Pseudodiverticular Colon Disease: A Therapeutic Challenge
DOI:
https://doi.org/10.14738/bjhmr.105.15653Keywords:
Pseudodiverticular disease, Hartmann, Diverticula, Complicated pseudodiverticular, Colon and Rectal SurgeryAbstract
Introduction: Pseudodiverticular disease of the colon is an entity of great relevance among surgical pathologies, since it presents with a high incidence of morbidity, with diagnostic and therapeutic complexity. Their etiopathogenesis is unknown to date; it is believed that they are formed acquired by an increase in pressure within the large intestine. Aim: Present the experience of 10 years in diagnosis and treatment, in a study of four hospital centers in Mexico City. Method: It is a study with a retrospective, longitudinal, observational and descriptive design. In the Colon and Rectal Surgery services, as well as second and third level General Surgery. Results: They were classified into three groups according to incidence/presentation, with a total of 219 records, where there were a total of 123 patients with acute complicated pseudodiverticular disease, 25 cases with chronic presentation were studied, and recurrent lower gastrointestinal bleeding where 71 subjects were reported. Discussion: Treatment in acute and/or chronic complicated pseudodiverticular disease, management is surgical with no option to make a mistake, since morbidity and mortality increase exponentially with the delay of definitively decisive surgical therapy. Additionally, elective surgery reduces, but does not eliminate, the risk of recurrent diverticulitis. Conclusions: Pseudodiverticular disease is a sequela of a commonly undiagnosed underlying disease. The surgical procedure today is the Hartmann technique or two-stage surgery, which statistically presents the least morbidity and almost no mortality.
References
Aguilar-Alvarado M.Y., et al. Benign Colorectal Disorders. Prim Care. 2023; 50(3):461-480.
Escalera-Pérez R., et al. Enfermedad diverticular del colon no complicada sintomática (EDCNCS): indicaciones para cirugía programada. Cir Andal. 2021; 32(4):447-59.
Pérez-Garcia L.A., Vinardell-Almira L.M. Evaluación de opciones terapéuticas para la enfermedad diverticular del colon. Revista Cubana de Cirugía. 2018; 57(4): 19-27.
Lamb R, Kahlon A, Sukumar S, Layton B. Small bowel diverticulosis: imaging appearances, complications and pitfalls. Clin Radiol. 2022; 77(4):264-73.
Martínez-Valdés. J.A., García Sánchez M.A., et al. “Massive Small Intestine Diverticular Disease”. EC Gastroenterology and Digestive System. 2020; 7: 57-61.
Barbaro M.R., et al. Pathophysiology of Diverticular Disease: From Diverticula Formation to Symptom Generation. Int J Mol Sci. 2022; 23(12):6698.
Bertassi-Mazucato J., et al. Pseudodiverticulosis intramural del esófago. Revista colombiana de Gastroenterología. 2022; 37:78-82.
González-González J.A., et al. Divertículo gigante verdadero del colon izquierdo. Reporte de caso. Revista. colomb. Gastroenterol. 2023; 38(2):206-210.
Martínez-Pérez C., García-Coret M.J., Villalba-Ferrer F.L. La enfermedad diverticular hoy. Revisión de la evidencia. Rev. cir. 2021; 73 (3): 322-328
Madrid A. M. Manometría intestinal: utilidad actual. 2003. Publicado el 1 de agosto de 2022. | http://doi.org/10.5867/medwave.2003.07.3177. 208
Abe T., et al. Are There Sex Differences in Defecation Patterns in Patients with Defecation Disorders? - A Single-center Observational Study. J Anus Rectum Colon. 2023; 7(3):150-158.
Brillantino A., et al. The Relevance of the Excessive Perineal Descent in the Obstructed Defecation Syndrome: A Prospective Study of 141 Patients. Dis Colon Rectum. 2023 Mar 21. doi: 10.1097/DCR.0000000000002526.
Marín-Fernández I. Trastornos de la motilidad del colon. 1ª Edic. Editorial; Oberta UOC Publishing, SL. Barcelona 2019; p 8-20.
Saiki S. [Association of Pathological Progression of Parkinson's Disease and the Thyroid Gland]. Brain Nerve. 2023; 75(8):965-970.
Chaichanavichkij P., et al. Disorders of Defaecation Delphi Group. Evaluating the risk factors for the development of benign disorders of defaecation: a surgical perspective. Tech Coloproctol. 2023., doi: 10.1007/s10151-023-02843-w.
Jadallah K., De Giorgio R., and Sanders D.S. Editorial: Irritable bowel syndrome: what is known and what is missing in daily practice. Front Med (Lausanne). 2023; 10:1247319. doi: 10.3389/fmed.2023.1247319.
