PDF herunterladen
Clin Colon Rectal Surg 2009; 22(3): 156-160
DOI: 10.1055/s-0029-1236159
© Thieme Medical Publishers

The Medical and Nonoperative Treatment of Diverticulitis

Heath Beckham1 , Charles B. Whitlow1
  • 1Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
10. August 2009 (online)

Auch verfügbar auf
    Lizenzen und Reprints

ABSTRACT

The success of medical management for diverticular disease depends on the patient's presentation and degree of response to treatment. The patient's presentation can be grouped into categories using classification systems such as the modified Hinchey system. Clinical presentation and diagnostic studies help to group patients. Mild disease can often be managed with oral antibiotics as an outpatient; more severe disease requires hospitalization, bowel rest, and intravenous antibiotics. Interventions such as percutaneous drainage of associated abscesses may allow successful medical management. Probiotics and antiinflammatories may have a supportive role. Indications for elective resections are discussed.

KEYWORDS

Diverticular disease - medical management - antibiotics - percutaneous drainage

REFERENCES

  • 1 Jacobs D O. Clinical practice. Diverticulitis.  N Engl J Med. 2007;  357(20) 2057-2066
    CrossrefPubMedGoogle Scholar
  • 2 Kircher M, Rhea J, Kihiczak D, Novelline R. Frequency, sensitivity, and specificity of individual signs of diverticulitis on thin-section helical CT with colonic contrast material.  Am J Roentgenol. 2002;  178 1313-1318
    PubMedGoogle Scholar
  • 3 Rafferty J, Shellito P, Hyman N H, Buie W D. Standards Committee of American Society of Colon and Rectal Surgeons . Practice parameters for sigmoid diverticulitis.  Dis Colon Rectum. 2006;  49(7) 939-944
    CrossrefPubMedGoogle Scholar
  • 4 Hinchey E J, Schaal P G, Richards G K. Treatment of perforated diverticular disease of the colon.  Adv Surg. 1978;  12 85-109
    PubMedGoogle Scholar
  • 5 Kaiser A M, Jiang J-K, Lake J P et al.. The management of complicated diverticulitis and the role of computed tomography.  Am J Gastroenterol. 2005;  100(4) 910-917
    CrossrefPubMedGoogle Scholar
  • 6 Mizuki A, Nagata H, Tatemichi M et al.. The out-patient management of patients with acute mild-to-moderate colonic diverticulitis.  Aliment Pharmacol Ther. 2005;  21(7) 889-897
    CrossrefPubMedGoogle Scholar
  • 7 Hjern F, Josephson T, Altman D et al.. Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory?.  Scand J Gastroenterol. 2007;  42(1) 41-47
    CrossrefPubMedGoogle Scholar
  • 8 Rao P, Rhea J, Novelline R et al.. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients.  Am J Roentgenol. 1998;  170 1445-1449
    PubMedGoogle Scholar
  • 9 Werner A, Diehl S J, Farag-Soliman M, Düber C. Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients.  Eur Radiol. 2003;  13(12) 2596-2603
    CrossrefPubMedGoogle Scholar
  • 10 Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management–a prospective study of 542 patients.  Eur Radiol. 2002;  12(5) 1114-1119
    CrossrefPubMedGoogle Scholar
  • 11 Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases.  Dis Colon Rectum. 2005;  48(4) 787-791
    CrossrefPubMedGoogle Scholar
  • 12 Siewart B, Tye G, Kruskal J, Sosna J, Opelka F. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters.  Am J Roentgenol. 2006;  186 680-686
    CrossrefPubMedGoogle Scholar
  • 13 Small A J, Young-Fadok T M, Baron T H. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases.  Surg Endosc. 2008;  22(2) 454-462
    CrossrefPubMedGoogle Scholar
  • 14 Forshaw M J, Sankararajah D, Stewart M, Parker M C. Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes.  Colorectal Dis. 2006;  8(2) 102-111
    CrossrefPubMedGoogle Scholar
  • 15 Paúl L, Pinto I, Gómez H, Fernández-Lobato R, Moyano E. Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases.  Radiology. 2002;  223(3) 715-722
    PubMedGoogle Scholar
  • 16 Dobbins C, Defontgalland D, Duthie G, Wattchow D A. The relationship of obesity to the complications of diverticular disease.  Colorectal Dis. 2006;  8(1) 37-40
    PubMedGoogle Scholar
  • 17 Stollman N H, Raskin J B. Diverticular disease of the colon.  J Clin Gastroenterol. 1999;  29(3) 241-252
    CrossrefPubMedGoogle Scholar
  • 18 Painter N S, Burkitt D P. Diverticular disease of the colon: a deficiency disease of Western civilization.  BM J. 1971;  2(5759) 450-454
    CrossrefPubMedGoogle Scholar
  • 19 Brodribb A J, Humphreys D M. Diverticular disease: three studies. Part II: Treatment with bran.  BMJ. 1976;  1(6007) 425-428
    CrossrefPubMedGoogle Scholar
  • 20 Hyland J M, Taylor I. Does a high fibre diet prevent the complications of diverticular disease?.  Br J Surg. 1980;  67(2) 77-79
    CrossrefPubMedGoogle Scholar
