Situaciones especiales en el tratamiento de la enfermedad diverticularenfermedad multifocal, divertículo gigante, diverticulitis en colon derecho y diverticulitis en pacientes inmunosuprimidos

  1. Gómez Sánchez J. 1
  2. Ramos Sanfiel J. 1
  3. Zurita Saavedra M. 1
  4. Ubiña Martínez J. A. 1
  5. García Martínez M. Á. 1
  6. de Castro Monedero P. 1
  7. González Callejas C. 1
  8. Mirón Pozo B. 1
  1. 1 Hospital Universitario San Cecilio. Granada
Revista:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Año de publicación: 2021

Volumen: 32

Número: 4

Páginas: 507-513

Tipo: Artículo

DOI: 10.37351/2021324.13 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: Cirugía Andaluza

Resumen

La enfermedad diverticular es la patología benigna más frecuente del colon. Se considera una entidad crónica con una variedad en su sintomatología abdominal cuya principal manifestación es la diverticulitis. Su prevalencia ha aumentado de forma significativa en los países occidentales en las últimas décadas y con ello el número de hospitalizaciones y valoraciones quirúrgicas, ya que pueden desembocar en complicaciones como la hemorragia, el absceso, la obstrucción y la perforación intestinal. La forma más frecuente de presentación es la diverticulitis sigmoidea en un contexto inmunológico normal, cuyas guías terapéuticas están bien definidas diferenciando entre diverticulitis complicadas y no complicadas. Sin embargo el propósito de este artículo es la revisión de todas aquellas diverticulitis menos usuales que pueden considerarse circunstancias especiales y en cuyo tratamiento no existe un protocolo tan establecido. Estas circunstancias serían la enfermedad multifocal, el divertículo colónico gigante, la diverticulitis del lado derecho y por último la diverticulitis en pacientes con inmunosupresión.

