Emerging evidence and recent controversies in diverticulitis: a 5-year review

Abstract

Diverticulitis is a common gastrointestinal disease that still garners significant attention and study because of its heterogeneity in presentation and outcome. We provide a review of the newest and most controversial topics in diverticulitis. Recent discoveries on the influence of diet and other environmental risk factors are discussed, showing how the epidemiology of the disease process is shifting away from what was previously felt to be a disorder primarily limited to older western populations. Interestingly, as has long been suspected, genetic mutations and variations associated with the development of diverticulitis are being discovered and are summarized here. The data for non-operative and outpatient management of diverticulitis are reviewed, as are pharmacologic agents studied for use in the secondary prevention of diverticulitis. Lastly, we present controversies in the surgical treatment of diverticulitis. This review will provide a synopsis of the last 5 years of literature relating to diverticulitis.

Keywords: Diverticulitis; epidemiology; etiology; management.

Figure 1

Pathophysiology of diverticulitis. The pathogenetic mechanisms leading to diverticulitis are multifactorial, including genetic, dietary, and environmental factors, ultimately resulting in inflammation of one or more colonic diverticula

Figure 2

Management algorithm for acute diverticulitis. Management and treatment strategies depend on the severity of presentation, presence of significant comorbidities, and presence of complications (peritonitis, abscess, etc.). Recommendations based on current WSES Guidelines 2020. High-risk presentation includes elevated WBC and/or CRP, fever, signs of sepsis or peritonitis, and/or immunocompromised status. Current recommendation is to not prescribe antibiotics in uncomplicated cases in immunocompetent patients CRP, C-reactive protein; CT, computed tomography; IV, intravenous; LLQ, left lower quadrant; NPO, nil per os; PO, per os; WBC, white blood cell count; WSES, World Society of Emergency Surgery