{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T09:54:22Z","timestamp":1756461262063},"reference-count":44,"publisher":"FapUNIFESP (SciELO)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Col. Bras. Cir."],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:p>The term \"complicated\" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +\/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and\/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and\/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.<\/jats:p>","DOI":"10.1590\/s0100-69912012000400013","type":"journal-article","created":{"date-parts":[[2012,8,29]],"date-time":"2012-08-29T08:58:36Z","timestamp":1346230716000},"page":"322-327","source":"Crossref","is-referenced-by-count":8,"title":["Complicated diverticular disease: the changing paradigm for treatment"],"prefix":"10.1590","volume":"39","author":[{"given":"Abe","family":"Fingerhut","sequence":"first","affiliation":[{"name":"University of Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Veyrie","sequence":"additional","affiliation":[{"name":"APHP University of Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"key":"ref1","first-page":"430","article-title":"Diagnosis and treatment of diverticular disease: results of a consensus development conference","volume":"13","author":"Kohler L","year":"1999","journal-title":"The Scientific Committee of the European Association for Endoscopic Surgery Surg Endosc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/SLA.0b013e31823acc5c","article-title":"Time for a (Re) Definition of (Recurrent) Sigmoid Diverticulitis?","volume":"254","author":"Gervaz P","year":"2011","journal-title":"Ann Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0003-4932","issn-type":"print"},{"key":"ref3","series-title":"Diverticular Disease World Gastroenterology Organisation Practice Guidelines World Gastroenterology Organisation","author":"Murphy T","year":"2007"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.juro.2009.05.022","article-title":"Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis","volume":"182","author":"Melchior S","year":"2009","journal-title":"J Urol","ISSN":"http:\/\/id.crossref.org\/issn\/0022-5347","issn-type":"print"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/BF02556792","article-title":"Internal fistulas in diverticular disease","volume":"31","author":"Woods RJ","year":"1988","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/bjs.6855","article-title":"Influence of hysterectomy on fistula formation in women with diverticulitis","volume":"97","author":"Altman D","year":"2010","journal-title":"Br J Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0007-1323","issn-type":"print"},{"key":"ref7","first-page":"457","article-title":"Colonic diverticular disease","volume":"37","author":"Young-Fadok TM","year":"2000","journal-title":"Curr Prob Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.gassur.2004.09.039","article-title":"Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis","volume":"9","author":"Khanna A","year":"2005","journal-title":"J Gastrointest Surg","ISSN":"http:\/\/id.crossref.org\/issn\/1091-255X","issn-type":"print"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1111\/j.1572-0241.2001.04048.x","article-title":"Endoscopic therapy of acute diverticular hemorrhage","volume":"96","author":"Bloomfield RS","year":"2001","journal-title":"Am J Gastroenterol","ISSN":"http:\/\/id.crossref.org\/issn\/0002-9270","issn-type":"print"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1056\/NEJM200001133420202","article-title":"Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage","volume":"342","author":"Jensen DM","year":"2000","journal-title":"N Engl J Med","ISSN":"http:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"key":"ref11","first-page":"85","article-title":"Treatment of perforated diverticular disease of the colon","volume":"12","author":"Hinchey EJ","year":"1978","journal-title":"Adv Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0065-3411","issn-type":"print"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s004649900340","article-title":"Laparoscopic surgery for diverticulitis","volume":"11","author":"Sher ME","year":"1977","journal-title":"Surg Endosc","ISSN":"http:\/\/id.crossref.org\/issn\/0930-2794","issn-type":"print"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1177\/000313489906500706","article-title":"Same hospitalization resection for acute diverticulitis","volume":"65","author":"Wasvary H","year":"1999","journal-title":"Am Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0003-1348","issn-type":"print"},{"key":"ref14","first-page":"443","article-title":"Prognostic factors in perforating diverticulitis of the large intestine","volume":"69","author":"Hansen O","year":"1998","journal-title":"Chirurg","ISSN":"http:\/\/id.crossref.org\/issn\/0009-4722","issn-type":"print"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1007\/s00330-001-1143-y","article-title":"Colonic diverticulitis: impact of imaging on surgical management-a prospective study of 542 patients","volume":"12","author":"Ambrosetti P","year":"2002","journal-title":"Eur Radiol","ISSN":"http:\/\/id.crossref.org\/issn\/0938-7994","issn-type":"print"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1111\/j.1572-0241.2005.41154.x","article-title":"The management of complicated diverticulitis and the role of computed tomography","volume":"100","author":"Kaiser AM","year":"2005","journal-title":"Am J Gastroenterol","ISSN":"http:\/\/id.crossref.org\/issn\/0002-9270","issn-type":"print"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/SLA.0b013e3181dbb5a5","article-title":"A Prospective, Randomized, Single-Blind Comparison of Laparoscopic Versus Open Sigmoid Colectomy for Diverticulitis","volume":"252","author":"Gervaz P","year":"2010","journal-title":"Ann Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0003-4932","issn-type":"print"},{"key":"ref18","first-page":"39","article-title":"Laparoscopic Sigmoid Resection for Diverticulitis Decreases Major Morbidity Rates: A Randomized Control Trial Short-term Results of the Sigma Trial","volume":"249","author":"Klarenbeek BR","year":"2009","journal-title":"Ann Surg 2009;"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/S0002-9610(97)89625-0","article-title":"Laparoscopic management of generalized peritonitis due to perforated colonic diverticula","volume":"171","author":"O'Sullivan GC","year":"1998","journal-title":"Am J Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0002-9610","issn-type":"print"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/bjs.6024","article-title":"Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis","volume":"95","author":"Myers E","year":"2008","journal-title":"Br J Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0007-1323","issn-type":"print"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s10350-006-0578-2","article-title":"Standards Committee of American Society of Colon and Rectal Surgeons: Practice parameters for