Search Results (72)

The segmental colitis associated with diverticulosis (SCAD) is a particular presentation of the diverticular disease. Its effective management hinges on accurate diagnosis, prognosis, and ongoing therapeutic monitoring. Although SCAD generally follows a benign clinical trajectory, it remains the subject of intensive investigation. Recent advances in the field have yielded new opportunities to improve clinical outcomes for individuals with SCAD by informing diagnostic precision, risk stratification, and personalized treatment strategies. Full article

Background/Objectives: Low-grade inflammation and microbial imbalance have been thought to play a role in the pathogenesis of Symptomatic Uncomplicated Diverticular Disease (SUDD). We aimed to assess the efficacy of a cranberry formulation in reducing the inflammatory state of the colon and symptoms in SUDD patients. Methods: Twenty patients were enrolled in a prospective, multi-center, open-label, pilot study. We enrolled SUDD patients in whom fecal calprotectin (FC) was assessed at baseline and during the follow-up, with a baseline value ≥ 50 µg/g. Patients were treated with a gastroresistant formulation of cranberry (Vaccinium macrocarpon), one tablet/day for 4 weeks, followed by an 8-week observation period. The primary endpoint was to assess the efficacy of this gastroresistant cranberry formulation in reducing the inflammatory state of the colon by FC assessment. The secondary main endpoint was to assess the impact of this formulation on SUDD symptoms (assessed by the Visual Analog Scale, VAS). Intention-to Treat (ITT) and Per-Protocol (PP) analyses were performed. Results: At baseline, the mean FC value was 110 ± 118 μg/g; it was 72 ± 24 μg/g and 82 ± 19 μg/g after 4 weeks of treatment, and after a further 8 weeks of observation, it was significantly reduced on both ITT (p = 0.0001) and PP (p = 0.001). About the secondary main endpoint (namely symptoms of SUDD), the mean values according to the VAS were reduced significantly both at the end of the treatment and after 8 weeks post treatment. Conclusions: This gastroresistant formulation of cranberry may be able to reduce inflammation and symptoms in SUDD patients. Furthermore, large studies have to confirm these preliminary and promising results. Full article

Background/Objectives: Diverticular disease (DD) affects a significant portion of the aging population and is increasingly linked to gut microbiota alterations. Probiotics have emerged as a potential adjunct therapy, particularly in managing symptoms and inflammation. The evidence for the recommended use of probiotics in clinical practice for management of diverticular disease is still a matter of controversy. Methods: A comprehensive literature search was conducted across five major databases up to October 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies assessing probiotic use in adult patients with diverticular disease. Results: Thirteen studies met the eligibility criteria. Probiotic therapy was associated with improvement in abdominal pain (SMD 0.63; 95% CI: 0.38–0.88). For bloating, probiotics demonstrated a small trend toward improvement (SMD 0.158; 95% CI: −0.107 to 0.422), although this did not reach statistical significance. C-reactive protein (CRP) outcomes were reported in three studies conducted in acute uncomplicated diverticulitis. All showed reductions in CRP following probiotic therapy; however, substantial variability in baseline levels and assessment timepoints prevented a reliable pooled estimate, and findings were summarized descriptively. Long-term outcomes from two RCTs showed a reduced risk of recurrence (RR 0.22; 95% CI: 0.095–0.510), with multi-strain and longer-duration regimens appearing more beneficial. Conclusions: Probiotics, particularly multi strain formulations administered over longer durations, may help improve symptoms and reduce inflammatory activity in diverticular disease; however, the certainty of evidence remains low to very low due to heterogeneity and methodological limitations. Larger, high-quality randomized trials are needed to clarify the long-term clinical impact of probiotic therapy. Full article

