International Journal of Gerontology
Volume 3, Issue 1 , Pages 9-15, March 2009

Colonic Diverticulitis in the Elderly

  • Chien-Kuo Liu

      Affiliations

    • Division of Colorectal Surgery, Department of Surgery, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chien-Kuo Liu, Division of Colorectal Surgery, Department of Surgery, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan
    • ,
  • Hsi-Hsien Hsu

      Affiliations

    • Division of Colorectal Surgery, Department of Surgery, Taipei, Taiwan
    • ,
  • She-Meng Cheng

      Affiliations

    • Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan

Accepted 14 February 2009.

Article Outline

SUMMARY 

Diverticular disease of the colon is a disease that mainly affects the elderly and presents in 50–70% of those aged 80 years or older. The most common complication is colonic diverticulitis. Eighty percent of patients who present with colonic diverticulitis are aged 50 years and older. Diagnosis and treatment of colonic diverticulitis in the elderly is more difficult and complicated owing to more comorbid conditions. Computed tomography is recommended for diagnosis when colonic diverticulitis is suspected. Most patients admitted with acute colonic diverticulitis respond to conservative treatment, but 15–30% of patients require surgery. Because surgery for acute colonic diverticulitis carries significant rates of morbidity and mortality, conservative treatment is recommended in the elderly. Conservative treatment of colonic diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for 1–2 weeks. In the absence of a response to conservative treatment, frequent recurrence or complications (abscesses, fistulas, bowel obstructions, and free perforations), surgery is indicated.

Key Words:  colon inflammation , colonic diverticular disease , colonic diverticulitis , elderly

