WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting
World Journal of Emergency Surgery ,
Jul 2016
Massimo Sartelli , Fausto Catena , Luca Ansaloni , Federico Coccolini , Ewen Griffiths , Fikri Abu-Zidan , Salomone Di Saverio , Jan Ulrych , Yoram Kluger , Ofir Ben-Ishay , et al.
Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.
A PDF file should load here. If you do not see its contents
the file may be temporarily unavailable at the journal website
or you do not have a PDF plug-in installed and enabled in your browser.
Alternatively, you can download the file locally and open with any standalone PDF reader:
http://www.wjes.org/content/pdf/s13017-016-0095-0.pdf
WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting
Sartelli et al. World Journal of Emergency Surgery
WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting
Massimo Sartelli 0
Fausto Catena
Luca Ansaloni
Federico Coccolini
Ewen A. Griffiths
Fikri M. Abu-Zidan
Salomone Di Saverio
Jan Ulrych
Yoram Kluger
Ofir Ben-Ishay
Frederick A. Moore
Rao R. Ivatury
Raul Coimbra
Andrew B. Peitzman
Ari Leppaniemi
Gustavo P. Fraga
Ronald V. Maier
Osvaldo Chiara
Jeffry Kashuk
Boris Sakakushev
Dieter G. Weber
Rifat Latifi
Walter Biffl
Miklosh Bala
Aleksandar Karamarkovic
Kenji Inaba
Carlos A. Ordonez
Andreas Hecker
Goran Augustin
Zaza Demetrashvili
Renato Bessa Melo
Sanjay Marwah
Sanoop K. Zachariah
Vishal G. Shelat
Michael McFarlane
Miran Rems
Carlos Augusto Gomes
Mario Paulo Faro
Gerson Alves Pereira Júnior
Ionut Negoi
Yunfeng Cui
Norio Sato
Andras Vereczkei
Giovanni Bellanova
Arianna Birindelli
Isidoro Di Carlo
Kenneth Y Kok
Mahir Gachabayov
Georgios Gkiokas
Konstantinos Bouliaris
Elif Çolak
Arda Isik
Daniel Rios-Cruz
Rodolfo Soto
Ernest E. Moore
0 Department of Surgery, Macerata Hospital , Via Santa Lucia 2, 62019 Macerata , Italy
Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.
Background
Acute left sided colonic diverticulosis is common in
Western countries, however its prevalence is increasing
throughout the world, probably because of changes in
lifestyle [
1
]. Although left sided colonic diverticulosis is
more common amongst elderly patients, a dramatic rise
of its incidence has been seen in the younger age groups
in recent years [
2
]. Data from Western populations
suggest that up to one fifth of patients with acute
diverticulitis are under the age of 50 years of age [
3–5
]. Recent
evidence suggests that lifetime risk of developing acute
left sided colonic diverticulitis (ALCD) is only about 4 %
among patients with diverticulosis [
6
].
ALCD is a common problem encountered by surgeons
in the acute setting. It encompasses a variety of
conditions, ranging from localized diverticular inflammation
to perforation and fecal peritonitis. Daily decisions in
the diagnosis and treatment of acute diverticulitis
generally depend on clinicians’ personal preferences rather
than evidence-based medicine. There is generally a lack
of well conducted randomized clinical trials in ALCD
and a large amount of evidence in the literature is low
quality and conflicting.
Methods
A World Society of Emergency Surgery (WSES) working
group published in 2015 a proposal for a new CT based
classification for ALCD [
7
]. This has been extended and
developed into guidelines for the management of acute
diverticulitis in an emergency setting. A literature search,
using the PubMed database, was performed without
restriction of time or type of manuscript. The search
was limited to English language publications. The final
grade of recommendation was performed by using the
Grades of Recommendation, Assessment, Development,
and Evaluation (GRADE) system (Table 1) [
8, 9
].
A World Society of Emergency Surgery (WSES)
Consensus Conference on acute diverticulitis was held
during the 3rd World Congress of the WSES in
Jerusalem, Israel, on July 7th, 2015. During this
consensus conference the guidelines were presented and
debated. This document represents the executive
summary of the final guidelines approved by the
consensus conference.
Results
Classification systems
ALCD ranges in severity from uncomplicated
inflammatory diverticulitis to complicated diverticulitis (abscess
formation or perforation). For the past three decades,
the Hinchey classification has been the most commonly
used classification for complicated ALCD in
international literature [
10
].
Based on the surgical findings of abscesses and
peritonitis, Hinchey et al. classified the severity of acute
diverticulitis into four grades:
Stage 1 Pericolic abscess
Stage 2 Pelvic, intra-abdominal, or retroperitoneal
abscess
Stage 3 Generalized purulent peritonitis
Stage 4 Generalized fecal peritonitis
The management of ALCD has recently changed
dramatically in recent years, due to better radiological
imaging and availability of non-surgical treatment options.
Computer tomography (CT) imaging has become a
primary diagnostic tool in the diagnosis and staging of
patients with acute diverticulitis and more detailed
information provided by CT scans led to several
modifications of the Hinchey classification [
4, 11–17
]. For
example, in 1989 Neff et al. presente (...truncated)
This is a preview of a remote PDF: http://www.wjes.org/content/pdf/s13017-016-0095-0.pdf
Massimo Sartelli, Fausto Catena, Luca Ansaloni, Federico Coccolini, Ewen Griffiths, Fikri Abu-Zidan, Salomone Di Saverio, Jan Ulrych, Yoram Kluger, Ofir Ben-Ishay, Frederick Moore, Rao Ivatury, Raul Coimbra, Andrew Peitzman, Ari Leppaniemi, Gustavo Fraga, Ronald Maier, Osvaldo Chiara, Jeffry Kashuk, Boris Sakakushev, Dieter Weber, Rifat Latifi, Walter Biffl, Miklosh Bala, Aleksandar Karamarkovic, Kenji Inaba, Carlos Ordonez, Andreas Hecker, Goran Augustin, Zaza Demetrashvili, Renato Melo, Sanjay Marwah, Sanoop Zachariah, Vishal Shelat, Michael McFarlane, Miran Rems, Carlos Gomes, Mario Faro, Gerson Júnior, Ionut Negoi, Yunfeng Cui, Norio Sato, Andras Vereczkei, Giovanni Bellanova, Arianna Birindelli, Isidoro Di Carlo, Kenneth Y Kok, Mahir Gachabayov, Georgios Gkiokas, Konstantinos Bouliaris, Elif Çolak, Arda Isik, Daniel Rios-Cruz, Rodolfo Soto, Ernest Moore.
WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting ,
World Journal of Emergency Surgery,
2016, pp. 37, 11, DOI: 10.1186/s13017-016-0095-0