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'Malignant' diverticulitis: a clinical entity.

L Morgenstern, R Weiner, S L Michel

    Archives of Surgery (Chicago, Ill. : 1960)
    |October 1, 1979
    PubMed
    Summary
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    Severe diverticulitis, termed "malignant" diverticulitis, presents with phlegmonous inflammation, fistulas, obstruction, and high mortality. Pathological findings confirm severe diverticulitis, distinct from granulomatous colitis.

    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Surgical Pathology

    Background:

    • A severe form of diverticulitis exhibits phlegmonous inflammation of the sigmoid and rectosigmoid colon.
    • This condition frequently involves fistulization to the skin, bladder, and small intestine, alongside colonic obstruction.
    • It is associated with high postoperative morbidity and mortality.

    Purpose of the Study:

    • To describe a severe form of diverticulitis with distinct clinical and pathological features.
    • To propose the term "malignant" diverticulitis due to its progressive nature and severe outcomes.
    • To analyze the characteristics and outcomes of patients with this severe diverticulitis.

    Main Methods:

    • Retrospective review of seventeen patients operated on for diverticular disease between 1965 and the study period.

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  • Clinical and pathological data analysis to differentiate from granulomatous colitis.
  • Assessment of postoperative morbidity and mortality rates.
  • Main Results:

    • Seventeen patients (approximately 7% of operated diverticular disease cases) were identified with this severe diverticulitis.
    • Clinical presentation mimicked granulomatous colitis but pathological findings confirmed severe diverticulitis.
    • High rates of postoperative morbidity and mortality were observed in the studied cohort.

    Conclusions:

    • A distinct, severe form of diverticulitis, termed "malignant" diverticulitis, is characterized by phlegmonous inflammation, fistulization, obstruction, and significant morbidity/mortality.
    • Pathological findings consistently support severe diverticulitis, differentiating it from granulomatous colitis.
    • The proposed term "malignant" diverticulitis reflects the disease's aggressive progression and associated severe outcomes.