Mistakes in ... Booklet 2020 - 11

ueg education

four RCTs that have been conducted and have
come to similar conclusions,30-33 rather than
on contradictive data from a retrospective
cohort study.34
Based on the current evidence, the clinical
condition of the patient and the expertise of the
surgeon, a primary resection with anastomosis
with or without a diverting ileostomy may be
preferred over a Hartmann's procedure for
patients with perforated diverticulitis. Moreover,
in general, patients do not like the idea of
having a colostomy, and for too many patients the
temporary stoma becomes a permanent stoma,
which results in disappointment and lower quality
of life. In conclusion, in haemodynamically stable
patients a primary anastomosis with or without
diverting loop ileostomy can be performed. The
choice of a diverting ileostomy depends on many
local and patient-related factors, and is left to the
discretion of the surgeon.
References
1. Painter NS. Diverticular disease of the colon. Br Med J
1968; 3: 475-479.
2. Stollman N and Raskin JB. Diverticular disease of the
colon. Lancet 2004; 363: 631-639.
3. Hinchey EJ, et al. Treatment of perforated diverticular
disease of the colon. Adv Surg 1978; 12: 85-109.
4. Wasvary H, et al. Same hospitalization resection for
acute diverticulitis. Am Surg 1999; 65: 632-635.
5. Burkitt DP, et al. Effect of dietary fibre on stools and
the transit-times, and its role in the causation of
disease. Lancet 1972; 2: 1408-1412.
6. Stam MA, et al. An unrestricted diet for uncomplicated
diverticulitis is safe: results of a prospective diverticulitis
diet study. Colorectal Dis 2017; 19: 372-377.
7. van de Wall BJ, et al. Dietary restrictions for acute
diverticulitis: evidence-based or expert opinion?
Int J Colorectal Dis 2013; 28: 1287-1293.
8. Rottier SJ, et al. Complicated disease course in
initially computed tomography-proven
uncomplicated acute diverticulitis. Surg Infect
(Larchmt) Epub ahead of print (August 14 2019).
doi: 10.1089/sur.2018.289.
9. Gregersen R, et al. Treatment of patients with acute
colonic diverticulitis complicated by abscess formation:
A systematic review. Int J Surg 2016; 35: 201-208.
10. Lambrichts DPV, et al. Multicentre study of nonsurgical management of diverticulitis with abscess
formation. Br J Surg 2019; 106: 458-466.
11. Nielsen K, et al. The limited role of ultrasound in the
diagnostic process of colonic diverticulitis. World J
Surg 2014; 38: 1814-1818.
12. Lameris W, et al. Graded compression
ultrasonography and computed tomography in acute
colonic diverticulitis: meta-analysis of test accuracy.
Eur Radiol 2008; 18: 2498-2511.
13. van Randen A, et al. A comparison of the accuracy of
ultrasound and computed tomography in common
diagnoses causing acute abdominal pain. Eur Radiol
2011; 21: 1535-1545.
14. Bridoux V, et al. Elective operation after acute
complicated diverticulitis: is it still mandatory?
World J Gastroenterol 2014; 20: 8166-8172.
15. Sallinen VJ, et al. Nonoperative management of
perforated diverticulitis with extraluminal air is safe
and effective in selected patients. Dis Colon Rectum
2014; 57: 875-881.

