Factors predicting severity level, progression and
recurrence risk of acute left colonic diverticulitis
in Turkey: A multicenter study

Ertekin, Cemalettin; ÖKMEN, HASAN; OZPEK, ADNAN; ATALAY, SÜLEYMAN; Sagiroglu, Julide; Beyazadam, Damla; Kurt, Yavuz; BAS, GÜRHAN; GOK, ALI FUAT KAAN; Aren, Acar; Ankarali, Handan; Ekinci, Ozgür

doi:10.14744/tjtes.2020.81839

Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study

Jülide Şükriye SAĞIROĞLU, (İstanbul Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, İstanbul, Türkiye)

Damla BEYAZADAM, (İstanbul Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, İstanbul, Türkiye)

Ali KAAN, (İstanbul Üniversitesi İstanbul Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye)

Hasan ÖKMEN, (Sağlık Bilimleri Üniversitesi, İstanbul Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye)

Adnan ÖZPEK, (Sağlık Bilimleri Üniversitesi, İstanbul Ümraniye Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye)

Süleyman ATALAY, (Sağlık Bilimleri Üniversitesi, İstanbul Sultan Abdulhamid Han Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye)

Handan ANKARALI, (İstanbul Medeniyet Üniversitesi, Fen Fakültesi, Biyoistatistik ve Tıbbi Bilişim Bilim Dalı, İstanbul, Türkiye)

Özgür EKİNCİ, (1 İstanbul Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, İstanbul, Türkiye)

Acar AREN, (İstanbul Kent Üniversitesi, Ameliyathane Hizmetleri, İstanbul, Türkiye)

Yavuz KURT, (Sağlık Bilimleri Üniversitesi, İstanbul Sultan Abdulhamid Han Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye)

Gürhan BAŞ, (İstanbul Medeniyet Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye)

Cemalettin ERTEKİN, (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye)

Diğer Yazarlar

Ulusal Travma ve Acil Cerrahi Dergisi

2 1

Yıl: 2021 Cilt: 27 Sayı: 1 Sayfa Aralığı: 132 - 138 Metin Dili: İngilizce DOI: 10.14744/tjtes.2020.81839 İndeks Tarihi: 11-06-2022

Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study

Öz:

BACKGROUND: Acute left colonic diverticulitis (ALCD) ranges from localized diverticulitis to perforation and fecal peritonitis, and treatment varies from conservative management to emergency surgery. The risk factors for recurrence following nonoperative management of ALCD is still controversial. We aimed to define the factors predicting severity level, progression and recurrence risk of ALCD to timely select patients requiring surgery. METHODS: This is a multicenter study where patients were included on accrual. Patients in our clinic between December 2017 and June 2019 with ALCD above 18 years of age were included (n=144) in this study, while 18 years and younger, pregnant or nursing mothers, those with Crohn’s disease, ulcerative colitis, colorectal and/or anal cancer were excluded from this study. Laboratory parameters, Modified Hinchey Scores, clinical features, demographics, diet, smoking, alcohol consumption, body mass index, previous diverticulitis episodes, chronic diseases of patients with ALCD, as well as recurrences within 18 months after discharge were evaluated. RESULTS: The findings showed that smoking was more common in patients with previous episodes (p=0.04) and patients who underwent emergency surgery (p=0.04). Recurrence was higher in Modified Hinchey 1b and 2 (p=0.03) than 0 and 1a. Patients who were older than 50y had a higher propensity to undergo emergency surgery than the patients younger than 50y (p=0.049). Nausea, fever, respiratory rate, procalcitonin, total bilirubin and direct bilirubin levels were higher in patients with Modified Hinchey 4 (p=0.03, 0.049, 0.02, 0.001, 0.002, 0.001, respectively). Recurrence was higher in patients with a smoking history, previous ALCD episodes, lower body mass index and pandiverticulitis. CONCLUSION: Laboratory parameters, body mass index, age, clinical features, previous episodes of diverticulitis and smoking may predict the severity and progression of ALCD. Smoking and having low BMI seem to be precursors of ALCD recurrence, especially when the patient with MHS 1b or 2 had at least one previous episode of ALCD. Control colonoscopy results are predictive of recurrence.

