Fistulating diverticulitis: a distinct clinical entity?

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Inflammatory Bowel Disease

Background:

• Diverticular disease (DD) presents with diverse phenotypes, from asymptomatic diverticulosis to complicated diverticulitis.
• The factors influencing these varied clinical presentations remain unclear.
• Fistulas are recognized complications of diverticulitis, treated on an individual basis.

Purpose of the Study:

• To investigate the hypothesis that fistulating diverticulitis (FD) represents a distinct phenotype of DD.
• To review the spectrum of diverticulitis-associated fistulas over the past 50 years.
• To assess the current management trends and propose potential modifications for FD.

Main Methods:

• A narrative review of 50 years of published literature on diverticulitis-associated fistulas.
• Analysis of common and uncommon fistula types, including colovesical, colovaginal, coloenteric, colocutaneous, and genitourinary fistulas.

Main Results:

• While common fistulas are well-documented, rarer types like coloenteric and colocutaneous fistulas are less understood.
• The majority of FD cases necessitate surgical treatment, contrasting with the conservative approach for uncomplicated diverticulitis.
• Histopathological findings in FD share similarities with Crohn's disease.

Conclusions:

• Epidemiological and histological data suggest FD is a distinct feature of chronic DD requiring individualized management.
• FD can involve the entire gastrointestinal tract and adjacent organs.
• Current surgical guidelines may need revision to adequately address FD, emphasizing its predominantly surgical treatment needs.