Mistakes in... 2019
16. van Dijk ST, et al. A systematic review of pericolic
extraluminal air in left-sided acute colonic
diverticulitis. Surg Infect (Larchmt) 2018; 19: 362-368.
17. Colas PA, et al. Failure of conservative treatment of
acute diverticulitis with extradigestive air. World J
Surg 2017; 41: 1890-1895.
18. Daniels L, et al. Randomized clinical trial of
observational versus antibiotic treatment for a first
episode of CT-proven uncomplicated acute
diverticulitis. Br J Surg 2017; 104: 52-61.
19. Chabok A, et al. Randomized clinical trial of
antibiotics in acute uncomplicated diverticulitis.
Br J Surg. 2012; 99: 532-539.
20. van Dijk ST, et al. Long-term effects of omitting
antibiotics in uncomplicated acute diverticulitis.
Am J Gastroenterol 2018; 113: 1045-1052.
21. van Dijk ST, et al. A systematic review and metaanalysis of outpatient treatment for acute
diverticulitis. Int J Colorectal Dis 2018; 33: 505-512.
22. de Boer MGJ, et al. The Dutch national guideline
'Acute Diverticulitis', (2018, accessed 28 November
2019 ; in Dutch).
23. Andersen JC, et al. Danish national guidelines for
treatment of diverticular disease. Dan Med J 2012; 59:
C4453.
24. Binda GA, et al. Practice parameters for the treatment
of colonic diverticular disease: Italian Society of
Colon and Rectal Surgery (SICCR) guidelines.
Tech Coloproctol 2015; 19: 615-626.
25. Feingold D, et al. Practice parameters for the
treatment of sigmoid diverticulitis. Dis Colon Rectum
2014; 57: 284-294.
26. Kruis W, et al. Diverticular disease: Guidelines of the
German Society for Gastroenterology, Digestive and
Metabolic Diseases and the German Society for

27.

28.
29.
30.

31.

32.

33.

34.

General and Visceral Surgery. Digestion 2014;
90: 190-207.
Stollman N, et al. American Gastroenterological
Association Institute guideline on the management
of acute diverticulitis. Gastroenterology 2015; 149:
1944-1949.
Wilkins T, et al. Diagnosis and management of acute
diverticulitis. Am Fam Physician 2013; 87: 612-620.
Rottier SJ, et al. Meta-analysis of the role of
colonoscopy after an episode of left-sided acute
diverticulitis. Br J Surg 2019; 106: 988-997.
Binda GA, et al. Primary anastomosis vs nonrestorative
resection for perforated diverticulitis with peritonitis: a
prematurely terminated randomized controlled trial.
Colorectal Dis 2012; 14: 1403-1410.
Bridoux V, et al. Hartmann's procedure or primary
anastomosis for generalized peritonitis due to
perforated diverticulitis: a prospective multicenter
randomized trial (DIVERTI). J Am Coll Surg 2017; 225:
798-805.
Oberkofler CE, et al. A multicenter randomized
clinical trial of primary anastomosis or Hartmann's
procedure for perforated left colonic diverticulitis
with purulent or fecal peritonitis. Ann Surg 2012; 256:
819-826.
Lambrichts DPV, et al. Hartmann's procedure versus
sigmoidectomy with primary anastomosis for
perforated diverticulitis with purulent or faecal
peritonitis (LADIES): a multicentre, parallel-group,
randomised, open-label, superiority trial. Lancet
Gastroenterol Hepatol 2019; 4: 599-610.
Cauley CE, et al. Use of primary anastomosis with
diverting ileostomy in patients with acute
diverticulitis requiring urgent operative intervention.
Dis Colon Rectum 2018; 61: 586-592.

Your diverticulitis briefing
UEG Week

* 'Update on diverticulitis' session at UEG Week 2019

[https://www.ueg.eu/education/session-files/?session
=2122&conference=156].

* 'Symptomatic diverticular disease' presentation in the
'Therapy update in functional gastrointestinal
disorders' session at UEG Week 2018
[https://www.ueg.eu/education/document/
symptomatic-diverticular-disease/183879/].

* 'Diverticulitis' presentation in 'Therapy update:

Practical algorithms in various GI disorders' session at
UEG week 2019 [https://www.ueg.eu/education/
document/diverticulitis/211467/].

* 'Update on diverticular disease' session at

25th UEG Week 2017 [https://www.ueg.eu/education/
session-files/?session=1897&conference=149].

