Diverticular Disease and Colectomy

By: Shima Ghavimi, MDPGY-2 Internal Medicine Resident

Howard University Hospital

Diverticular DiseaseIs one of the most prevalent medical conditions in western countries. Etiology- occur at the site of vasa recta insertion- associated with a Western diet—low fiber, high fat

Incidence:- ~71% in those greater than 85.- ~33% in those greater than 45.

Location:~95% of diverticular disease occurs in the sigmoid colon

Number of Patients with Diverticular Disease (1996-2014)

•2400 Patients with Diverticular Disease

-20 to 102 years old , Median age of 55

-1438 Female (59.8%)

-962 Male (40.2%)

•

Diverticolosis Diverticulitis

Male 820 (34%) 145 (6%)

Female 1200 (50%) 235 (10%)

total 2020 (60%) 380 (40%)

Number of Patients with DD and Colectomy (1996-2014) – (2400 Patients with DD)

174 (7.3 %) patients who got colectomy

81 Male (3.4%)

93 Female (3.9%)

Diverticulosis Diverticulitis

Male 54/2400 (2.3) 27/2400 (1.1%)

Female 58/2400 (2.4) 35/2400 (1.5%)

Total 112/2400 (4.7%) 62/2400 (2.6%)

Patients with DD and Colectomy (1996-2014)

Age : 25 to 101

Median age 54

Number Patients with Diverticulosis vs patients with Diverticulitis

- 380 [16%] Diverticulitis

318/380 acute [84%] 62/380 [16%] complicated Complicated ones all got colectomy

- 2020 [84%] Diverticulosis

( which 112/2020 [5.5%] got colectomy)

Table 4: Hinchey classification

Stage DescriptionI Pericolic abscess or phlegmon

II Pelvic, intraabdominal, or retroperitoneal abscess

III Generalized purulent peritonitis

IV Generalized fecal peritonitis

Complicated Diverticulitis who got Colectomy - 14/62 [23%] had hemorrhage ( 2 stage 1 , 2 stage 2, 6 state 3, 4 stage 4 )

- 48/62 [77%] without hemorrhage ( 5 stage 1, 3 stage 2, 5 stage 3 , 4 stage 4). 35/48 [72.9%] had recurrent Diverticulitis

Patients with Diverticulosis who got Colectomy

- 112 Diverticulosis Which

- 44/112 had hemorrhage (40%) -68/112 without hemorrhage (60%)

(5.3%) 6 patients with Colorectal Cancer, (0.9%) 1 tubolovilus adenoma without high grade dysplasia (5.8%) 4 multiple Polyps that lead to perforation (0.9%) 1 Adenocarcinoma 56 patients had colectomy without mention of hemorrhage but there is not hx or any electronic medical records from them!!!

Diverticulitis without hemorrhage• Diverticulitis and immunosuppression : 1/62 (1.6%)• Recurrent diverticulitis:35/62 (56.7%)• Perforated diverticulitis : 6/62 (9.6%)• Intussusception 2/62 (3.2%)• Peridiverticular abscess : 1/62(1.6%)• Colovesicular fistula: 2/62 (3.2%)• Large bowel obstruction secondary to diverticulitis: 1/62 (1.6%)

Figure 1: Management of Rectal Bleeding

Rectal Bleeding

ResuscitateStable Unstable

Angiography or

Red Blood Cell count

Surgery

Colonoscopy

ObserveEndoscopic

Therapy

Bleeding stoppedActive bleeding

Bleeding stopped

Bleedingcontinues

Table 5. Type of Surgery for the 174 patients

Wheat et al, (2015)

100000 patients

- diverticular bleeding decreased over the 10-year period from 32.5 to 27.1%

- hospitalizations for diverticulitis peaked in 2008

- The prevalence of diverticulitis was higher in women than in men.

- The prevalence of diverticular bleeding was highest in African Americans (34.4%)

- prevalence of diverticulitis was highest in whites (75.5%)

Masoumi et al, (2011)

Did a research on 1,073,397 patients admitted with diverticulitis (emergent: 78.3%, elective: 21.7%) during 2002 to 2007

The emergent admission rate increased by 9.5% over the study period.

Stamos et al, (2014)

- “The frequency of elective surgical resection for diverticulitis has dramatically increased by 38%

- which is nearly 9 times greater than the relative increase in urgent surgical resection.

- This may reflect the influence of the American Society of Colon and Rectal Surgeons guidelines from 2000.”

Etzioni et al, (2007)

Did a research on 267,000

- Rates of admission increased more rapidly within patients aged 18 to 44 years (82%) 45 to 74 years (36%).

- rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years.

Thank you