Left colon diverticular disease (LCDD) is prevalent in the aging populations of industrialized countries, with many patients requiring surgery. Elective surgery decisions should consider individual health conditions and quality of life. Typically, surgery is recommended six weeks after an acute episode. This scoping review, following PRISMA-ScR guidelines, analyzed the literature on elective LCDD surgery, focusing on inferior mesenteric artery (IMA) ligation, splenic flexure mobilization (SFM), surgical approach, and extent of resection. The databases searched included PubMed, Embase, and Cochrane Library up to May 2025. Twenty studies met the inclusion criteria: 2 randomized trials (RCTs), 6 systematic reviews, 3 prospective studies, and 9 retrospective cohorts. The findings suggest preserving the IMA and selectively omitting SFM may reduce minor complications without compromising safety. Resection should reach the rectosigmoid junction and include only the affected colon segment. Minimally invasive techniques, especially laparoscopic surgery improve outcomes, reduce morbidity, and are more cost-effective than open surgery. Robotic approaches offer new options for complex cases. Surgical strategies must be tailored to disease severity, patient comorbidities, and anatomy. Further prospective studies are needed to refine guidelines and support personalized surgical decisions in LCDD management. Full article

Background and Clinical Significance: Preoperative planning is crucial for improving surgical safety and outcomes, particularly in minimally invasive surgery, where tactile feedback is absent. Three-dimensional (3D) printing offers patient-specific anatomical models that can enhance surgical planning. Its application in diverticular disease remains underexplored. Case Presentation: We present the case of a 65-year-old male with recurrent diverticulitis involving the sigmoid and descending colon. After conservative management of an acute episode, preoperative imaging revealed extensive diverticulosis. A patient-specific 3D-printed model was created from CT images to plan the surgical approach. The model helped determine the need for a left hemicolectomy rather than a simple sigmoidectomy, anticipated technical challenges such as lowering the left colic flexure and ligating the inferior mesenteric artery, and improved patient counseling. The surgery was performed laparoscopically without complications, and the patient was discharged on postoperative day six. Histology confirmed diverticulosis with perivisceritis and reactive lymphadenitis. Conclusions: This case demonstrates the potential of 3D printing to optimize surgical planning in diverticular disease, enabling tailored resections and improving operative strategy. Broader adoption may be limited by time and cost but offers clear educational and clinical benefits. Full article

Background: Neuraxial anesthesia, delivered as a combined spinal–epidural without intubation or neuromuscular blockade, is a promising alternative for patients undergoing minimally invasive colorectal surgery. Evidence is limited to case series, with no cohort studies available. Methods: This is a retrospective analysis of consecutive patients undergoing minimally invasive colorectal surgery for both benign and malignant disease at a single institution, between October 2022 and October 2024. Patients were divided by the type of anesthesia. Propensity score matching was performed to reduce confounding bias. Outcomes assessed included anesthesiologic preparation time, duration of surgery, intraoperative features, intensive care unit admission, length of hospital stay, and 90-day postoperative complications, including anastomotic leak and readmission rates. Results: Thirty-two patients (40.5%) received neuraxial anesthesia and forty-seven (59.5%) received general anesthesia. No conversions from neuraxial to general anesthesia occurred. After matching, anesthesia preparation time was longer in the neuraxial group (42.5 vs. 30 min, p = 0.011), while operative time was significantly shorter (181 vs. 231 min, p = 0.002). Length of stay, postoperative complications, including leak, and readmission rates were comparable between groups. Conclusions: Neuraxial anesthesia may be a valid alternative to general anesthesia for minimally invasive colorectal surgery. In this single-center experience, it required longer anesthetic preparation but was associated with shorter operative times, without affecting surgical outcomes or increasing complication rates. These results support further investigation into its application in colorectal procedures. Full article

