Editorial calls for a precision medicine approach to follow-up of diverticulitis
(Regenstrief Institute) An editorial challenges physicians and the US healthcare system to reconsider the current 'one size fits all' care for diverticulitis and to employ a precision medicine approach to determine which patients should be referred for colonoscopy.
A 60-year-old female with prior hysterectomy with bilateral salpingo-oophorectomy for endometriosis who presented 3 times over 8 months to the emergency department with severe left-sided pelvic pain. Pelvic and abdominal examinations were negative for abnormalities or myofascial pain. Lower extremity demonstrated no edema or varicosities. The patient received additional evaluation by gastroenterology and urology. Colonoscopy was negative for overt diverticulitis however she received antibiotics for possible colonic inflammation.
BACKGROUND: CT findings of acute diverticulitis can overlap with features of malignancy, and current guidelines recommend colonic evaluation after acute diverticulitis. However, the benefits of routine colonic evaluation have been questioned. OBJECTIVE: We review 30 studies, composed of 29,348 subjects, to evaluate the role of routine colonic evaluation after CT-proven acute diverticulitis. DATA SOURCES: Medline, EMBASE, and the Cochrane Library were searched for articles published up to July 2018 to identify all relevant articles. STUDY SELECTION: A combination of both Medical Subject Headings and non-Medical S...
Purpose: The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs). Methods: The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with χ2 test or the Fisher exact probability. P-values
ConclusionsIn clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.
Acute diverticulitis (AD) is a significant clinical and economic burden, with over 200,000 inpatient admissions and costs exceeding 2 billion dollars annually.1 Current guidelines recommend colonoscopy after AD resolution “in an effort to exclude misdiagnosis of colorectal cancer (CRC) in patients who have not undergone recent high-quality colonoscopy.”2 However, this is a conditional recommendation based on low-quality evidence. Some studies suggest that this recommendation may be too broad. Understanding the ri sk of CRC in persons with AD is a necessary starting point for identifying when colonoscopic evalua...
Abstract Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purpose...
ConclusionRobot-assisted colostomy takedown and anastomosis of the descending colon to rectum were successfully performed. Although there is a paucity of literature examining this technique within gynecologic surgery, the literature on general surgery has supported laparoscopic Hartmann's reversal and has demonstrated improved rates of postoperative complications and incisional hernia and reduced duration of hospitalization . Minimally invasive technique is a feasible alternative to laparotomy for gynecologic oncology patients who undergo colostomy, as long as the patients are recurrence free.
PMID: 31869470 [PubMed - in process]
PMID: 31869466 [PubMed - in process]
ConclusionRobotic-assisted colostomy take-down and anastomosis of descending colon to rectum were successfully performed. While there is a paucity of literature examining this technique within gynecologic surgery, general surgery literature has supported laparoscopic Hartmann's reversal and have demonstrated improved rates of postoperative complications and incisional hernia, while lowering the length of hospitalization (1). Minimally invasive technique is a feasible alternative to laparotomy for gynecologic oncology patients with colostomy, as long as they are recurrence-free.