* 'Trial presentation: Randomised clinical trial of

observational versus antibiotic treatment for a first
episode of CT-proven uncomplicated acute
diverticulitis' presentation in the 'Clinical Trials
revisited: Antibiotics in lower GI diseases - Should they
be used?' session at 25th UEG Week 2017
[https://www.ueg.eu/education/document/
trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/].

* 'Diverticular disease: Medical and surgical
management' session at UEG Week 2016

[https://www.ueg.eu/education/session-files/?session
=1568&conference=144].

Standards and Guidelines

* Trifan A-V, et al. Diagnosis and treatment of colonic

diverticular disease: position paper of the Romanian
Society of Gastroenterology and Hepatology.
J Gastrointestin Liver Dis 2018: 27; 449-457
[https://www.ueg.eu/education/document/
diagnosis-and-treatment-of-colonic-diverticular-disease-position-paper-of-the-romanian-society-of-gastroenterology-and-hepatology/203028/].

* Kruis W, et al. Diverticular disease: Guidelines of the

German Society for Gastroenterology, Digestive and
Metabolic Diseases and the German Society for
General and Visceral Surgery. Digestion 2014; 90:
190-207 [https://www.karger.com/Article/
Abstract/367625].

* Andersen JC, et al. Danish national guidelines for

treatment of diverticular disease. Dan Med J 2012;
59: C4453 [https://ugeskriftet.dk/dmj/
danish-national-guidelines-treatment-diverticulardisease].

* Binda GA, et al. Practice parameters for the

treatment of colonic diverticular disease:
Italian Society of Colon and Rectal Surgery
(SICCR) guidelines. Tech Coloproctol
2015; 19: 615-626 [https://link.springer.com/
article/10.1007%2Fs10151-015-1370-x].

35


https://www.ueg.eu/education/session-files/?session=1568&conference=144 https://www.ueg.eu/education/session-files/?session=1568&conference=144 https://www.ueg.eu/education/session-files/?session=2122&conference=156 https://www.ueg.eu/education/session-files/?session=2122&conference=156 https://www.ueg.eu/education/document/symptomatic-diverticular-disease/183879/ https://www.ueg.eu/education/document/diagnosis-and-treatment-of-colonic-diverticular-disease-position-paper-of-the-romanian-society-of-gastroenterology-and-hepatology/203028/ https://www.ueg.eu/education/document/symptomatic-diverticular-disease/183879/ https://www.ueg.eu/education/document/diagnosis-and-treatment-of-colonic-diverticular-disease-position-paper-of-the-romanian-society-of-gastroenterology-and-hepatology/203028/ https://www.ueg.eu/education/document/diagnosis-and-treatment-of-colonic-diverticular-disease-position-paper-of-the-romanian-society-of-gastroenterology-and-hepatology/203028/ https://www.ueg.eu/education/document/diagnosis-and-treatment-of-colonic-diverticular-disease-position-paper-of-the-romanian-society-of-gastroenterology-and-hepatology/203028/ https://www.ueg.eu/education/document/diverticulitis/211467/ https://www.ueg.eu/education/document/diverticulitis/211467/ https://www.ueg.eu/education/session-files/?session=1897&conference=149 https://www.ueg.eu/education/session-files/?session=1897&conference=149 https://www.karger.com/Article/Abstract/367625 https://www.karger.com/Article/Abstract/367625 https://www.ugeskriftet.dk/dmj/ https://www.ueg.eu/education/document/trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/ https://www.ueg.eu/education/document/trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/ https://www.ueg.eu/education/document/trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/ https://www.ueg.eu/education/document/trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/ https://www.ueg.eu/education/document/trial-presentation-randomised-clinical-trial-of-observational-versus-antibiotic-treatment-for-a-first-episode-of-ct-proven-uncomplicated-acute-diverticulitis/155576/ https://link.springer.com/article/10.1007%2Fs10151-015-1370-x https://link.springer.com/article/10.1007%2Fs10151-015-1370-x

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