Symptomatic uncomplicated diverticular disease (SUDD) is the primary clinical manifestation of diverticular disease (DD). Although gut microbiota (GM) perturbation and dietary habits are considered important factors in the development of the disease, there is currently a lack of data on the potential relationship between diet, GM profile and SUDD. An exploratory retrospective study was conducted in a SUDD cohort of 47 patients to investigate this relationship; a diverticulosis cohort of 19 patients served as the control group. Patients were stratified by their self-reported dietary habits, i.e., Mediterranean diet, predominantly plant-based diet or omnivorous diet. GM was profiled using 16S rRNA amplicon sequencing of fecal swabs. SUDD patients following a Mediterranean or predominantly plant-based diet showed higher alpha diversity and enrichment of known fibre degraders and short-chain fatty acid producers, such as members of the Lachnospiraceae, Ruminococcaceae, Oscillospiraceae and Prevotellaceae families. This suggests that their gut (and whole-body) health is less impaired. In contrast, those following an omnivorous diet showed an increased presence of pro-inflammatory taxa, including the mucus degrader R. torques, which suggests impaired gut barrier function and potential systemic implications. Similar associations between GM profile and dietary habits were found when considering SUDD patients with moderate abdominal pain severity (according to visual analogue scale, VAS) and those scored as DICA 1 according to the endoscopic severity of the disease. However, no such associations or trends were observed in SUDD patients scored as DICA 2, which suggests that diet may be unable to impact GM dysbiosis as SUDD severity increases. Despite the study’s limitations, primarily its retrospective design and related biases, our findings suggest that other GM modulation tools should be employed in more severe cases of SUDD to reverse dysbiosis while alleviating symptoms. Full article

Colovesical fistulas (CVFs) are abnormal connections between the colon and bladder, most commonly associated with complicated diverticular disease. The standard treatment involves bowel resection to remove the fistulous tract and reduce the risk of recurrence. This study aimed to evaluate the feasibility and safety of laparoscopic and robotic conservative surgery for CVFs, avoiding bowel resection. Between 2012 and 2019, 12 consecutive patients underwent conservative treatment: 5 with a laparoscopic approach and 7 with a robotic approach. Perioperative outcomes showed shorter operative time and lower blood loss in the robotic group (101 min vs. 144 min, p = 0.02; 47 mL vs. 176 mL, p = 0.02). No surgical conversions were required, and the complication rate was low. One recurrence occurred in the laparoscopic group due to extensive diverticular disease. Short- and long-term outcomes demonstrated favorable functional results, with a reduced risk of complications compared to traditional bowel resection. The robotic technique provided advantages in operative time and blood loss. A conservative approach is an option for selected patients, particularly those with non-extensive diverticular disease. Full article

Background: Symptomatic uncomplicated diverticular disease (SUDD) is a common condition in older adults, primarily managed through symptom control. Emerging evidence highlights the role of gut microbiota in symptom modulation and disease progression. Butyrate supplementation offers anti-inflammatory benefits and supports gut barrier integrity; when combined with specific probiotic strains, it may further promote microbiota balance. Objectives: To evaluate the clinical and microbiological effects of an oral formulation combining microencapsulated sodium butyrate with probiotic strains from four probiotic strains (Lacticaseibacillus rhamnosus, Lactiplantibacillus plantarum, Limosilactobacillus reuteri, and Bifidobacterium longum subsp. infantis) in patients with SUDD. Methods: This prospective, preliminary observation enrolled 23 patients. To control for high interindividual variability in microbiota composition, each participant served as their own control. The intervention lasted 12 weeks and included five scheduled visits, incorporating a 3-week washout period. Symptom severity and quality of life were assessed using validated questionnaires. Faecal microbiota composition was evaluated using 16S rRNA sequencing and strain-specific colonisation was monitored with qPCR. Results: Significant improvements were observed in seven out of nine reported symptoms, including reductions in abdominal pain, bloating, and discomfort. Overall symptom burden decreased, especially symptoms related to gas and stool consistency. Quality of life scores improved notably. qPCR confirmed colonisation by the administered probiotic strains. Microbiome analysis demonstrated individualized but meaningful improvements in microbial profiles. Conclusions: The combined use of microencapsulated sodium butyrate and selected probiotic strains led to measurable clinical improvements and the positive modulation of gut microbiota in patients with SUDD. This formulation was well tolerated and may represent a promising adjunct or standalone approach in the dietary management of SUDD. Full article

