{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:11:20Z","timestamp":1792548680783,"version":"4.5.0"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Diverticular disease (DD) of the colon has a number of phenotypes, including asymptomatic diverticulosis and complicated diverticulitis with bowel perforation or bleeding. The factor that affects the phenotype of this condition and leads to a wide range of clinical presentations is unknown. The formation of fistulas associated with diverticulitis has long been recognized, and they are treated according to\n                      <jats:italic>ad hoc<\/jats:italic>\n                      indications. We hypothesized that the formation of fistulas in diverticular disease exhibits such a wide range of variable anatomic features that it may be considered a distinct form of the condition, fistulating diverticulitis (FD).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative review based on 50\u202fyears of publications covering a wide range of diverticulitis-associated fistulas, both common and uncommon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While there is abundant literature on common fistulas, such as colovesical and colovaginal fistulas, little is known about rarer fistulas, such as coloenteric fistulas, colocutaneous fistulas, and genitourinary tract fistulas. The majority of these fistulas are treated surgically, which is in contrast to the trend toward conservative management that is predominant in acute or chronic diverticulitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Epidemiological and histological evidence support the hypothesis that FD may be a feature of chronic DD that requires individual management. Histopathology shows similarities with Crohn\u2019s disease. It remains unknown which underlying immune or genetic factors may be affecting the clinical presentation of these patients, leading to fistulation. We contend that there is adequate published evidence to characterize a distinct phenotype of FD that can involve the entire GI tract and other organs. Surgical guidelines may need to be modified to treat this small but important group, which predominantly requires surgical treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1500053","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T03:04:54Z","timestamp":1741835094000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Fistulating diverticulitis: a distinct clinical entity?"],"prefix":"10.3389","volume":"12","author":[{"given":"Savvas","family":"Papagrigoriadis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Brandimarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Tursi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1055\/s-0036-1580732","article-title":"Enterocutaneous fistula: proven strategies and updates","volume":"29","author":"Gribovskaja-Rupp","year":"2016","journal-title":"Clin Colon Rectal Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1038\/s41572-020-0153-5","article-title":"Colonic diverticular disease","volume":"6","author":"Tursi","year":"2020","journal-title":"Nat Rev Dis Prim"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1136\/jclinpath-2013-202137","article-title":"Chronic diverticulitis and Crohn's disease share the same expression of basic fibroblastic growth factor, syndecan 1 and tumour necrosis factor-alpha","volume":"67","author":"Tursi","year":"2014","journal-title":"J Clin Pathol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s00464-022-09504-3","article-title":"Defining diverticular fistula through inpatient admissions: a population study","volume":"37","author":"Underhill","year":"2023","journal-title":"Surg Endosc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.1007\/s10151-011-0745-x","article-title":"Sakantamis a (2011) current management of diverticular disease complications","volume":"15","author":"Psarras","year":"2011","journal-title":"Tech Coloproctol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1001\/archsurg.1979.01370340018002","article-title":"'Malignant' diverticulitis: a clinical entity","volume":"114","author":"Morgenstern","year":"1979","journal-title":"Arch Surg"},{"key":"ref7","first-page":"71","article-title":"Malignant diverticulitis of the left colon complicating heart transplantation","volume":"15","author":"Pagano","year":"2010","journal-title":"Ann Transplant"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8835222","DOI":"10.1155\/2023\/8835222","article-title":"Colovesical fistula due to sigmoid diverticulitis","volume":"2023","author":"Stefanou","year":"2023","journal-title":"Case Rep Surg"},{"key":"ref9","doi-asserted-by":"publisher","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","year":"2009","journal-title":"J Urol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s10350-004-0849-8","article-title":"Colovesical fistula: not a contraindication to elective laparoscopic colectomy","volume":"48","author":"Bartus","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"101","DOI":"10.9738\/INTSURG-D-13-00024.1","article-title":"Laparoscopic management of diverticular colovesical fistula: experience in 15 cases and review of the literature","volume":"98","author":"Marney","year":"2013","journal-title":"Int Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1007\/s11605-018-3950-3","article-title":"Laparoscopic surgery for diverticular fistulas: outcomes of 111 consecutive cases at a single institution","volume":"23","author":"Martinolich","year":"2019","journal-title":"J Gastrointest Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"36","DOI":"10.23922\/jarc.2018-008","article-title":"Laparoscopic surgery for colovesical fistula associated with sigmoid colon diverticulitis: a review of 39 cases","volume":"3","author":"Tomizawa","year":"2019","journal-title":"J Anus Rectum Colon"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.ijsu.2015.11.007","article-title":"Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? 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