Anahtar Kelime:

Türkiye’de akut sol kolon divertikülitinin şiddet, progresyon ve nüksüne etkili faktörler: Çok merkezli çalışma

Öz:

AMAÇ: Akut sol kolon divertiküliti (ASKD) klinikte lokalize divertikülitten perforasyon ve fekal divertikülite varan geniş bir yelpazede görülebilir; tedavi hastalığın şiddetine göre konservatif yöntemlerden acil cerrahiye kadar değişkenlik gösterebilir. Akut sol kolon divertikülitinin ameliyatsız tedavisini takiben görülebilen nüksüne neden olan risk faktörleri hala tartışmalıdır. Bu çalışmada, cerrahi tedavi gerektiren hastaların uygun zamanda belirlenmesine yönelik olarak ASKD şiddet, progresyon ve nüksünü belirleyici faktörlerin tanımlanmasını amaçladık. GEREÇ VE YÖNTEM: Çalışmamız çok merkezli ve ileriye yönelik olarak gerçekleştirildi. Kiliniğimizde aralık 2017–Haziran 2019 tarihleri arasında klinik, laboratuvar ve görüntüleme yöntemleriyle ASKD tanısı konularak yatışlı tedavisi yapılan (n=144) 18 yaş üzeri hastalar çalışmaya dahil edildi, 18 yaş ve daha genç, gebe veya emziren, önceden tanısı konulmuş Crohn, ülseratif kolon hastalığı, kolo-rektal ve/veya anal kanalda malign tümörü mevcut fakat ameliyat edilmemiş hastalar çalışmadan dışlandı. Hastaların yatış esnasındaki laboratuvar parametreleri, Modifiye Hinchey Skoru (MHS), klinik özellikleri, demografi, beslenme, sigara ve alkol alışkanlıkları, vücut kütle indeksleri (VKİ), önceki divertikülit atakları, mevcut kronik hastalıklarının yanısıra taburculuktan itibaren 18 ay içindeki divertikülit nüksleri kaydedildi. BULGULAR: Sigara içme alışkanlığı önceden divertikülit atağı geçirmiş (p=0.04) veya acil cerrahiye alınmış (p=0.04) hastalarda anlamlı olarak daha fazla görüldü. Nüksetme, MHS 1b ve 2 de, 0 ve 1a’dan anlamlı olarak yüksekti (p=0.03). Acil cerrahi girişim yapılan hastalar incelendiğinde 50 yaş üzeri hastaların, daha genç hastalardan anlamlı olarak fazla olduğu görüldü (p=0.049). Yatış esnasında bulantı, ateş, solunum sayısı, prokalsitonin, total bilirubin ve direkt bilirubin seviyeleri MHS 4 olan hastalarda, diğer hastalara göre anlamlı olarak daha yüksek bulundu (sırasıyla, p=0.03, 0.049, 0.02, 0.001, 0.002, 0.001). Nüksetme, sigara içme alışkanlığı, önceden ASKD öyküsü, düşük VKİ ve pandivertikülit mevcudiyeti olan hastalarda diğer hastalara göre yüksekti. TARTIŞMA: Laboratuvar parametreleri, VKİ, yaş, klinik özellikler, önceden geçirilen divertikülit öyküsü ve sigara kullanımı, ASKD’nin şiddet ve seyri hakkında belirleyicidir. Önceden en az bir ASKD atağı geçirmiş olan MHS 1b-2 hastalarda sigara alışkanlığı ve düşük VKİ mevcudiyeti ASKD nüksüne yatkınlık oluşturmaktadır. Kontrol kolonoskopi sonuçları nüksetme olasılığı hakkında yönlendiricidir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Mäkelä J, Vuolio S, Kiviniemi H, Laitinen S. Natural history of diverticular disease: when to operate?. Dis Colon Rectum 1998;41:1523−8.
2. Käser SA, Fankhauser G, Glauser PM, Toia D, Maurer CA. Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis. World J Surg 2010;34:2717−22.
3. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85−109.
4. Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis 2012;27:207−14.
5. Biondo S, Parés D, Martí Ragué J, Kreisler E, Fraccalvieri D, Jaurrieta E. Acute colonic diverticulitis in patients under 50 years of age. Br J Surg 2002;89:1137−41.
6. Schauer PR, Ramos R, Ghiatas AA, Sirinek KR. Virulent diverticular disease in young obese men. Am J Surg 1992;164:443−8.
7. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C. Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 2002;45:962−6.
