Title:Treatment options in acute, complicated diverticulitis
Background:Although diverticulosis is common in western countries, only some of the affected patients develop acute, complicated diverticulitis. The choice of treatment and surgical method depends much on the severity of the diverticulitis. For a long time the choice of surgical method regarding acute diverticulitis causing generalized purulent peritonitis has been a matter of debate. The preferred methods have included a three-stage procedure including secondary resection, primary resection with either proximal colostomy and closing of the distal end (i.e. Hartmann’s procedure) or construction of an anastomosis with or without a stoma. Also laparoscopic peritoneal lavage has been suggested.
Purpose:The purpose is to try to answer the question Which is the best treatment option for acute, complicated diverticulitis?
Method:This literature study is a non-systematic review. A search was preformed in PubMed with identified key words. Inclusion- and exclusioncriteria were defined and articles chosen. The articles were evaluated and the results are presented in charts according to a set of variables.
Results:This literature study is based on seven studies; including two RCTs, four non-randomized comparative studies and one observational study. The studies identify some significant differences in mortality, morbitity and length of hospital stay. The results of this literature study are not conclusive and the studies are difficult to compare.
Conclusion:This literature study illustrates the difficulty to compare existing studies and draw a conclusion from them. There is not enough evidence to change clinical praxis at this moment. More and better research is needed.
Key words:Acute complicated diverticulitis, surgical methods, secondary resection, three-stage procedure, Hartmann’s procedure, primary resection, primary anastomosis, laparoscopic lavage