REVIEW   Free access

Minerva Chirurgica 2019 December;74(6):465-71

DOI: 10.23736/S0026-4733.18.07744-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment of acute complicated diverticulitis in the elderly

Roberto CIROCCHI ¹ ✉, Riccardo NASCIMBENI ², Gian A. BINDA ³, Nereo VETTORETTO ⁴, Rosario CUOMO ^{1, 5}, Giovanni GAMBASSI ⁶, Antonio AMATO ⁷, Bruno ANNIBALE ⁸

¹ Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy; ² Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; ³ Department of General Surgery, Galliera Hospital, Genoa, Italy; ⁴ Unit of Laparoscopic Surgery, Department of Surgery, M. Mellini Hospital, Chiari, Brescia, Italy; ⁵ Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; ⁶ Department of Internal Medicine, Sacred Heart Catholic University, Rome, Italy; ⁷ Department of Surgery, Hospital of Sanremo, Sanremo, Imperia, Italy; ⁸ Department of Medical-Surgical Science and Translational Medicine, Sapienza University, Rome, Italy

Although the true prevalence is unknown, colonic diverticulosis is one of the most common disease of the digestive tract in Western countries. Based on administrative data of hospitalized patients, the incidence of diverticulitis has been increasing in last decades. In general, elderly patients undergo less frequently an elective colonic resection; but a substantial part of emergency surgeries is performed in elderly patients. In these older patients the choice of any clinical and surgical option is to be correlated not only to the severity of diverticulitis, but also to general status and the co-existing comorbidities. In this regard, it is mandatory that all patients undergo a multidimensional, comprehensive geriatric assessment to correctly identify those who are fit, vulnerable or frail. The analysis of data currently available highlights three relevant elements: type and severity of peritoneal contamination, hemodynamic conditions (stable or unstable), and concomitant comorbidities (fit or frail status). There is no single ideal surgical treatment that can be considered as gold standard for all clinical presentations; the final clinical decision-making should always be based on patient’s general health status, severity of peritonitis and of sepsis. In a septic elderly patient who is hemodynamically unstable, treatment should be as prompt as possible independent of the Hinchey’s stage, and could include either a Mickulicz stoma or a DCS strategy. In an elderly patient who is fit and hemodynamically stable, the surgical options are similar to those in a younger patient. If a patient is frail but hemodynamically stable, he should be treated with a Hartmann’s procedures.

KEY WORDS: Diverticulitis; Peritonitis; Aged