John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Natural history of colonic diverticulosis - diverticular disease Volume 27, issue 10, Décembre 2020


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1 Hôpital La Timone, AP-HM, Service de chirurgie digestive, Université de Marseille
2 Hôpital Saint-Louis, AP-HP, Service de chirurgie viscérale, cancérologique et endocrinienne, 1 avenue Claude Vellefaux, 75010, Paris ; Université de Paris
* Correspondance

Colonic diverticulosis, anatomically defined by the presence of one or more diverticula, constituted of a mucosal and sub-mucosal hernia through the colonic muscular layer, is extremely frequent in industrialized countries. Its prevalence increases with age, but its occurrence remains asymptomatic. However, in 30% of the cases, the occurrence of infectious or hemorrhagic complications will be responsible for the entry into the diverticular disease, which is one of the most frequent gastro-intestinal emergencies and might lead to life-threatening situations. Infectious complications are the most frequent and computed tomography is the cornerstone of their diagnosis, allowing to distinguish non-complicated diverticulitis, whose treatment will be symptomatic and ambulatory, from complicated diverticulitis with perforation, abscess or fistula, which will require a hospitalization. In acute phase, indications of emergency surgery are scarce and mainly limited to patients with peritonitis. Finally, in 2017 the Haute Autorité de Santé published practice guidelines to clearly define the indications of prophylactic surgery following an acute flare. If these indications are less frequent than during the previous decades, prophylactic surgery is nevertheless still frequently required and allows a significant reduction of recurrence risk and improvement of quality of life of these patients.