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Related Concept Videos

Diverticular Disease of the Colon01:27

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Microscopic findings in sigmoid diverticulitis--changes after conservative therapy.

Christoph Holmer1, Kai S Lehmann, Sabrina Engelmann

  • 1Department of General, Vascular and Thoracic Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. christoph.holmer@charite.de

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|February 27, 2010
PubMed
Summary

Conservative treatment for acute sigmoid diverticulitis (SD) shows inflammation regression in phlegmonous types but persistent changes in covered perforated types. Late surgery is better for covered perforated SD, while clinical assessment remains key for phlegmonous SD decisions.

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Radiology

Background:

  • The management of acute sigmoid diverticulitis (SD) with phlegmonous or covered perforated types remains debated.
  • The correlation between CT findings and histological evidence in SD, especially after conservative treatment, requires further clarification.
  • Understanding the temporal changes in inflammation is crucial for determining optimal surgical indications.

Purpose of the Study:

  • To analyze time-course changes in inflammation for phlegmonous and covered perforated SD following antibiotic therapy.
  • To evaluate the correlation between preoperative CT findings and histological results at different surgical timing.
  • To inform the decision-making process for prophylactic surgery in acute SD.

Main Methods:

  • Retrospective analysis of 257 patients undergoing surgery for CT-diagnosed phlegmonous or covered perforated SD (2002-2007).
  • Patients were grouped into early elective surgery (7-10 days post-antibiotics) and late elective surgery (4-6 weeks post-conservative treatment).
  • Comparison of CT-based inflammation extent with histological findings, excluding emergency cases and free perforations.

Main Results:

  • Phlegmonous SD showed complete inflammation subsidence in 100% of late surgery cases versus 33% in early surgery.
  • Covered perforated SD demonstrated significant inflammatory changes even after conservative treatment, with 74% showing subsidence in late surgery compared to 10% in early surgery.
  • Histological analysis confirmed considerable inflammatory changes under conservative therapy, with varying degrees of regression depending on SD type.

Conclusions:

  • Phlegmonous SD exhibits significant inflammation regression with conservative treatment, questioning the routine need for early prophylactic surgery.
  • Covered perforated SD often retains marked inflammatory changes post-antibiotics, suggesting a preference for later elective surgery.
  • While CT and histological findings provide valuable data, clinical presentation remains paramount in guiding surgical decisions for acute sigmoid diverticulitis.