ACUTE DIVERTICULITIS MANAGEMENT

EDITORS: Dimitrios Ntourakis (MD, PhD), Joël Leroy (MD, FRCS), Didier Mutter (MD, PhD, FACS)
Chief Editor: Jacques Marescaux (MD, FACS, Hon. FRCS, Hon. FJSES)

Educational objectives

To describe the causes and pathophysiology of acute diverticulitis
To define diagnostic criteria and work-up
To provide treatment options according to the stage of the disease
To describe the necessary follow-up and the indications for a prophylactic sigmoidectomy

Acute diverticulitis management

Dimitrios Ntourakis, MD, PhD
, Greece
Joël Leroy, MD, FRCS
Hôpitaux Universitaires de Strasbourg, France
miguel li, PERU
2018-01-18 04:36
very interesting management and review of literature
ibrahim bakr, EGYPT
2018-01-11 23:02
VERY GOOD PRESENTATION
Stanislav Shadskiy, RUSSIAN FEDERATION
2017-12-24 12:37
Thanks a lot for a quite clear and interesting review!
Khristine Botezan, UNITED STATES
2017-12-22 16:51
Wonderful comprehensive review of current management and areas of controversy. The videos showed cutting edge techniques.
Jeon-Uk Lee, JAPAN
2017-10-07 13:07
I think Hinchey's classification should be modified in the point of view that the abscess is caused by reaction or perforation.
Jose Alberto Gonzalez, MEXICO
2017-09-20 18:55
excelent talk
Bruno Arena, ITALY
2017-09-05 00:11
Quite clear . Thank you!
Sorin Cimpean, BELGIUM
2017-08-29 13:28
Congratulation
Nguyễn Khải, VIET NAM
2017-08-22 04:31
thanks
André Tojal, PORTUGAL
2017-08-08 18:21
Great! Nice work! Congrats
Edison Vadakkenchery Varghese, INDIA
2017-08-04 04:40
Perfect!
Manuel Vílchez, PERU
2017-08-03 05:23
excellent, thanks
paolo aiello, ITALY
2017-07-21 13:15
very clear presentation..thank you very much!!!
Joel Corella, MEXICO
2017-07-02 23:32
excelente
kakha tiginashvili, GEORGIA
2017-07-02 13:06
exelente
jose suazo, NICARAGUA
2017-06-12 01:46
exelente
jose suazo, NICARAGUA
2017-06-12 01:46
exelente
thienthuong nguyen, VIET NAM
2017-06-01 07:49
good job !!!
gustavo mantovani, ARGENTINA
2017-05-07 20:20
exelente
CARLOS BERNARDOS, SPAIN
2017-04-16 19:05
Vera interesting discussion. Great!!
Luis Aguilar, SPAIN
2017-04-11 23:39
Great
JOEL RAMIREZ MIRANDA, MEXICO
2017-03-22 02:49
Very good prsentation
Sandra Barco, COLOMBIA
2017-03-07 04:34
great review!
roberto bruni, ITALY
2017-02-22 19:03
very good presentation
THUSHARA DISSANAYAKE, AUSTRALIA
2017-02-20 01:42
excellent
fabio mura, ITALY
2016-12-21 15:47
great job
Ruben Martins, PORTUGAL
2016-11-20 18:04
Good review!!
Zaira Osorio, MEXICO
2016-10-26 22:10
Good' tks
Alexander Durnov, RUSSIAN FEDERATION
2016-10-26 15:56
Excellent! Could not be better. Thank you!
Egor Borovik, BELARUS
2016-10-26 00:07
Thank you, colleagues. It was very interesting and actionable to listen.
Sergio Baldan, ITALY
2016-10-22 12:00
Thank you very much
Clear and simple
Precious as gold
Andreia Barao, PORTUGAL
2016-10-17 16:27
Helpful, very good!!
Lorenzo Riva, SWEDEN
2016-10-01 12:38
Very good and helpful; excellent presentation.
Thank you very much indeed.
roberto edde, VENEZUELA
2016-09-29 16:01
Very good presentation
Excellent review
Thanks
Stefan Leichtle, UNITED STATES
2016-08-19 03:42
Very good presentation and excellent surgical videos.
Дмитрий Левченко, UKRAINE
2016-08-10 20:56
Thank you for your great work
Jorge Guillen, VENEZUELA
2016-08-07 22:51
excellent presentation! thank you
Oliver Fisher, AUSTRALIA
2016-07-21 05:04
excellent, evidence-based presentation. thank you!
KESHAV VERMA, UNITED KINGDOM
2016-07-13 20:15
Good and comprehensive
Roman Koch, GERMANY
2016-07-06 10:44
Very helpful, very modern well linked presentation.

