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Acute diverticulitis
What's new
Updated 2024 EAES/ESCP guidelines for surgical management of complicated diverticulitis .
Background
Overview
Definition
Acute diverticulitis is a disease resulting from acute inflammation and/or micro-perforation of colonic diverticula.
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Pathophysiology
The putative etiology of acute diverticulitis include alterations in colonic structure, colonic motility, microbiome, genetics, immune system, in addition to connective tissue disorders and environmental factors (obesity, smoking, NSAIDs).
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Epidemiology
The incidence of acute diverticulitis has increased in the past several decades and is estimated at 188 cases per 100,000 person-years in the US.
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Disease course
Alterations in gut motility, intraluminal pressure, and the accumulation of inspissated fecal particles in diverticula leads to erosion of the diverticular wall, causing inflammation that can progress to perforation and diffuse peritonitis. The sequelae of diverticula covered by mesentery may cause phlegmons or abscesses, as well as fistulas.
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Prognosis and risk of recurrence
Acute diverticulitis has a recurrence rate of 13-23% in patients with uncomplicated disease, and around 40% in patients with complicated disease.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acute diverticulitis are prepared by our editorial team based on guidelines from the European Society of Coloproctology (ESCP/EAES 2024), the Infectious Diseases Society of America (IDSA 2024), the American College of Radiology (ACR 2023,2022), the Academy of Emergency Medicine and Care (AcEMC/SIFIPAC/SICUT/WSES/ACOI/SICG 2022), the American College of Physicians (ACP 2022), ...
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