8. McGuire HH Jr. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg 1994;220:653−6.
9. Efron JE, Nogueras JJ. Controversies in diverticular disease: indications for surgery and surgical options. Semin Colon Rectal Surg 2000;11:206−13.
10. Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 2003;186:696−701.
11. Chung CH, Ng CP, Lai KK. Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study. Hong Kong Med J 2000;6:254−9.
12. Mengücük ME, Ayten R, Bülbüller N, Gödekmerdan A, Başbuğ M, Mungan İ. Role of C-reactive protein, procalsitonin and neopterin in the diagnosis of acute appendicitis. Fırat Med J 2010;15:40−3.
13. Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Ann Gastroenterol 2013;26:325−31.
14. Reynolds IS, Heaney RM, Khan W, Khan IZ, Waldron R, Barry K. The Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Intervention in Acute Diverticulitis. Dig Surg 2017;34:227−32.
15. Mäkelä JT, Klintrup K, Takala H, Rautio T. The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit. Scand J Gastroenterol 2015;50:536−41.
16. Jeger V, Pop R, Forudastan F, Barras JP, Zuber M, Piso RJ. Is there a role for procalcitonin in differentiating uncomplicated and complicated diverticulitis in order to reduce antibiotic therapy? A prospective diagnostic cohort study . Swiss Med Wkly 2017;147:w14555.
17. Ido F, Lina M, Tegeltija V, Kulairi Z. Procalcitonin in Uncomplicated Diverticulitis (ProUD). Am J Gastroenterol 2018;113:81–2.
18. Nikberg M, Ji J, Leppert J, Sundquist K, Chabok A. Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997- 2012. Int J Colorectal Dis 2017;32:1591−6.
19. Humes DJ, Ludvigsson JF, Jarvholm B. Smoking and the Risk of Hospitalization for Symptomatic Diverticular Disease: A Population-Based Cohort Study from Sweden. Dis Colon Rectum 2016;59:110−4.
20. Faria GR, Almeida AB, Moreira H, Pinto-de-Sousa J, Correia-da-Silva P, Pimenta AP. Acute diverticulitis in younger patients: any rationale for a different approach?. World J Gastroenterol 2011;17:207−12.
21. Benjamin ER, Dilektasli E, Haltmeier T, Beale E, Inaba K, Demetriades D. The effects of body mass index on complications and mortality after emergency abdominal operations: The obesity paradox. Am J Surg 2017;214:899−903.
22. Beresneva O, Hall J. Influence of body mass index on outcomes in patients undergoing surgery for diverticular disease. Surg Open Sci 2019;1:80−5.
23. Dietch ZC, Duane TM, Cook CH, O’Neill PJ, Askari R, Napolitano LM, et al. Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. Surg Infect (Larchmt) 2016;17:412−21.
24. Ma W, Nguyen LH, Song M, Jovani M, Liu PH, Cao Y, et al. Intake of Dietary Fiber, Fruits, and Vegetables and Risk of Diverticulitis. Am J Gastroenterol 2019;114:1531−8.
25. Tursi A. Dietary pattern and colonic diverticulosis. Curr Opin Clin Nutr Metab Care 2017;20:409−13.
26. Sartelli M, Catena F, Ansaloni L, Coccolini F, Griffiths EA, Abu-Zidan FM, et al. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg 2016;11:37.
27. Biondo S, Trenti L, Elvira J, Golda T, Kreisler E. Outcomes of colonic diverticulitis according to the reason of immunosuppression. Am J Surg 2016;212:384−90.
28. Durmishi Y, Gervaz P, Brandt D, Bucher P, Platon A, Morel P, et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surg Endosc 2006;20:1129−33.
29. El-Sayed C, Radley S, Mytton J, Evison F, Ward ST. Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis. Dis Colon Rectum 2018;61:382−9.
30. Al Harakeh H, Paily AJ, Doughan S, Shaikh I. Recurrent Acute Diverticulitis: When to Operate?. Inflamm Intest Dis 2018;3:91−9.