Referencias bibliográficas

  • Francis NK, Sylla P, Abou-Khalil M, Arolfo S, Berler D, Curtis NJ et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019 Sep;33(9):2726-2741. doi: 10.1007/s00464-019-06882-z. Epub 2019 Jun 27. PMID: 31250244; PMCID: PMC6684540.
  • Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32. doi: 10.1186/s13017-020-00313-4. PMID: 32381121; PMCID: PMC7206757.
  • Schultz JK, Azhar N, Binda GA, Barbara G, Biondo S, Boermeester MA et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020 Sep;22 Suppl 2:5-28. doi: 10.1111/codi.15140. Epub 2020 Jul 7. PMID: 32638537.
  • Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM et al. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-747. doi: 10.1097/DCR.0000000000001679. PMID: 32384404.
  • Hajibandeh S, Smart NJ, Maw A. Meta-analysis of the demographic and prognostic significance of right-sided versus left-sided acute diverticulitis. Colorectal Dis. 2020 Dec;22(12):1908-1923. doi: 10.1111/codi.15328. Epub 2020 Sep 18. PMID: 32854157.
  • Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004 Feb 21;363(9409):631-9. doi: 10.1016/S0140-6736(04)15597-9. PMID: 14987890.
  • Peery AF, Keku TO, Martin CF, Eluri S, Runge T, Galanko JA et al. Distribution and Characteristics of Colonic Diverticula in a United States Screening Population. Clin Gastroenterol Hepatol. 2016 Jul;14(7):980-985.e1. doi: 10.1016/j.cgh.2016.01.020. Epub 2016 Feb 9. PMID: 26872402; PMCID: PMC4912930.
  • Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg. 1984 Oct;200(4):466-78. doi: 10.1097/00000658-198410000-00008. PMID: 6333217; PMCID: PMC1250513.
  • Ryan P. Changing concepts in diverticular disease. Dis Colon Rectum. 1983 Jan;26(1):12-8. doi: 10.1007/BF02554670. PMID: 6600422.
  • Kline BP, Schieffer KM, Choi CS, Connelly T, Chen J, Harris L et al. Multifocal Versus Conventional Unifocal Diverticulitis: A Comparison of Clinical and Transcriptomic Characteristics. Dig Dis Sci. 2019 Nov;64(11):3143-3151. doi: 10.1007/s10620-018-5403-y. Epub 2018 Dec 3. PMID: 30511196.
  • Wood EH, Sigman MM, Hayden DM. Special Situations in the Management of Diverticular Disease. Clin Colon Rectal Surg. 2021 Mar;34(2):121-126. doi: 10.1055/s-0040-1716704. Epub 2021 Feb 24. PMID: 33642952; PMCID: PMC7904335.
  • Greenwald M, Nussbaum T. Right colon, sigmoid colon, and transverse colon diverticulitis in the same patient: report of a case. Dis Colon Rectum. 2005 Jan;48(1):162-6. doi: 10.1007/s10350-004-0757-7-y. PMID: 15690675.
  • Krajewski E, Szomstein S, Weiss EG. Synchronous diverticular perforation: report of a case. Am Surg. 2005 Jun;71(6):528-31. PMID: 16044938.
  • López Marcano AJ, Ramia JM, De la Plaza Llamas R, Alonso S, Gonzales Aguilar JD, Kühnhardt Barrantes AW. Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review. Rev Gastroenterol Peru. 2017 Jul-Sep;37(3):240-245. PMID: 29093588.
  • Kricun R, Stasik JJ, Reither RD, Dex WJ. Giant colonic diverticulum. AJR Am J Roentgenol. 1980 Sep;135(3):507-12. doi: 10.2214/ajr.135.3.507. PMID: 6773370.
  • Nigri G, Petrucciani N, Giannini G, Aurello P, Magistri P, Gasparrini M et al. Giant colonic diverticulum: clinical presentation, diagnosis and treatment: systematic review of 166 cases. World J Gastroenterol. 2015 Jan 7;21(1):360-8. doi: 10.3748/wjg.v21.i1.360. PMID: 25574112; PMCID: PMC4284356.
  • Macht R, Sheldon HK, Fisichella PM. Giant Colonic Diverticulum: a Rare Diagnostic and Therapeutic Challenge of Diverticular Disease. J Gastrointest Surg. 2015 Aug;19(8):1559-60. doi: 10.1007/s11605-015-2773-8. Epub 2015 Feb 14. PMID: 25681218.
