Introduction
Diverticular disease (DD) of the digestive system is a common disease with an increasing incidence recorded. The most frequently affected anatomical areas are the distal sections of the large intestine, namely the distal colon and sigmoid colon.
Aim
The aim of this article is to investigate the frequency of DD, the position of the diverticula, the types of complications and treatment.
Material and Methods
The study was single-center, retro- and prospective, covering 1,879 patients hospitalized at the General Hospital in Pleven for the period 01.01.2022–01.06.2023. A total of 66 patients (3.5%) were diagnosed with DD. Both sexes were affected equally.
Results
The complications were as follows: bleeding in 39 (59%) patients, and 12 (18%) had the presence of an inflammatory process. Eleven of the patients (16.6%) were operated on. In 27% Hartmann’s resection was performed, in 72%—partial resection or hemicolectomy with primary anastomosis. We have no lethal outcomes in the studied patient group. The operated patients were evaluated according to CDD, Modified Hinchey and Hansen-Stock classifications.
Conclusion
The most frequent factors affecting the incidence of DD are the increased survival rate of the population, inadequate prevention of gastrointestinal tract (GIT) diseases, constipation, disturbances in the dietary regimen. The GIT parts affected by DD in the group of patients was of the Western type, i.e., mainly on the left. The most common complication is bleeding, which in most cases is controlled with medication. Operative treatment was applied in cases of diagnosed peritonitis and/or unsatisfactory result of antibiotic treatment.
Golder M, Ster IC, Babu P, Sharma A, Bayat M, Farah A. Demographic determinants of risk, colon distribution and density scores of diverticular disease. World J Gastroenterol 2011;17(8):1009–17. doi: 10.3748/wjg.v17.i8.1009.
Oh HK, Han EC, Ha HK, Choe EK, Moon SH, Ryoo SB, et al. Surgical management of colonic diverticular disease: discrepancy between right- and left-sided diseases. World J Gastroenterol. 2014;20(29):10115-20. doi: 10.3748/wjg.v20.i29.10115.
Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011;25(7):385-9. doi: 10.1155/2011/795241.
Kozak LJ, DeFrances CJ, Hall MJ. National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2006;(162):1-209.
Imaeda H, Hibi T. The burden of diverticular disease and its complications: West versus East. Inflamm Intest Dis. 2018;3(2):61-8. doi: 10.1159/000492178.
Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971;2(5759):450-4. doi: 10.1136/bmj.2.5759.450.
Schauer PR, Ramos R, Ghiatas AA, Sirinek KR. Virulent diverticular disease in young obese men. Am J Surg. 1992;164(5):443-6; discussion 446-8. doi: 10.1016/s0002-9610(05)81177-8.
Yamamichi N, Shimamoto T, Takahashi Y, Sakaguchi Y, Kakimoto H, Matsuda R, et al. Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic-related factors may cooperatively affect on the colorectal diverticula formation. PLoS One. 2015;10(4):e0123688. doi: 10.1371/journal.pone.0123688..
Bates DDB, Fernandez MB, Ponchiardi C, von Plato M, Teich JP, Narsule C, et al. Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters. Abdom Radiol (NY). 2018;43(8):2060-2065. doi: 10.1007/s00261-017-1422-y.
Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2012;27(2):207-14. doi: 10.1007/s00384-011-1314-5.
Nagata N, Niikura R, Aoki T, Shimbo T, Itoh T, Goda Y, et al. Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan. Int J Colorectal Dis. 2014;29(3):379-85. doi: 10.1007/s00384-013-1808-4.
Zuccaro G Jr. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol. 1998;93(8):1202-8. doi: 10.1111/j.1572-0241.1998.00395.x.
Forgey DE. The treatment of diverticulitis of the colon. Am J Proctol. 1966 Aug;17(4):278-87.
Salem L, Flum DR. Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum. 2004;47(11):1953-64. doi: 10.1007/s10350-004-0701-1.
Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A, et al. Diverticular disease of the colon--on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003;17(9):1189-95. doi: 10.1046/j.1365-2036.2003.
Wong WD, Wexner SD, Lowry A, Vernava A 3rd, Burnstein M, Denstman F, et al. Practice parameters for the treatment of sigmoid diverticulitis--supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000;43(3):290-7. doi: 10.1007/BF02258291.
Gervaz P, Ambrosetti P. Critical appraisal of laparoscopic lavage for Hinchey III diverticulitis. World J Gastrointest Surg. 2016;8(5):371-5. doi: 10.4240/wjgs.v8.i5.371.
Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85-109.
Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1999;94(11):3110-21. doi: 10.1111/j.1572-0241.1999.01501.x.
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