Clinical Scorecard: Management Approaches for Acute Diverticulitis: Trends Among Surgeons in Italy Based on a Survey by the Italian Society of Colorectal Surgery (SICCR)

At a Glance

Key Highlights

• Acute diverticulitis incidence is rising worldwide, affecting younger patients and causing significant morbidity and mortality.
• CT scan is pivotal for preoperative diagnosis and severity assessment, guiding management decisions.
• Management is evolving with improved antibiotics, minimally invasive drainage techniques, and laparoscopic surgery in emergencies.

Guideline-Based Recommendations

Diagnosis

• Use CT imaging as the primary tool for diagnosis and severity classification of acute diverticulitis.
• Differentiate acute diverticulitis from colon cancer using imaging.
• Apply Wasvary or Hinchey classifications for severity assessment, acknowledging limitations in some clinical scenarios.

Management

• Adopt flexible management strategies based on severity, ranging from non-operative treatment to surgical resection.
• Utilize improved antibiotic regimens for mild cases.
• Consider image-guided minimally invasive drainage for abscesses.
• Employ laparoscopic techniques in emergency surgery when feasible.

Monitoring & Follow-up

• Monitor clinical response and imaging findings to guide ongoing management decisions.
• Recognize the need for multidisciplinary approaches in emergency settings.

Risks

• Be aware of potential complications including abscess formation, fistulas, stenosis, and extraluminal air.
• Consider risks related to delayed or inappropriate management, especially in complex or severe cases.

Patient & Prescribing Data

Patients with varying severity of acute diverticulitis, including mild, complicated, and emergency cases

Antibiotic regimens have improved efficacy; non-operative and minimally invasive options are increasingly utilized; surgical approaches are tailored by severity and surgeon experience.

Clinical Best Practices

• Perform thorough CT-based assessment using established classifications to guide treatment.
• Tailor management to individual patient severity and clinical context, balancing non-operative and surgical options.
• Incorporate minimally invasive drainage and laparoscopic surgery when appropriate to reduce morbidity.
• Maintain awareness of evolving guidelines and adapt practice accordingly.
• Encourage multidisciplinary collaboration, especially in emergency and complex cases.
• Recognize variability in surgeon experience and resource availability influencing management decisions.

References

• Hinchey Classification of Diverticulitis (1978)
• Italian Society of Colorectal Surgery (SICCR) Survey on Diverticulitis Management
• Checklist for Reporting Results of Internet ESurveys (CHERRIES)