  • Pérez-Aguilar F, Nicolás D, Lloret M, Catalá F, Sáiz V. Divertículo gigante de sigma: presentación de un caso y consideraciones sobre el manejo de esta rara complicación de la enfermedad diverticular. Cir Esp 2000;67:616-618.
  • Steenvoorde P, Vogelaar FJ, Oskam J, Tollenaar RA. Giant colonic diverticula. Review of diagnostic and therapeutic options. Dig Surg. 2004;21(1):1-6; doi: 10.1159/000074833. Epub 2003 Nov 19. PMID: 14631129.
  • Beddy D, DeBlacam C, Mehigan B. An unusual cause of an acute abdomen--a giant colonic diverticulum. J Gastrointest Surg. 2010 Dec;14(12):2016-7. doi: 10.1007/s11605-010-1235-6. Epub 2010 May 28. PMID: 20509001
  • Ueda P, Hall D. Images in clinical medicine. Giant colonic diverticulum. N Engl J Med. 1995 Jul 27;333(4):228. doi: 10.1056/NEJM199507273330405. PMID: 7791839.
  • Coulier B, Rezazadeh Azar A, Pierard F. Giant diverticulum of the sigmoid colon. Diagn Interv Imaging. 2020 Nov;101(11):761-762. doi: 10.1016/j.diii.2020.04.010. Epub 2020 May 15. PMID: 32423619.
  • Levi DM, Levi JU, Rogers AI, Bergau DK, Wenger J. Giant colonic diverticulum: an unusual manifestation of a common disease. Am J Gastroenterol. 1993 Jan;88(1):139-42. PMID: 8420256.
  • Choong CK, Frizelle FA. Giant colonic diverticulum: report of four cases and review of the literature. Dis Colon Rectum. 1998 Sep;41(9):1178-85; discussion 1185-6. doi: 10.1007/BF02239441. PMID: 9749503.
  • de Oliveira NC, Welch JP. Giant diverticula of the colon: a clinical assessment. Am J Gastroenterol. 1997 Jul;92(7):1092-6. PMID: 9219776.
  • Collin JE, Atwal GS, Dunn WK, Acheson AG. Laparoscopic-assisted resection of a giant colonic diverticulum: a case report. JMed Case Reports 2009;3:7075http://doi.org.archer.luhs.org/10.1186/1752- 1947-3-7075
  • Ocaña J, Vivas A, Labalde M, Pelaez P, García S, García-Borda J et al. Laparoscopic sigmoid resection for a giant colonic diverticulum - a video vignette. Colorectal Dis. 2021 Apr;23(4):1011. doi: 10.1111/codi.15520. Epub 2021 Feb 5. PMID: 33421280.
  • Singh AK, Raman S, Brooks C, Philips D, Desai R, Kandarpa K. Giant colonic diverticulum: percutaneous computed tomography-guided treatment. J Comput Assist Tomogr. 2008 Mar-Apr;32(2):204-6. doi: 10.1097/RCT.0b013e3180683bd8. PMID: 18379302.
  • Tan KK, Wong J, Yan Z, Chong CS, Liu JZ, Sim R. Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg. 2014 Mar;84(3):181-4. doi: 10.1111/ans.12273. Epub 2013 Jun 25. PMID: 23796226.
  • Schlussel AT, Lustik MB, Cherng NB, Maykel JA, Hatch QM, Steele SR. Right-Sided Diverticulitis Requiring Colectomy: an Evolving Demographic? A Review of Surgical Outcomes from the National Inpatient Sample Database. J Gastrointest Surg. 2016 Nov;20(11):1874-1885. doi: 10.1007/s11605-016-3233-9. Epub 2016 Sep 12. PMID: 27619806.
  • Radhi JM, Ramsay JA, Boutross-Tadross O. Diverticular disease of the right colon. BMC Res Notes. 2011 Oct 6;4:383. doi: 10.1186/1756-0500-4-383. PMID: 21978459; PMCID: PMC3206858.
  • Fischer MG, Farkas AM. Diverticulitis of the cecum and ascending colon. Dis Colon Rectum. 1984 Jul;27(7):454-8. doi: 10.1007/BF02555537. PMID: 6745016.
  • Chen Z, Zhang B, Wu D, Jin Y. Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy. BMC Surg. 2020 Sep 14;20(1):202. doi: 10.1186/s12893-020-00863-z. PMID: 32928169; PMCID: PMC7491128.
  • Lee KY, Lee J, Park YY, Kim Y, Oh ST. Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis. Sci Rep. 2020 Feb 28;10(1):3754. doi: 10.1038/s41598-020-60397-5. PMID: 32111862; PMCID: PMC7048749..
  • Gómez Sánchez J, Forneiro Pérez R, Hernández García MD, Mirón Pozo B. Perforated cecal diverticulum mimicking acute appendicitis. Cir Esp. 2021 Jul 10:S0009-739X(21)00219-0. English, Spanish. doi: 10.1016/j.ciresp.2021.06.008. Epub ahead of print. PMID: 34256934
