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[Management of complications of sigmoid diverticulosis].
Presse Med. 2008 May; 37(5 Pt 2):827-30.PM

Abstract

Computed tomography (CT) with contrast enhancement for vascular and bowel opacification is the reference examination for suspected sigmoid diverticulitis because it makes it possible to confirm the diagnosis and look for signs of severity (pericolic abscess, or presence of air or extraintestinal contrast product). Therapeutic management depends on the patient's general condition and on the severity of the intraperitoneal infection, assessed according to Hinchey's 4-stage classification. For Hinchey stages I and II (pericolic or pelvic abscess), radiologically guided puncture-drainage is an effective treatment, combined with antibiotic therapy. Emergency surgery is only indicated if this drainage fails. Two to three months later, elective prophylactic sigmoidectomy, by laparoscopy, is indicated. In stage III or IV diverticulitis (generalized purulent or fecal peritonitis), the surgical treatment of reference is a Hartmann procedure (sigmoidectomy and left iliac colostomy with closure of the rectal stump). But because of burden of the procedure and the risk of failing to re-establish gastrointestinal continuity, it is preferable, if local conditions allow, to propose resection-anastomosis with a temporary protective stoma. Prophylactic sigmoidectomy is controversial. It is indicated regardless of the number of episodes and regardless of age in patients at high risk of recurrence, that is, those with a complicated clinical form or radiologic signs of severity. There is no consensus for patients aged younger than 75 years with a first uncomplicated episode, for whom the risk of recurrence is also elevated. Finally, for patients older than 50 years with an uncomplicated episode on CT, the role of prophylactic surgery, even after 2 or 3 episodes, has not been demonstrated, because of the very low risk (<5%) of subsequent complications. More than 80% of diverticular hemorrhages stop spontaneously but their rate of recurrence is high (25% of cases) and they sometimes require emergency colectomy.

Authors+Show Affiliations

Service de chirurgie colorectale, SAMU 93, EA 3409, Hôpital Beaujon, F-92110 Clichy, France.No affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

fre

PubMed ID

18281188

Citation

Bretagnol, Frédéric, and Yves Panis. "[Management of Complications of Sigmoid Diverticulosis]." Presse Medicale (Paris, France : 1983), vol. 37, no. 5 Pt 2, 2008, pp. 827-30.
Bretagnol F, Panis Y. [Management of complications of sigmoid diverticulosis]. Presse Med. 2008;37(5 Pt 2):827-30.
Bretagnol, F., & Panis, Y. (2008). [Management of complications of sigmoid diverticulosis]. Presse Medicale (Paris, France : 1983), 37(5 Pt 2), 827-30. https://doi.org/10.1016/j.lpm.2007.07.032
Bretagnol F, Panis Y. [Management of Complications of Sigmoid Diverticulosis]. Presse Med. 2008;37(5 Pt 2):827-30. PubMed PMID: 18281188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Management of complications of sigmoid diverticulosis]. AU - Bretagnol,Frédéric, AU - Panis,Yves, Y1 - 2008/02/20/ PY - 2007/04/12/received PY - 2007/07/16/accepted PY - 2008/2/19/pubmed PY - 2008/6/5/medline PY - 2008/2/19/entrez SP - 827 EP - 30 JF - Presse medicale (Paris, France : 1983) JO - Presse Med VL - 37 IS - 5 Pt 2 N2 - Computed tomography (CT) with contrast enhancement for vascular and bowel opacification is the reference examination for suspected sigmoid diverticulitis because it makes it possible to confirm the diagnosis and look for signs of severity (pericolic abscess, or presence of air or extraintestinal contrast product). Therapeutic management depends on the patient's general condition and on the severity of the intraperitoneal infection, assessed according to Hinchey's 4-stage classification. For Hinchey stages I and II (pericolic or pelvic abscess), radiologically guided puncture-drainage is an effective treatment, combined with antibiotic therapy. Emergency surgery is only indicated if this drainage fails. Two to three months later, elective prophylactic sigmoidectomy, by laparoscopy, is indicated. In stage III or IV diverticulitis (generalized purulent or fecal peritonitis), the surgical treatment of reference is a Hartmann procedure (sigmoidectomy and left iliac colostomy with closure of the rectal stump). But because of burden of the procedure and the risk of failing to re-establish gastrointestinal continuity, it is preferable, if local conditions allow, to propose resection-anastomosis with a temporary protective stoma. Prophylactic sigmoidectomy is controversial. It is indicated regardless of the number of episodes and regardless of age in patients at high risk of recurrence, that is, those with a complicated clinical form or radiologic signs of severity. There is no consensus for patients aged younger than 75 years with a first uncomplicated episode, for whom the risk of recurrence is also elevated. Finally, for patients older than 50 years with an uncomplicated episode on CT, the role of prophylactic surgery, even after 2 or 3 episodes, has not been demonstrated, because of the very low risk (<5%) of subsequent complications. More than 80% of diverticular hemorrhages stop spontaneously but their rate of recurrence is high (25% of cases) and they sometimes require emergency colectomy. SN - 2213-0276 UR - https://www.unboundmedicine.com/medline/citation/18281188/[Management_of_complications_of_sigmoid_diverticulosis]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0755-4982(08)00005-5 DB - PRIME DP - Unbound Medicine ER -