Morelos Adolfo García Sánchez., et al. “Colonoscopy in Mexico, 18 Years of Experience”. EC Gastroenterology and Digestive System. 2021; 8: 68-77.
Montoya A.P., y Murillo-Alvarado K. Diverticulosis colónica. Rev.méd. sinerg. 2021; 6(7): e691.
Carranza-Zamora A.J., Villalobos-Vega E., y Mora-Sandino V. Abordaje de la diverticulitis aguda. Rev.méd. sinerg. 2020; 5(4): e347.
Cascante-Gutiérrez A., Arriola-Gutiérrez J., y Castillo-Arias R. Actualización sobre fisiopatología y manejo inicial de diverticulitis aguda. 2022; 7(9): 2215-5279.
Xu R., Vaughan A., Fagan M., et al. Colovesical fistula in men with chronic urinary tract infection: A diagnostic challenge. Cleve Clin J Med. 2023; 90(3):165-171.
Adekunle A.D., Rubens M., Sedarous M., et al. Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic. World J Gastroenterol. 2023; 29(4):744-757.
Almario C.V., Sharabi E., Chey W.D., et al. Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results from a Nationwide Cross-Sectional Study. Gastroenterology. 2023: S0016-5085(23)04889-8.
Sartelli M., De Simone B., Coccolini F., et al. Acute left colonic diverticulitis in the emergency setting: from diagnosis to treatment. Minerva Surg. 2023; 78(4):413-420.
Morelos Adolfo García Sánchez., et al. “Pneumoperitoneum! Is it a Diagnosis?” EC Gastroenterology and Digestive System. 2021(8) 1: 33-38.
Garteiz-Martínez Denzil, Weber-Sánchez Alejandro. Neumoperitoneo residual en laparoscopia: métodos de medición e implicaciones clínicas. Cir. cir. 2022; 90 (6): 796-803.
Ocaña J., García-Pérez J.C., Fernández-Martínez D., et al; DIPLICAB Study Collaborative Group. Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. Surgery. 2023; 174(3):492-501.
Al-Saadi H., Abdulrasool H., Murphy E. Complicated Diverticulitis: Age Distribution, Management and Burden on Health Care. Cureus. 2023; 15(2): e34482. 209
Shokoohi H., Selame L.A., Loesche M.A., et al. Accuracy of "TICS" ultrasound protocol in detecting simple and complicated diverticulitis: A prospective cohort study. Acad Emerg Med. 2023; 30(3):172-179.
Pavlidis E.T., Pavlidis T.E. Current Aspects on the Management of Perforated Acute Diverticulitis: A Narrative Review. Cureus. 2022; 14(8): e28446.
Polese B., Carabotti M., Rurgo S., et al. Patients with Diverticular Disease Have Different Dietary Habits Compared to Control Subjects: Results from an Observational Italian Study. Nutrients. 2023; 15(9):2119.
Talemal L., Yaratha K., Monahan B.V., et al. Seasonal Variations and Factors that Influence Diverticular Bleeding in the United States of America. J Res Health Sci. 2023; 23(2): e00577.
Raţiu I., Lupuşoru R., Popescu A., et al. Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding. Medicine (Baltimore). 2022; 101(45): e31543.
Acevedo-Cabrera J.J. Experiencia actual en hemorragia digestiva alta en el Hospital Regional “General Ignacio Zaragoza” del ISSSTE. Endoscopia. 2020; 32 (Suppl 2): 322-335.
Mellado-Herrera J, Mellado-Soler J.J. Variación estacional de la hemorragia digestiva alta. Rev Cuba Reumatol. 2022; 24(2): e798.
Lupio-García B.R., García-Sánchez M. A., De La Fuente-González M., et al. Pólipos intestinales. Un enigma diagnóstico-terapéutico. Ocronos. 2023; 6(7): 128-132.
Morelos Adolfo García Sánchez., et al. Ulcerous Colitis in Mexico: Is It Still a Diagnostic-Therapeutic Myth? 20 Years of Experience. British Journal of Healthcare and Medical Research. 2023; 4(10): 146-163.
Lee J.G., Park Y.E., Chang J.Y., et al. Diagnosis and management of acute colonic diverticulitis: results of a survey among Korean gastroenterologists. Korean J Intern Med. 2023. doi: 10.3904/kjim.2023.133.
Seta T., Iwagami H., Agatsuma N., et al. Efficacy of antimicrobial therapy in patients with uncomplicated acute colonic diverticulitis: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2023; 35(10):1097-1106.
Nocera F., Haak F., Posabella A., et al. Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients. Langenbecks Arch Surg. 2023; 408(1):295. doi: 10.1007/s00423-023-03034-9.
Bhatia M., Mattoo A. Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends. Cureus. 2023; 15(8): e43158.
