therapy in acute uncomplicated diverticulitis, a systemic review and meta-analysis

Chen Wei Poh et al.

Summary: This meta-analysis compares observational therapy and antibiotics regime in patients with acute uncomplicated diverticulitis. The study findings indicate that there is no statistically significant difference in outcomes such as mortality, complications, emergency surgery rates, length of stay, and recurrence between the two treatment methods.

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Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis A Systematic Review

Ethan M. Balk et al.

Summary: This study evaluated the value of CT imaging, outpatient treatment, antibiotic treatment, and interventional radiology for managing diverticulitis. The findings suggest that CT imaging is highly accurate for diagnosing acute diverticulitis, and there are no significant differences in outcomes between outpatient and inpatient care for uncomplicated diverticulitis. Additionally, avoiding antibiotics may be safe for most patients with uncomplicated acute diverticulitis, but more evidence is needed for other evaluated questions.

ANNALS OF INTERNAL MEDICINE (2022)

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Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians

Amir Qaseem et al.

Summary: This article provides clinical recommendations on the diagnosis and management of acute left-sided colonic diverticulitis, based on best available evidence and patient values and preferences. The recommendations include the use of abdominal CT imaging, outpatient management, and initial management without antibiotics.

ANNALS OF INTERNAL MEDICINE (2022)

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The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly

Paola Fugazzola et al.

Summary: Acute left colonic diverticulitis in the elderly has distinct epidemiological features and presents with more nuanced clinical characteristics compared to younger patients. The elderly population has higher in-hospital and postoperative mortality, and geriatric comorbidities increase the risk of complicated diverticulitis. However, elderly patients have a lower risk of recurrence and urgent surgical intervention. This study investigates age-related factors that may support a unique approach to the diagnosis and treatment of this condition in older patients.

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Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial

Rebekah Jaung et al.

Summary: A study comparing placebo vs antibiotic treatment for acute diverticulitis found no difference in hospital stay length, adverse events, or readmission rates, providing strong evidence for omitting antibiotics for selected patients with uncomplicated acute diverticulitis.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2021)

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Complicated Diverticular Disease

Kathleen M. Coakley et al.

Summary: The modern management of colonic diverticular disease involves categorizing patients into uncomplicated or complicated diverticulitis and determining the appropriate treatment paradigm. Recent controversies highlight the overlap in management strategies between these two categories. While surgical intervention is still supported for complicated diverticular disease in most cases, emerging data suggests that surgical resection may not be necessary for all scenarios of complicated diverticulitis. Given the significant risks associated with surgery for diverticulitis, careful patient and procedure selection is essential to avoid early and late postoperative complications.

CLINICS IN COLON AND RECTAL SURGERY (2021)

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AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review

Anne F. Peery et al.

Summary: Management of colonic diverticulitis should involve personalized diagnosis and treatment based on the patient's condition, including the use of imaging and lower endoscopy to exclude alternative diagnoses, selective antibiotic use, and lifestyle modifications to reduce the risk of recurrence. Patients should understand the importance of diet and healthy behaviors in preventing future episodes of diverticulitis.

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Prospectively Assigned AAST Grade versus Modified Hinchey Class and Acute Diverticulitis Outcomes

Jeff Choi et al.

Summary: This study integrated AAST grade assignment into electronic medical records to explore its potential as a clinical decision-making tool. Results demonstrated strong correlations between AAST grade and operative decision, hospital stay, and complication severity. The study suggests prospectively assigned AAST grade as an accurate method for outcome associations, though further validation is needed.

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Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study) A Multicentre, Randomised, Open-label, Noninferiority Trial

Laura Mora-Lopez et al.

Summary: The study demonstrates that outpatient treatment of mild AD without antibiotics is safe and effective, and is not inferior to the current standard treatment.

ANNALS OF SURGERY (2021)

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Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use

Franziska Jerjen et al.

Summary: Diverticular disease is a common condition in Australia, with a high prevalence in older age groups. Medical imaging, particularly CT, is essential for diagnosing and managing complications like acute colonic diverticulitis (ACD). Although MRI shows promise as an alternative imaging tool, there is a lack of research in this area.

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Diagnosis of appendiceal diverticulitis by multidetector computed tomography

Koji Fukata et al.

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Colonic diverticular disease

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Current Controversies in the Management of Diverticulitis: A Review

Deirdre M. Nally et al.

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Multicentre study of non-surgical management of diverticulitis with abscess formation

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EAES/SAGES consensus conference on acute diverticulitis: a paradigm shift in the management of acute diverticulitis

Steven D. Wexner et al.

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Determinants of treatment and outcomes of diverticular abscesses

Juha Mali et al.

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Unenhanced CT for clinical triage of elderly patients presenting to the emergency department with acute abdominal pain

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Population-based study of outcomes following an initial acute diverticular abscess

C. T. Aquina et al.

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Epidemiology, Pathophysiology, and Treatment of Diverticulitis

Lisa L. Strate et al.

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What's New in Diagnosing Diverticular Disease

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Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis

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Diverticular Disease: An Update on Pathogenesis and Management

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Development and validation of a diagnostic prediction model distinguishing complicated from uncomplicated diverticulitis

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Index C-reactive protein predicts increased severity in acute sigmoid diverticulitis

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American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis

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Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess

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External validation of two tools for the clinical diagnosis of acute diverticulitis without imaging

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Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

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Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

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Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis:: A case-control study

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