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Diverticular disease of colon — Clinical Guidelines

Overview

Diverticular disease of the colon encompasses diverticulosis (presence of diverticula) and diverticulitis (inflammation of diverticula), often leading to complications such as abscess formation, fistula, bleeding, and toxic megacolon. 1 3 5

Diagnosis

Clinical Presentation: Abdominal pain, fever, changes in bowel habits.

Imaging: CT scans are crucial for diagnosing complications like abscesses, fistulas, and toxic megacolon 5.

Laboratory Tests: Elevated white blood cell count may indicate infection or inflammation 1.

Management

Surgical Intervention: Urgent or emergent colectomy may be required for complications like perforation, severe bleeding, or toxic megacolon 1.

Laparoscopic vs Open Surgery: Laparoscopic colectomy is associated with improved failure to rescue and reduced morbidity compared to open surgery 3.

Re-operation: Common indications include managing surgical complications; planned second look and supportive procedures are frequent 1.

Special Populations

Elderly: Higher risk of complications and may benefit from laparoscopic approaches to reduce morbidity 3.

Comorbidities: Patients with sepsis or requiring intraoperative vasopressors have increased morbidity and mortality, highlighting the need for careful perioperative management 1.

Key Recommendations

Consider Laparoscopic Approach for Emergent Colectomy to improve outcomes such as failure to rescue and reduce overall morbidity (Evidence: Moderate) 3.

Utilize CT Imaging for accurate diagnosis of complications like toxic megacolon and abscesses (Evidence: Expert opinion) 5.

Monitor for Re-operation Indications closely, recognizing that planned second look procedures are common and reflect necessary supportive care rather than solely negative outcomes (Evidence: Moderate) 1.

References

1 Gao R, Flewelling K, Stevens N, Wyland C, McGoff T, Brubaker A et al.. Re-operation following urgent and emergent colectomies: An investigation of indications and utility as a quality indicator. American journal of surgery 2025. link 2 Ziegler MA, Bauman JC, Welsh RJ, Wasvary HJ. Can the American College of Surgeons National Surgical Quality Improvement Program Risk Calculator Predict Outcomes for Urgent Colectomies?. The American surgeon 2022. link 3 Patel R, Patel KS, Alvarez-Downing MM, Merchant AM. Laparoscopy improves failure to rescue compared to open surgery for emergent colectomy. Updates in surgery 2020. link 4 Cuffe JE, Bertog M, Velázquez-Rocha S, Dery O, Bunnett N, Korbmacher C. Basolateral PAR-2 receptors mediate KCl secretion and inhibition of Na+ absorption in the mouse distal colon. The Journal of physiology 2002. link 5 Brawner SD, Tishler JM, Rubin E, Luna RF. Computerized tomographic demonstration of toxic megacolon: report of a case. Computerized radiology : official journal of the Computerized Tomography Society 1983. link90113-0) 6 Colony PC, Helmstaedter V, Moody AJ, Garaud JC, Forssmann WG. Glucagon and glicentin immunoreactive cells in human colon. Cell and tissue research 1982. link

Diverticular disease of colon