Pietryga S., Lock J.F., Diers J., et al. Nationwide volume-outcome relationship concerning in-hospital mortality and failure-to-rescue in surgery of sigmoid diverticulitis. Int J Colorectal Dis. 2023; 38(1):203., doi: 10.1007/s00384-023-04495-6.
Murzi V., Locci E., Carta A., et al. Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis-A Retrospective Single-Center Cohort Study. Medicina (Kaunas). 2023 ;59(7):1236. doi: 10.3390/medicina59071236.
Connelly T.M., Cheong J.Y., Lincango E.P., et al. Surgery for young onset diverticulitis: is it curative? Int J Colorectal Dis. 2023; 38(1):195. doi: 10.1007/s00384-023-04479-6.
Klingler M.J., Lipman J.M. Acute left-sided colonic diverticulitis: A surgeon's perspective on the ACP guidelines. Cleve Clin J Med. 2023; 90(7):403-406.
Pellegrin A., Sabbagh C., Berdah S., et al; Groupe de travail diverticulite de l’Association française de chirurgie. Quality of life after sigmoid diverticulitis: A review. J Visc Surg. 2023; 160(4):269-276.
Guerra F., and Coletta D. Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review with Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery. Surg Laparosc Endosc Percutan Tech. 2023; 33(4):428-430.
Mizrahi I., Abu-Gazala M., Fernandez L.M., et al. Elective minimally invasive surgery for sigmoid diverticulitis: operative outcomes of patients with complicated versus uncomplicated disease. Colorectal Dis. 2021; 23(11):2948-2954.
Lee Y., McKechnie T., Samarasinghe Y., et al. Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015-2019. Int J Colorectal Dis. 2023; 38(1):156. doi: 10.1007/s00384-023-04452-3.
Dreifuss N.H., Casas M.A., Angeramo C.A., et al. Sigmoid resection and primary anastomosis for perforated diverticulitis with peritonitis: To divert or not to divert-A systematic review and meta-analysis. Surgery. 2023; 174(2):180-188.
Horesh N., Emile S.H., Khan S.M., et al. Meta-Analysis of Randomized Clinical Trials on Long-Term Outcomes of Surgical Treatment of Perforated Diverticulitis. Ann Surg. 2023. doi: 10.1097/SLA.0000000000005909.
Solaini L., Giuliani G., Cavaliere D., et al. Robotic versus laparoscopic left colectomy: a propensity score matched analysis from a bi-centric experience. J Robot Surg. 2023. doi: 10.1007/s11701-023-01634-7.
Chaconas C.E., Melmer P.D., Pinnola A.D. Perforated Sigmoid Diverticulitis Within a Strangulated Inguinal Hernia. Am Surg. 2023; 89(8):3646-3647.
Arezzo A., Nicotera A., Bonomo L.D., et al. Outcomes of surgical treatment of diverticular abscesses after failure of antibiotic therapy. Updates Surg. 2023; 75(4):855-862.
Connelly T.M., Cheong J.Y., Lincango E.P., et al. Low incidence of occult colorectal carcinoma in a cohort of 150 consecutive patients with diverticular strictures. Surgery. 2023; 174(3):487-49.
Narayanaswamy S., Goradia R., Bhujbal S., and Patwardhan S. Unique case of colovesical fistula in a renal allograft recipient. BMJ Case Rep. 2023; 16(6): e254534. doi: 10.1136/bcr-2022-254534.
Underhill J., Pinzon M.C.M., Ritz E., et al. Defining diverticular fistula through inpatient admissions: a population study. Surg Endosc. 2023 Jan;37(1):645-652. doi: 10.1007/s00464-022-09504-3.
Giulio M, Gaia S, Andrea C, Giacomo C, Angela P, Dario M, Isacco M. Recurrent diverticulitis after elective surgery. Int J Colorectal Dis. 2022 Oct;37(10):2149-2155.
Waser A., Balaphas A., Uhe I., et al. Incidence of diverticulitis recurrence after sigmoid colectomy: a retrospective cohort study from a tertiary center and systematic review. Int J Colorectal Dis. 2023 Jun 1;38(1):157. doi: 10.1007/s00384-023-04454-1.
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Copyright (c) 2023 García Sánchez Morelos Adolfo, De La Fuente González Mireya, Méndez Barrón Gema, Estrada Rodríguez María Isabel, Flores Pazos Mauricio Israel, Ortiz Vargas Astrid, Jiménez Bonola Yamileth, Castillo García Giselle, Li Gómez Huiyu Beatriz, Hernández Medina Myrna Sofia, Beltrán Navarrete Jessica, Fernández Zenteno Sergio, Zazueta Cruz Ernesto Salvador, Medina Medrano Carlos Enrique
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