  • 21 Taylor I, Duthie H L. Bran tablets and diverticular disease.  BMJ. 1976;  1(6016) 988-990
    PubMedGoogle Scholar
  • 22 Brodribb A J. Treatment of symptomatic diverticular disease with a high-fibre diet.  Lancet. 1977;  1(8013) 664-666
    PubMedGoogle Scholar
  • 23 Smits B J, Whitehead A M, Prescott P. Lactulose in the treatment of symptomatic diverticular disease: a comparative study with high-fibre diet.  Br J Clin Pract. 1990;  44(8) 314-318
    PubMedGoogle Scholar
  • 24 Hodgson W J. The placebo effect. Is it important in diverticular disease?.  Am J Gastroenterol. 1977;  67(2) 157-162
    PubMedGoogle Scholar
  • 25 Ornstein M H, Littlewood E R, Baird I M, Fowler J, North W R, Cox A G. Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial.  Br Med J (Clin Res Ed). 1981;  282(6273) 1353-1356
    CrossrefPubMedGoogle Scholar
  • 26 Strate L L, Liu Y L, Syngal S, Aldoori W H, Giovannucci E L. Nut, corn, and popcorn consumption and the incidence of diverticular disease.  JAMA. 2008;  300(8) 907-914
    CrossrefPubMedGoogle Scholar
  • 27 White J A. Probiotics and their use in diverticulitis.  J Clin Gastroenterol. 2006;  40(Suppl 3) S160-S162
    CrossrefPubMedGoogle Scholar
  • 28 Frič P, Zavoral M. The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon.  Eur J Gastroenterol Hepatol. 2003;  15(3) 313-315
    PubMedGoogle Scholar
  • 29 Tursi A, Brandimarte G, Elisei W et al.. Mesalamine and/or Lactobacillus casei for maintaining remission of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized study.  Dig Liver Dis. 2005;  37 S20
    PubMedGoogle Scholar
  • 30 Papi C, Ciaco A, Koch M, Capurso L. Diverticular Disease Study Group . Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial.  Ital J Gastroenterol. 1992;  24(8) 452-456
    PubMedGoogle Scholar
  • 31 Papi C, Ciaco A, Koch M, Capurso L. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial.  Aliment Pharmacol Ther. 1995;  9(1) 33-39
    CrossrefPubMedGoogle Scholar
  • 32 Latella G, Pimpo M T, Sottili S et al.. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon.  Int J Colorectal Dis. 2003;  18(1) 55-62
    CrossrefPubMedGoogle Scholar
  • 33 D'Incà R, Pomerri F, Vettorato M G et al.. Interaction between rifaximin and dietary fibre in patients with diverticular disease.  Aliment Pharmacol Ther. 2007;  25(7) 771-779
    PubMedGoogle Scholar
  • 34 Colecchia A, Vestito A, Pasqui F et al.. Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease.  World J Gastroenterol. 2007;  13(2) 264-269
    PubMedGoogle Scholar
  • 35 Di Mario F, Aragona G, Leandro G et al.. Efficacy of mesalazine in the treatment of symptomatic diverticular disease.  Dig Dis Sci. 2005;  50(3) 581-586
    CrossrefPubMedGoogle Scholar
  • 36 Comparato G, Fanigliulo L, Aragona G et al.. Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment?.  Dig Dis. 2007;  25 252-259
    CrossrefPubMedGoogle Scholar
  • 37 Tursi A, Brandimarte G, Giorgetti G M, Elisei W. Continuous versus cyclic mesalazine therapy for patients affected by recurrent symptomatic uncomplicated diverticular disease of the colon.  Dig Dis Sci. 2007;  52(3) 671-674
    CrossrefPubMedGoogle Scholar
  • 38 Tursi A, Brandimarte G, Daffinà R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon.  Dig Liver Dis. 2002;  34(7) 510-515
    CrossrefPubMedGoogle Scholar
  • 39 Brandimarte G, Tursi A. Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease.  Med Sci Monit. 2004;  10(5) PI70-PI73
    PubMedGoogle Scholar
  • 40 Salem L, Veenstra D L, Sullivan S D, Flum D R. The timing of elective colectomy in diverticulitis: a decision analysis.  J Am Coll Surg. 2004;  199(6) 904-912
    CrossrefPubMedGoogle Scholar
  • 41 Richards R J, Hammitt J K. Timing of prophylactic surgery in prevention of diverticulitis recurrence: a cost-effectiveness analysis.  Dig Dis Sci. 2002;  47(9) 1903-1908
    CrossrefPubMedGoogle Scholar
  • 42 Chapman J, Davies M, Wolff B et al.. Complicated diverticulitis: is it time to rethink the rules?.  Ann Surg. 2005;  242(4) 576-581 discussion 581-583
    PubMedGoogle Scholar
  • 43 Chapman J R, Dozois E J, Wolff B G, Gullerud R E, Larson D R. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?.  Ann Surg. 2006;  243(6) 876-830 discussion 880-883
    CrossrefPubMedGoogle Scholar
  • 44 Kaiser A M. Complicated diverticulitis: it is not yet time to rethink the rules!.  Ann Surg. 2006;  243(5) 707-708, author reply 708–709
    PubMedGoogle Scholar
  • 45 Novitsky Y, Sechrist C, Payton B, Kercher K, Heniford B. Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis?.  Am J Surg. 2009;  187(2) 227-231
    PubMedGoogle Scholar

Charles B WhitlowM.D. 

Department of Colon and Rectal Surgery, Ochsner Clinic Foundation

1514 Jefferson Hwy., New Orleans, LA 70121

eMail: cwhitlow@ochsner.org