HOSPITAL ADMISSION, MEDICAL, AND SURGICAL PROCEDURES FOR ACUTE DIVERTICULITIS ARE MORE APPROPRIATE WHEN USING A DIAGNOSTIC AND THERAPEUTIC ASSISTANCE PATHWAY: AN EXPERIENCE FROM A REFERRAL CENTRE.

IIntroduction: Our aim was to assess the impact of the Diagnostic and Therapeutic Assistance Pathway (PDTA) developed for acute diverticulitis (AD) on the management of patients with AD and referring to the emergency Room (ER) in a referral centre. METHODS: This retrospective study includes all patients diagnosed with AD and referring to the ER between January 1st 2021 and December 31st 2022 (after approval of PDTA), compared to the same period of 2015-2019. Length of stay in ER, medical and surgical management, and lenght in hospital stay (in days) were also measured according to the type of disease (uncomplicated vs. complicated). RESULTS: ER admission due to AD during the period 2015-2019 was 240±13 cases per year, while it was 290 cases in 2022 (p=0.05). After adopting the PDTA, the rate of lenght of stay in ER >24h for AD was significantly reduced (p=0.01); the median rate of hospital admission for AD was significantly reduced (p<0.05); the rate of medical treatment of uncomplicated disease was increased (p=0.01), while the rate of surgical management was decreased (p=0.05); the rate of medical treatment of complicated disease was increased (p=0.01), while the rate of surgical management was decreased (p=0.001); the hospital stay was significantly reduced both in uncomplicated (p=0.05) and uncomplicated (p=0.05) AD. CONCLUSIONS: The development and the routinely use of a PDTA dedicated to AD has significantly improved the management of these patients, reducing the ER stay, the surgical procedures and the overall hospital stay.

[Perforated jejunal diverticulitis: a case report]. / Diverticolite digiunale perforata: caso clinico.

The authors present a case of midgut perforated diverticulitis in a 78-year-old patient, associated with a colovesical fistula and sigmoid obstruction of diverticular origin. Surgical resection of the small bowel segment affected together with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. In complicated midgut diverticulitis the preoperative diagnosis is a challenge: the symptoms are aspecific and imaging techniques are of no use. As a result, the diagnosis of complicated jejunoileal diverticulitis can be quite difficult, and a definitive diagnosis may often be made only after surgical exploration.