Thank you!
Dimitrios Ntourakis, GREECE
2016-06-29 09:59
UPDATE: two of the trials for laparoscopic lavage vs Hartmann's procedure for Hinchey III diverticulitis showed improved outcomes for laparoscopy, one showed similar results and one found worse outcomes with laparoscopy.
The debate is still on.
http://www.ncbi.nlm.nih.gov/pubmed/25489672
http://www.ncbi.nlm.nih.gov/pubmed/26784672
http://www.ncbi.nlm.nih.gov/pubmed/26209030
http://www.ncbi.nlm.nih.gov/pubmed/26441181
Luis Hernandez, VENEZUELA
2016-06-12 15:22
excellent
George Skroubis, GREECE
2016-05-24 12:58
Excellent work !!!
Domenico Massimo Pellegrino, ITALY
2016-05-22 18:27
you made a very a excellent work!
my compliments
hector dermidio ronza, ARGENTINA
2016-05-22 08:07
excellent slice and presentation
Levon Grigoryan, ARMENIA
2016-05-21 23:29
Good presentation.
Thank you.
mohammed ismael, KUWAIT
2016-05-20 18:48
excellent presentation really to the point, thanks dimitrios
hesham cavb, EGYPT
2016-05-09 14:00
Very Good
Great
Alexey Veselko, RUSSIAN FEDERATION
2016-05-07 15:01
very good presentation
Mateus Quitembo, ANGOLA
2016-04-28 17:44
muito bom, gostei
sethu murugan, INDIA
2016-04-21 11:51
graet Explanation..
Tran Ngoc, VIET NAM
2016-04-04 10:09
thank you
Rosa Luz Avalos Rojo, PERU
2016-03-25 17:33
excelente gracias..
Jorge Muñoz adauta, MEXICO
2016-03-23 07:48
Excelente gracias
Manuel Ordoñez, HONDURAS
2016-03-11 17:55
Thank you Dimitrios!!!!
Rodrigo Angel Araya Villar, VENEZUELA
2016-03-07 07:03
Magnifico...
Muchas Gracias.
viktor popov, BULGARIA
2016-02-27 16:08
It is very useful presentation
Ira Sotirova, GREECE
2016-02-21 11:10
Very useful presentation ! Thank you!
Fabrizio Lazzara, ITALY
2016-02-05 16:36
A really useful presentation. Thank you.
KAMEL BOUCHENAK, ALGERIA
2016-02-05 13:18
thank you for this presentation
Pieter Gerritsen, NETHERLANDS
2016-02-05 13:13
Good concise overview of the problem.
Ubaldo Piedra, ECUADOR
2016-01-25 19:47
EXCELLENT PRESENTATION.THANK YOU VERY MUCH
Montserrat Salvi, SPAIN
2016-01-24 17:44
Muy buena presentación, didáctica y actualizada. Todos los residentes deberían verla. Gracias
Evaristo Bejarano Peña, COLOMBIA
2016-01-23 16:20
Such a useful information
gildo melo, BRAZIL
2016-01-16 13:46
Thank you
David Aguirre, NICARAGUA
2016-01-08 05:08
Muchas gracias por la actualización.
cong tru huynh, VIET NAM
2016-01-03 14:56
Thank you
Luigi Valerio Abate, ITALY
2015-12-27 10:35
Thank you !
Omar Abdel-lah, SPAIN
2015-12-13 13:00
Great idea, thank you for this, is perfect.
Constantinos GEMOS, GREECE
2015-12-06 17:13
very understandable and pleasant presence
Andre Risha, BELGIUM
2015-11-30 23:14
excellent presentation
ARSHAD MAHMOOD, UNITED KINGDOM
2015-11-28 15:08
Well done.
sharif jan, UNITED ARAB EMIRATES
2015-11-28 13:24
excellent presetation clearing all ambiguity related to the management of this disease . Thank you sir
cong tru huynh, VIET NAM
2015-11-26 15:31
It' good