  • ang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol. 2000 May;174(5):1397-402. doi: 10.2214/ajr.174.5.1741397. PMID: 10789802.
  • Telem DA, Buch KE, Nguyen SQ, Chin EH, Weber KJ, Divino CM. Current recommendations on diagnosis and management of right-sided diverticulitis. Gastroenterol Res Pract. 2009;2009:359485. doi: 10.1155/2009/359485. Epub 2009 Mar 24. PMID: 19325923; PMCID: PMC2659845.
  • Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004 Feb;187(2):233-7. doi: 10.1016/j.amjsurg.2003.11.009. PMID: 14769311.
  • Lane JS, Sarkar R, Schmit PJ, Chandler CF, Thompson JE Jr. Surgical approach to cecal diverticulitis. J Am Coll Surg. 1999 Jun;188(6):629-34; discussion 634-5. doi: 10.1016/s1072-7515(99)00043-5. PMID: 10359355.
  • Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Aggressive resection is indicated for cecal diverticulitis. Am J Surg. 2003 Feb;185(2):135-40. doi: 10.1016/s0002-9610(02)01209-6. PMID: 12559443.
  • Chung BH, Ha GW, Lee MR, Kim JH. Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon. Ann Coloproctol. 2016 Dec;32(6):228-233. doi: 10.3393/ac.2016.32.6.228. Epub 2016 Dec 31. PMID: 28119866; PMCID: PMC5256252.
  • Etzioni DA, Cannom RR, Ault GT, Beart RW Jr, Kaiser AM. Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am Surg. 2009 Oct;75(10):981-5. PMID: 19886149.
  • Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum. 2010 Dec;53(12):1699-707. doi: 10.1007/DCR.0b013e3181f5643c. PMID: 21178867.
  • Golda T, Kreisler E, Mercader C, Frago R, Trenti L, Biondo S. Emergency surgery for perforated diverticulitis in the immunosuppressed patient. Colorectal Dis. 2014 Sep;16(9):723-31. doi: 10.1111/codi.12685. PMID: 24924699.
  • Biondo S, Borao JL, Kreisler E, Golda T, Millan M, Frago R et al. Recurrence and virulence of colonic diverticulitis in immunocompromised patients. Am J Surg. 2012 Aug;204(2):172-9. doi: 10.1016/j.amjsurg.2011.09.027. Epub 2012 Mar 23. PMID: 22444713.
  • Qasabian RA, Meagher AP, Lee R, Dore GJ, Keogh A. Severe diverticulitis after heart, lung, and heart-lung transplantation. J Heart Lung Transplant. 2004 Jul;23(7):845-9. doi: 10.1016/j.healun.2003.07.019. PMID: 15261179.
  • Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum. 2010 Dec;53(12):1699-707. doi: 10.1007/DCR.0b013e3181f5643c. PMID: 21178867.
  • Bordeianou L, Hodin R. Controversies in the surgical management of sigmoid diverticulitis. J Gastrointest Surg. 2007 Apr;11(4):542-8. doi: 10.1007/s11605-007-0126-y. PMID: 17436142; PMCID: PMC1852385.
  • Sugrue J, Lee J, Warner C, Thomas S, Tzvetanov I, Mar W et al. Acute diverticulitis in renal transplant patients: should we treat them differently? Surgery. 2018 Apr;163(4):857-865. doi: 10.1016/j.surg.2017.11.013. Epub 2017 Dec 27. PMID: 29289391.
  • Biondo S, Trenti L, Elvira J, Golda T, Kreisler E. Outcomes of colonic diverticulitis according to the reason of immunosuppression. Am J Surg. 2016 Sep;212(3):384-90. doi: 10.1016/j.amjsurg.2016.01.038. Epub 2016 May 7. PMID: 27255782.
  • Samdani T, Pieracci FM, Eachempati SR, Benarroch-Gampel J, Weiss A, Pietanza MC et al. Colonic diverticulitis in chemotherapy patients: should operative indications change? A retrospective cohort study. Int J Surg. 2014 Dec;12(12):1489-94. doi: 10.1016/j.ijsu.2014.10.032. Epub 2014 Nov 7. PMID: 25448673; PMCID: PMC4440494.
  • Al-Khamis A, Abou Khalil J, Demian M, Morin N, Vasilevsky CA, Gordon PH et al. Sigmoid Colectomy for Acute Diverticulitis in Immunosuppressed vs Immunocompetent Patients: Outcomes From the ACS-NSQIP Database. Dis Colon Rectum. 2016 Feb;59(2):101-9. doi: 10.1097/DCR.0000000000000513. PMID: 26734967.
Fuente de los datos: Dialnet