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researchsquare; 2022.


Background Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis. Methods This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher’s exact test. The Mann–Whitney U test was used for continuous variables. Multivariate regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases. Results Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784–0.956); CRP, 0.800 (95% CI, 0.707–0.892); NLR, 0.724 (95% CI, 0.616–0.832); PLR, 0.662 (95% CI, 0.525–0.798); and WBC, 0.679 (95% CI, 0.563–0.795). The MDW had the largest AUC for diagnosing complicated diverticulitis; when the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively. Conclusions Patients with complicated diverticulitis were significantly older and predominantly had left-sided colonic diverticulitis. A large MDW was a significant and independent predictor of complicated diverticulitis. The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.

Diverticulitis, Colonic , Pancreatitis , Diverticulitis , Abdominal Pain , Coronavirus Infections
West Afr J Med ; 39(9): 982-984, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2034207


This is a case of a 53-year-old African American woman with newly diagnosed concomitant acute cholecystitis, diverticulitis, and SARS-COV-2 infection. She underwent treatment for COVID-19 with antibiotics and supportive treatment, and on day 32 after initial symptoms presented, she had an elective laparoscopic cholecystectomy. Our patient was one of the first cases to present with acute cholecystitis and diverticulitis complicated by COVID-19, and serves as a template for surgical management of non-emergent abdominal pathologies in the midst of the COVID-19 pandemic.

Voici le cas d'une Afro-Américaine de 53 ans chez qui on a diagnostiqué récemment une cholécystite aiguë concomitante, une diverticulite et une infection par le SRAS-COV-2. Elle a été traitée pour l'infection COVID-19 avec des antibiotiques et un traitement de soutien, et le 32e jour après l'apparition des premiers symptômes, elle a subi une cholécystectomie laparoscopique élective. Notre patiente a été l'un des premiers cas à présenter une cholécystite et une diverticulite aiguës compliquées par le COVID-19, et sert de modèle pour la gestion chirurgicale des pathologies abdominales non urgentes au milieu de la pandémie de COVID-19. Mots-clés: COVID-19, Diverticulite, Cholécystite, SARCOV-2.

COVID-19 , Cholecystitis, Acute , Diverticulitis, Colonic , Diverticulitis , Abscess/complications , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Cholecystitis, Acute/complications , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/surgery , Diverticulitis/complications , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Female , Humans , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
Am Surg ; 88(1): 133-139, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1574563


BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in fewer emergency presentations of many acute medical and surgical conditions. The purpose of this study was to assess the severity of disease at presentation and quantify the change in number of presentations during this period. METHODS: This retrospective study includes all patients diagnosed with acute diverticulitis on abdominopelvic computerised tomography (CT) between March 1, 2020 and June 30, 2020, compared to the same period in 2019. Follow up scans on the index admission were excluded. Hinchey grade was assessed for all CT scans. Inflammatory markers were analysed, along with outcome measures including length of stay and mortality. RESULTS: Acute diverticulitis was diagnosed in 52 CT scans in the acute pandemic period - a decrease of 51.4%. Average age at presentation was unchanged (63.3 ± 14.3 vs. 62.8 ± 13.8, P = .848). The number of Hinchey II, III and IV presentations were significantly higher in the acute pandemic period (28.8% vs. 11.2%, P = .005) and significantly more emergency operations were carried out (7.69% vs. .93%, P = .04). Mortality was not significantly increased, nor were serum levels of C-reactive protein, white cell count and lactate. DISCUSSION: During the COVID-19 pandemic, fewer patients presented and were diagnosed with acute diverticulitis. A significantly greater proportion presented at a more advanced stage and required emergency surgery, suggesting late presentation. Our findings support the need for maintaining acute surgical services and the provision of early radiological and surgical input in patients presenting with signs and symptoms of acute diverticulitis in future pandemics.

COVID-19 , Diverticulitis, Colonic/diagnosis , Diverticulitis, Colonic/surgery , Emergency Medical Services/trends , Facilities and Services Utilization/trends , Patient Acceptance of Health Care , Patient Acuity , Acute Disease , Adult , Aged , Aged, 80 and over , Diverticulitis, Colonic/epidemiology , Emergencies , Female , Follow-Up Studies , Humans , Length of Stay/statistics & numerical data , London/epidemiology , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed
Medicina (Kaunas) ; 57(10)2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1470928


Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.

COVID-19 , Diverticulitis, Colonic , Diverticulitis , Acute Disease , Diverticulitis, Colonic/diagnostic imaging , Diverticulitis, Colonic/surgery , Humans , Pandemics , SARS-CoV-2
Emerg Radiol ; 28(2): 279-282, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-803501


PURPOSE: To evaluate the frequency with which patients with an urgent health concern, specifically diverticulitis, avoided appropriate medical care during the early weeks of the coronavirus pandemic of 2020 and to study the consequences of the resultant delay in care, the incidence of an associated abscess. METHODS: This study was institutional review board approved. Reports for CT studies with findings of newly diagnosed diverticulitis within Henry Ford Health System during the early weeks of the coronavirus pandemic of 2020 were reviewed and compared with the same time period in 2019. Total cases of diverticulitis on CT were compared, as well as the prevalence of an associated abscess. A chi-squared analysis was performed to determine the statistical significance of the percentage of patients presenting with an abscess in each year. RESULTS: During the early weeks of the coronavirus pandemic, 120 patients were identified with CT findings of newly diagnosed diverticulitis with 11.7% of those patients (14 patients) presenting with an associated abscess. During the same time period in 2019, many more CT studies with newly diagnosed diverticulitis were obtained (339), and, compared to 2020, less than half the percentage of those patients had an associated abscess (4.4% or 15 patients). CONCLUSION: Patients with urgent health concerns avoided appropriate and necessary care during the early weeks of the coronavirus pandemic. While non-COVID-19 emergency visits were diminished, patients who did present with diverticulitis were more likely to present with greater disease severity as manifested by an associated abscess. Patients must be encouraged to seek care when appropriate and need reassurance that hospitals and their emergency departments are safe to visit. Furthermore, emergency physicians and radiologists in particular should be vigilant during times when emergency volumes are low, such as a future surge in coronavirus patients, other pandemics, snow storms, and holidays as the patients who do present for care are more likely to present at later stages and with serious complications.

Abscess/diagnostic imaging , Diverticulitis, Colonic/diagnostic imaging , Patient Acceptance of Health Care , Tomography, X-Ray Computed , COVID-19/epidemiology , Female , Humans , Male , Pandemics , Prevalence , SARS-CoV-2