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Tursi A . Mesalazine for diverticular disease of the colon- a new role for an old drug . Expert Opin Pharmacother . 2005;6:69–74
  2. Ferzoco LB , Raptopoulos V , Silen W . Acute diverticulitis . N Engl J Med . 1998;338:1521–1526
  3. Stollman NH , Raskin JB . Diverticular disease of the colon . J Clin Gastroenterol . 1999;29:241–252
  4. Jun S , Stollman N . Epidemiology of diverticular disease . Best Pract Res Clin Gastroenterol . 2002;16:529–542
  5. Yap I , Hoe J . A radiological survey of diverticulitis in Singapore . Singapore Med J . 1991;32:218–220
  6. Chan CC , Lo KK , Chung EC , Lo SS , Hon TY . Colonic diver-ticulosis in Hong Kong: distribution pattern and clinical significance . Clin Radiol . 1998;53:842–844
  7. Sugihara K , Muto T , Morioka Y , Asano A , Yamamoto T . Diverticular disease of the colon in Japan: a review of 615 cases . Dis Colon Rectum . 1984;27:531–537
  8. Miura S , Kodaira S , Aoki H , Hosoda Y . Bilateral type diverticular disease of the colon . Int J Colorectal Dis . 1996;11:71–75
  9. Markham NI , Li AK . Diverticulitis of the right colon-experience from Hong Kong . Gut . 1992;33:547–549
  10. Beranbaum SL , Zausner J , Lane B . Diverticular disease of the right colon . Am J Roentgenol Radium Ther Nucl Med . 1972;115:334–348
  11. Stemmermann GN . Patterns of disease among Japanese living in Hawaii . Arch Environ Health . 1970;20:266–273
  12. Parks TG . Natural history of diverticular disease of the colon . Clin Gastroenterol . 1975;4:53–69
  13. Ambrosetti P , Robert JH , Witzig JA , Mirescu D , Mathey P , Borst F , et al.   Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases . Surgery . 1994;115:546–550
  14. Simpson J , Scholefield JH , Spiller RC . Pathogenesis of colonic diverticula . Br J Surg . 2002;89:546–554
  15. Stollman N , Raskin JB . Diverticular disease of the colon . Lancet . 2004;363:631–639
  16. Burkitt DP , Walker AR , Painter NS . Dietary fiber and disease . JAMA . 1974;229:1068–1074
  17. Floch MH , White JA . Management of diverticular disease is changing . World J Gastroenterol . 2006;12:3225–3228
  18. Di Mario F , Comparato G , Fanigliulo L , Aragona G , Cavallaro LG , Cavestro GM , et al.   Use of mesalazine in diverticular disease . J Clin Gastroenterol . 2006;40(Suppl 3):S155–S159
  19. Ghorai S , Ulbright TM , Rex DK . Endoscopic findings of diverticular inflammation in colonoscopy patients without clinical acute diverticulitis: prevalence and endo-scopic spectrum . Am J Gastroenterol . 2003;98:802–806
  20. Floch MH , Bina I . The natural history of diverticulitis: fact and theory . J Clin Gastroenterol . 2004;38(Suppl 5):S2–S7
  21. Peppercorn MA . The overlap of inflammatory bowel disease and diverticular disease . J Clin Gastroenterol . 2004;38(Suppl 5):S8–10
  22. Shepherd NA . Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades . Gut . 1996;38:801–802
  23. Brook I , Frazier EH . Aerobic and anaerobic microbiology in intra-abdominal infections associated with divertic-ulitis . J Med Microbiol . 2000;49:827–830
  24. Hinchey EJ , Schaal PG , Richards GK . Treatment of perforated diverticular disease of the colon . Adv Surg . 1978;12:85–109
  25. Schwesinger WH , Page CP , Gaskill HV , Steward RM , Chopra S , Strodel WE , et al.   Operative management of diverticular emergencies: strategies and outcomes . Arch Surg . 2000;135:558–562
  26. Sarma D , Longo WE . NDSG. Diagnostic imaging for diverticulitis . J Clin Gastroenterol . 2008;42:1139–1141
  27. Simmang CL , Shires GT . Diverticular disease of the colon . In:  Feldman M ,  Friedman LS ,  Sleisenger MH editor. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management . 7th edition. Philadelphia: Saunders; 2002;p. 2100–2112
  28. Werner A , Diehl SJ , Farag-Soliman M , Düber C . Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients . Eur Radiol . 2003;13:2596–2603
  29. Siewert B , Tye G , Kruskal J , Sosna J , Opelka F , Raptopoulos V , et al.   Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters . AJR Am J Roentgenol . 2006;186:680–686
  30. Schwerk WB , Schwarz S , Rothmund M . Sonography in acute colonic diverticulitis: a prospective study . Dis Colon Rectum . 1992;35:1077–1084
  31. Johnson CD , Baker ME , Rice RP , Silverman P , Thompson WM . Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT . AJR Am J Roentgenol . 1987;148:541–546
  32. Schreyer AG , Fürst A , Agha A , Kikinis R , Scheibl K , Schölmerich J , et al.   Magnetic resonance imaging based colonography for diagnosis and assessment of divertic-ulosis and diverticulitis . Int J Colorectal Dis . 2004;19:474–480
  33. Comparato G , Pilotto A , Franzè A , Franceschi M , Di Mario F . Diverticular disease in the elderly . Dig Dis . 2007;25:151–159
  34. Jacobs DO . Clinical practice: diverticulitis . N Engl J Med . 2007;357:2057–2066
  35. Salzman H , Lillie D . Diverticular disease: diagnosis and treatment . Am Fam Physician . 2005;72:1229–1234
  36. Saini S , Mueller PR , Wittenberg J , Butch RJ , Rodkey GV , Welch CE . Percutaneous drainage of diverticular abscess: an adjunct to surgical therapy . Arch Surg . 1986;121:475–478
  37. Janes SE , Meagher A , Frizelle FA . Management of diver-ticulitis . BMJ . 2006;332:271–275
  38. Cinat ME , Wilson SE , Din AM . Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess . Arch Surg . 2002;137:845–849
  39. Broderick-Villa G , Burchette RJ , Collins JC , Abbas MA , Haigh PI . Hospitalization for acute diverticulitis does not mandate routine elective colectomy . Arch Surg . 2005;140:576–583
  40. Boland E , Hsu A , Brand MI , Saclarides TJ . Hartmann's colostomy reversal: outcome of patients undergoing surgery with the intention of eliminating fecal diversion . Am Surg . 2007;73:664–668
  41. Schilling MK , Maurer CA , Kollmar O , Büchler MW . Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis . Dis Colon Rectum . 2001;44:699–705
  42. Richter S , Lindemann W , Kollmar O , Pistorius GA , Maurer CA , Schilling MK . One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey Stages III and IV) . World J Surg . 2006;30:1027–1032
  43. Perez RO , Habr-Gama A , Seid VE , Proscurshim I , Sousa AH , Kiss DR , et al.   Loop ileostomy morbidity: timing of closure matters . Dis Colon Rectum . 2006;49:1539–1545
  44. Aydin HN , Remzi FH , Tekkis PP , Fazio VW . Hartmann's reversal is associated with high postoperative adverse events . Dis Colon Rectum . 2005;48:2117–2126
  45. Wong WD , Wexner SD , Lowry A , Vernava A , Burnstein M , Denstman F , et al.   Practice parameters for the treatment of sigmoid diverticulitis-supporting documentation. The standards task force. The American Society of Colon and Rectal Surgeons . Dis Colon Rectum . 2000;43:290–297
  46. Köhler L , Sauerland S , Neugebauer E . Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery . Surg Endosc . 1999;13:430–436
  47. Janes S , Meagher A , Frizelle FA . Elective surgery after acute diverticulitis . Br J Surg . 2005;92:133–142
  48. Egger B , Peter MK , Candinas D . Persistent symptoms after elective sigmoid resection for diverticulitis . Dis Colon Rectum . 2008;51:1044–1048

PII: S1873-9598(09)70015-8

doi:10.1016/S1873-9598(09)70015-8

International Journal of Gerontology
Volume 3, Issue 1 , Pages 9-15, March 2009

Article Tools