APA	Sagiroglu J, Beyazadam D, GOK A, ÖKMEN H, OZPEK A, ATALAY S, Ankarali H, Ekinci O, Aren A, Kurt Y, BAS G, Ertekin C (2021). Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. , 132 - 138. 10.14744/tjtes.2020.81839
Chicago	Sagiroglu Julide,Beyazadam Damla,GOK ALI FUAT KAAN,ÖKMEN HASAN,OZPEK ADNAN,ATALAY SÜLEYMAN,Ankarali Handan,Ekinci Ozgür,Aren Acar,Kurt Yavuz,BAS GÜRHAN,Ertekin Cemalettin Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. (2021): 132 - 138. 10.14744/tjtes.2020.81839
MLA	Sagiroglu Julide,Beyazadam Damla,GOK ALI FUAT KAAN,ÖKMEN HASAN,OZPEK ADNAN,ATALAY SÜLEYMAN,Ankarali Handan,Ekinci Ozgür,Aren Acar,Kurt Yavuz,BAS GÜRHAN,Ertekin Cemalettin Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. , 2021, ss.132 - 138. 10.14744/tjtes.2020.81839
AMA	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. . 2021; 132 - 138. 10.14744/tjtes.2020.81839
Vancouver	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. . 2021; 132 - 138. 10.14744/tjtes.2020.81839
IEEE	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C "Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study." , ss.132 - 138, 2021. 10.14744/tjtes.2020.81839
ISNAD	Sagiroglu, Julide vd. "Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study". (2021), 132-138. https://doi.org/10.14744/tjtes.2020.81839

APA	Sagiroglu J, Beyazadam D, GOK A, ÖKMEN H, OZPEK A, ATALAY S, Ankarali H, Ekinci O, Aren A, Kurt Y, BAS G, Ertekin C (2021). Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. Ulusal Travma ve Acil Cerrahi Dergisi, 27(1), 132 - 138. 10.14744/tjtes.2020.81839
Chicago	Sagiroglu Julide,Beyazadam Damla,GOK ALI FUAT KAAN,ÖKMEN HASAN,OZPEK ADNAN,ATALAY SÜLEYMAN,Ankarali Handan,Ekinci Ozgür,Aren Acar,Kurt Yavuz,BAS GÜRHAN,Ertekin Cemalettin Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. Ulusal Travma ve Acil Cerrahi Dergisi 27, no.1 (2021): 132 - 138. 10.14744/tjtes.2020.81839
MLA	Sagiroglu Julide,Beyazadam Damla,GOK ALI FUAT KAAN,ÖKMEN HASAN,OZPEK ADNAN,ATALAY SÜLEYMAN,Ankarali Handan,Ekinci Ozgür,Aren Acar,Kurt Yavuz,BAS GÜRHAN,Ertekin Cemalettin Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. Ulusal Travma ve Acil Cerrahi Dergisi, vol.27, no.1, 2021, ss.132 - 138. 10.14744/tjtes.2020.81839
AMA	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. Ulusal Travma ve Acil Cerrahi Dergisi. 2021; 27(1): 132 - 138. 10.14744/tjtes.2020.81839
Vancouver	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study. Ulusal Travma ve Acil Cerrahi Dergisi. 2021; 27(1): 132 - 138. 10.14744/tjtes.2020.81839
IEEE	Sagiroglu J,Beyazadam D,GOK A,ÖKMEN H,OZPEK A,ATALAY S,Ankarali H,Ekinci O,Aren A,Kurt Y,BAS G,Ertekin C "Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study." Ulusal Travma ve Acil Cerrahi Dergisi, 27, ss.132 - 138, 2021. 10.14744/tjtes.2020.81839
ISNAD	Sagiroglu, Julide vd. "Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study". Ulusal Travma ve Acil Cerrahi Dergisi 27/1 (2021), 132-138. https://doi.org/10.14744/tjtes.2020.81839