sigmoid diverticulitis","volume":"49","author":"Rafferty J","year":"2006","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.jamcollsurg.2004.07.029","article-title":"The Timing of Elective Colectomy in Diverticulitis: A Decision Analysis","volume":"199","author":"Salem L","year":"2004","journal-title":"J Am Coll Surg","ISSN":"http:\/\/id.crossref.org\/issn\/1072-7515","issn-type":"print"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1007\/s00268-008-9705-7","article-title":"Elective resection for diverticular disease: an evidence-based review","volume":"32","author":"Collins D","year":"2008","journal-title":"World J Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0364-2313","issn-type":"print"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00384-011-1314-5","article-title":"Review of current classifications for diverticular disease and a translation into clinical practice","volume":"27","author":"Klarenbeek BR","year":"2012","journal-title":"Int J Colorectal Dis","ISSN":"http:\/\/id.crossref.org\/issn\/0179-1958","issn-type":"print"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"3373","DOI":"10.1007\/s00464-011-1728-8","article-title":"Laparoscopic versus open sigmoid resection for diverticulitis: long-term results of a prospective, randomized trial","volume":"25","author":"Gervaz P","year":"2011","journal-title":"Surg Endosc","ISSN":"http:\/\/id.crossref.org\/issn\/0930-2794","issn-type":"print"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1111\/j.1463-1318.2009.02052.x","article-title":"Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review","volume":"12","author":"Toorenvliet BT","year":"2010","journal-title":"Colorectal disease"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/DCR.0b013e3181f2ee44","article-title":"Complicated Diverticulitis: Are There Indications for Laparoscopic Lavage and Drainage?","volume":"53","author":"Mutch MG","year":"2010","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref28","series-title":"Laparoscopic Lavage for Acute Non-Faeculant Diverticulitis Study","year":"2011"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1471-2482-10-29","article-title":"The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis","volume":"10","author":"Swank HA","year":"2010","journal-title":"BMC Surgery"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/1745-6215-12-186","article-title":"Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): study protocol for a randomised controlled trial","volume":"12","author":"Thornell A","year":"2011","journal-title":"Trials"},{"key":"ref31","first-page":"916","article-title":"Mesalazine and\/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon","volume":"55","author":"Tursi A","year":"2008","journal-title":"Hepatogastroenterology","ISSN":"http:\/\/id.crossref.org\/issn\/0172-6390","issn-type":"print"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2934","DOI":"10.1007\/s10620-007-9766-8","article-title":"Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up","volume":"52","author":"Comparato G","year":"2007","journal-title":"Dig Dis Sci","ISSN":"http:\/\/id.crossref.org\/issn\/0163-2116","issn-type":"print"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1002\/bjs.7376","article-title":"Use of antibiotics in uncomplicated diverticulitis","volume":"98","author":"de Korte N","year":"2011","journal-title":"Br J Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0007-1323","issn-type":"print"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"680","DOI":"10.2214\/AJR.04.1708","article-title":"Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters","volume":"186","author":"Siewert B","year":"2006","journal-title":"Am J Roentgenol","ISSN":"http:\/\/id.crossref.org\/issn\/0361-803X","issn-type":"print"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10350-005-0274-7","article-title":"Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage","volume":"49","author":"Kumar RR","year":"2006","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1007\/s10350-006-0613-3","article-title":"Percutaneous CT scan-guided drainage versus antibiotherapy alone for Hinchey II diverticulitis: a case-control study","volume":"49","author":"Brandt D","year":"2006","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/01.sla.0000225357.82218.ce","article-title":"Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann's procedures","volume":"245","author":"Constantinides VA","year":"2007","journal-title":"Ann Surg","ISSN":"http:\/\/id.crossref.org\/issn\/0003-4932","issn-type":"print"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s00384-010-1071-x","article-title":"Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?","volume":"26","author":"Trenti L","year":"2011","journal-title":"Int J Colorectal Dis","ISSN":"http:\/\/id.crossref.org\/issn\/0179-1958","issn-type":"print"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/j.1463-1318.2008.01694.x","article-title":"Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis","volume":"12","author":"Zingg U","year":"2010","journal-title":"Colorectal Dis"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1007\/s10350-004-0701-1","article-title":"Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis?: A systematic review","volume":"47","author":"Salem L","year":"2004","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/s00464-007-9453-z","article-title":"Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases","volume":"22","author":"Small AJ","year":"2008","journal-title":"Surg Endosc","ISSN":"http:\/\/id.crossref.org\/issn\/0930-2794","issn-type":"print"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/j.1463-1318.2006.01171.x","article-title":"Management of diverticular fistulae to the female genital tract","volume":"9","author":"Hjern F","year":"2007","journal-title":"Colorectal Dis"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1463-1318.2007.01268.x","article-title":"Laparoscopic resection of diverticular fistulae: a 10-year experience","volume":"9","author":"Engledow AH","year":"2007","journal-title":"Colorectal Dis"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1007\/s10350-006-0500-y","article-title":"Laparoscopic versus hand-assisted laparoscopic sigmoidectomy for diverticulitis","volume":"49","author":"Lee SW","year":"2006","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"}],"container-title":["Revista do Col\u00e9gio Brasileiro de Cirurgi\u00f5es"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/rcbc\/v39n4\/13.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T13:18:43Z","timestamp":1687699123000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0100-69912012000400013&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,8]]},"references-count":44,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,8]]}},"alternative-id":["S0100-69912012000400013"],"URL":"https:\/\/doi.org\/10.1590\/s0100-69912012000400013","relation":{},"ISSN":["0100-6991"],"issn-type":[{"value":"0100-6991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,8]]}}}