Alan Ford, UNITED KINGDOM
2015-11-25 04:35
Well presented
ricardo vega, PERU
2015-11-19 20:37
very nice information
Marino Di Furia, ITALY
2015-11-14 16:46
Very nice, and very useful in daily clinical practice.
Jose Daniel Andrada Alvarez, SPAIN
2015-11-12 20:40
Excellent review
Zaira Osorio, MEXICO
2015-11-11 03:19
Good information, thanks you
Ahmed Faeq, IRAQ
2015-10-27 19:40
really it is nice informative lecture,thanks
Fredrick Goldsmith-Allya, IRELAND
2015-10-18 18:02
Great overview.
giovanna busuito, ITALY
2015-10-18 16:45
Excellent....
German Acosta, ECUADOR
2015-10-16 17:40
Short, precise and concise explanation of the topic. Congrats!
Dimitrios Ntourakis, GREECE
2015-10-10 13:25
@ David Barzallo: Thank you for your comment. We agree that there are newer and more complex classification systems, that are largely based on the classic Hinchey classification. It is almost certain that the wide use of CT scan will make their use more widespread.
David Barzallo, ECUADOR
2015-10-10 01:14
A great overview of diverticular disease. However I think we should start to use any of the new classifications proposed in 2015 on the literature.
sezgin mumcu, TURKEY
2015-10-09 13:13
Perfect
Rafael Ramos, UNITED STATES
2015-10-06 18:09
Excellent review
liming wang, JAPAN
2015-09-26 16:52
Good
peter loogna, SWEDEN
2015-09-24 12:23
Thank you !
Juan Carlos Bernal-Sprekelsen, SPAIN
2015-09-18 18:56
Excellent revision
Abd Hamid Mat Sain, MALAYSIA
2015-09-16 15:37
good revision
CRISTOBAL ANTONIO MANCILLAS BARRAGAN, MEXICO
2015-09-15 20:38
Excellent learning tool
In this brand-new state-of-the-art, the authors focus on the management of acute diverticulitis encompassing the latest international guidelines and consensus recommendations, and surgical approaches.
The educational objectives are the following:
- To describe the causes and pathophysiology of acute diverticulitis;
- To define diagnostic criteria and work-up;
- To provide treatment options according to the stage of the disease;
- To describe the necessary follow-up and the indications for a prophylactic sigmoidectomy.

Stage-specific laparoscopic treatment

datta ram, INDIA
2018-01-06 02:22
whats the incidencee of a fistula after such a drainage alone procedure
castellvi jordi, SPAIN
2017-10-24 20:24
Muy interesante y practico.
Que % presenta fistula y precisa intervencion posteriromente ?
Rosalí Aranzamendi Paredes, PERU
2017-08-07 04:09
Thank you!
Robert Metaj, ALBANIA
2017-06-04 23:46
Thank you
Kimon Flokas, GREECE
2017-05-27 11:28
Very clear
Good job
Renan Menolli, BRAZIL
2016-12-26 03:34
Very good
Emilio Feliciotti, ITALY
2016-11-15 11:24
Really good!
Jiang Nan, CHINA
2016-07-04 18:10
Great!
Wayne Huang, TAIWAN
2016-03-29 06:50
great!
Senol Tahir, MACEDONIA
2016-02-02 11:01
exellent
gildo melo, BRAZIL
2016-01-27 15:00
Thank you
cezmi karaca, TURKEY
2016-01-20 17:57
thankyou Excelente presentacıon
Robert Metaj, ALBANIA
2016-01-04 20:57
Great experience,thank you
paulo garcia, MEXICO
2015-10-30 16:38
Excelente presentacion
paulo garcia, MEXICO
2015-10-30 16:38
Excelente presentacion
Gustavo Ramirez-Wiella, MEXICO
2015-09-12 20:06
Excellent demonstration
Hinchey II diverticulitis consists of acute diverticulitis complicated with a pelvic or interloop abscess. The standard of care for abscesses >5cm is radiological drainage coupled with antibiotic treatment. However, if radiologic drainage is not available, a laparoscopic drainage can then be proposed.
In this video, we show the laparoscopic view of a Hinchey II diverticulitis with a large interloop abscess, which is drained laparoscopically.

Advanced Techniques and Complicated Cases

miguel li, PERU
2018-01-18 05:15
we had an ureteral sigmoidoscopy fistula, we made him a Hartmann and suture de ureter with a double J catheter for 6 months
Dimitrios Ntourakis, GREECE
2016-06-29 09:25
@Oscar Pena
We inject diluted methylene blue through the urinary catheter. If there is any leak then we perform simple suturing and leave the folley catheter in place for a few weeks.
Oscar Peña, MEXICO
2016-05-27 03:43
How do you repair The vesical fistula?
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.

Authors

Dimitrios Ntourakis, MD, PhD
, Greece
Joël Leroy, MD, FRCS
Hôpitaux Universitaires de Strasbourg, France
Didier Mutter, MD, PhD, FACS
Hôpitaux Universitaires de Strasbourg, France
Jacques Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Hôpitaux Universitaires de Strasbourg, France
Ludovic Marx, MD
Hôpitaux Universitaires de Strasbourg, France
Federico Costantino, MD
Hôpitaux Civils de Colmar, France
Ghassan Sojod, MD
Hôpitaux Universitaires de Strasbourg, France
Olivier Raspado, MD
Croix Rousse Hospital - Infirmerie Protestante, France
Armando Melani, MD
IRCAD América Latina (Unit of Barretos and Unit of Rio de Janeiro), Brazil
Antonio D'Urso, MD, PhD
Hôpitaux Universitaires de Strasbourg, France
Heithem Jeddou, MD
Hôpitaux Universitaires de Strasbourg, France
Michael Li, MD
Pamela Youde Nethersole Eastern Hospital, China
Brian Barry, MD
Mercy Hospital, Ireland
Cosimo Callari, MD
, Italy

References

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