Diverticular disease
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- left lower quadrant abdominal pain
- fever
Otros factores de diagnóstico
- guarding in left lower quadrant
- tenderness in left lower quadrant
- rebound tenderness
- diffuse abdominal tenderness
- change in bowel habit
- palpable abdominal mass
Factores de riesgo
- age >50 years
- low dietary fiber
- diet rich in salt, meat, and sugar
- obesity (BMI >30)
- use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or opioids
- tobacco smoking
- alcohol consumption
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- CBC with differential
- CRP
- basic metabolic panel
- contrast CT scan of abdomen
Pruebas diagnósticas que deben considerarse
- blood culture
- ABG and serum lactate
- noncontrast CT scan of abdomen
- abdominal ultrasound (graded-compression)
- abdominal MRI scan
- colonoscopy or sigmoidoscopy
- diagnostic laparoscopy/exploratory laparotomy
Algoritmo de tratamiento
asymptomatic diverticulosis
acute uncomplicated diverticulitis
acute complicated diverticulitis
recurrent diverticulitis
Colaboradores
Consejeros especializados
Marilyse Boutros, MD, FACS, FRCSC
Vice-Chair and Regional Director of Research for the Digestive Disease Institute, Cleveland Clinic Weston Hospital
Colorectal Surgeon, Cleveland Clinic Florida
Weston
Clinical Affiliate Professor of Surgery, Florida Atlantic University
Boca Raton
FL
Professor of Surgery, McGill University
Montreal
Canada
Divulgaciones
MB has received teaching honorarium from Ethicon and Johnson and Johnson.
Sameh Hany Emile, MBBCh, MSc, MD, FACS
Project Scientist
Department of Colorectal Surgery
Cleveland Clinic Florida
Weston
Clinical Affiliate Associate Professor of Surgery
Florida Atlantic University
Boca Raton
FL
Associate Professor of Surgery
Mansoura University Faculty of Medicine
Mansoura City
Egypt
Divulgaciones
SHE receives consultancy fees from Becton, Dickinson and Company.
Agradecimientos
Dr Marilyse Boutros and Dr Sameh Hany Emile would like to gratefully acknowledge Dr Mohamed A. Thaha, Dr Jayan D. Jayasinghe, Dr Emma Carrington, Ms Kathryn Lynes, Professor Norman S. Williams, and Dr Abbasi Akhtar, the previous contributors to this topic.
Divulgaciones
MAT declares he has no competing interests. JDJ declares that he has no competing interests. EC has received honoraria for teaching, and acts as a consultant for Laborie Medical Management Systems. KL has received funding for a research fellowship from the David Johnston Fellowship through the Royal College of Surgeons of England. NSW is an author of a reference cited in this topic. AA declares that he has no competing interests.
Revisores por pares
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Divulgaciones
NS declares that he has no competing interests.
Nicolas Regenet, MD
Clinic of digestive and endocrine surgery
University Hospital
Nantes
France
Divulgaciones
NR declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Hall J, Hardiman K, Lee S, et al. 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):728-47.Texto completo Resumen
Sartelli M, Weber DG, Kluger Y, 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.Texto completo Resumen
Stollman N, Smalley W, Hirano I; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9.Texto completo Resumen
Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.Texto completo Resumen
American College of Radiology. ACR appropriateness criteria: left lower quadrant pain. 2023 [internet publication].Texto completo
Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):399-415.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Endometriosis
- Colorectal cancer
- Appendicitis
Más DiferencialesGuías de práctica clínica
- Diagnosis and management of acute left-sided colonic diverticulitis
- 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
Más Guías de práctica clínicaFolletos para el paciente
Appendicitis
Constipation in adults
Más Folletos para el paciente
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