Introduction: Diverticular disease is common in Western countries, and the frequency of emergency operations for acute left-sided complicated diverticulitis (ALCD) has increased over the past 15 years. Methods: A total of 49 patients aged over 80 years and 125 younger patients who underwent emergency surgery for ALCD between October 2018 and June 2025 were analyzed. Demographics and postoperative outcomes were compared between the groups. Multivariate logistic regression was used to assess the association between age and postoperative morbidity and mortality. A separate regression model was used to identify risk factors for postoperative mortality and morbidity, specifically in elderly patients. Results: Significant differences between the two groups were found in sex distribution (p < 0.001), cardiovascular comorbidities (p < 0.001), chronic renal insufficiency (CRI) (p < 0.001), ASA score (p < 0.001), ALCD severity according to the modified Hinchey classification (p = 0.006), Mannheim Peritonitis Index (MPI) (p = 0.021), postoperative complications (p < 0.001), and 90-day mortality rates (p < 0.001). Advanced age was a significant predictor of 90-day postoperative mortality and morbidity. In the elderly subgroup, an ASA score ≥ 3, MPI > 25, CRI, and COPD were identified as independent predictors of 90-day postoperative mortality and morbidity. Conclusions: Advanced age is an independent risk factor for 90-day postoperative mortality and morbidity following emergency surgery for ALCD. In patients over 80 years, an ASA score ≥ 3, CRI, COPD, and MPI ≥ 25 are associated with a poorer prognosis. Full article

Background: Colovesical fistulas are abnormal communications between the colon and urinary bladder, most commonly caused by diverticular disease. Although colovesical fistulas are rare, they should be suspected in patients presenting with recurrent urinary tract infections, pneumaturia, or fecaluria. We integrated two case reports with a retrospective national cohort analysis to assess the surgical treatment of colovesical fistulas. Methods: We report two cases of colovesical fistulas, both secondary to sigmoid diverticulitis, treated surgically via minimally invasive approaches. A retrospective analysis using the National Inpatient Sample database from 2016 to 2022 was conducted to compare outcomes of open surgery with those of minimally invasive surgery. Propensity score matching and multivariable regression analyses were used to evaluate clinical outcomes. Results: The first patient underwent hand-assisted laparoscopic sigmoidectomy with fistula takedown and has remained asymptomatic at 8 months, while the second patient underwent robotic-assisted sigmoidectomy with staged ileostomy reversal and has remained asymptomatic at 1 month. National data analysis showed no significant difference in mortality (<1% versus <1%, p = 0.931), wound complications (1.4% versus 1.0%; p = 0.554), or postoperative sepsis or shock (7.1% versus 5.6%; p = 0.114) between open and minimally invasive surgical approaches. However, the minimally invasive surgery group had significantly shorter length of stay than the open surgery group (6.9 versus 7.3 days, p < 0.001). Conclusions: Minimally invasive repair of colovesical fistulas was associated with shorter hospital stays than open surgery, with no significant differences in major complications. Early identification and timely surgical management are critical for achieving favorable outcomes. Full article

Partial cystectomy is a surgical bladder-sparing option for selected patients with muscle-invasive bladder cancer (MIBC), urachal adenocarcinoma and diverticular bladder tumors. Partial cystectomy hold several advantages. It allows for definite pathology and accurate staging while avoiding side effects from radiation therapy and preserves the option for salvage radical therapy (radical cystectomy or radical radiotherapy). Patients should have a CT urogram, prostatic urethral biopsy and mapping biopsies or blue light cystoscopy to rule out multifocal disease or CIS. Small solitary MIBC patients without carcinoma in situ in an area of the bladder where resection can be performed with negative margin would be the ideal candidates for partial cystectomy. Neoadjuvant systemic therapy is recommended for patients undergoing partial cystectomy. Partial cystectomy can be performed either by open or robotic approaches. When compared to radical cystectomy, partial cystectomy affords a lower complication rate and length of stay and better quality of life. Recurrence-free survival, cancer-specific survival and overall survival at 5 years is 39–67%, 62–84% and 45–70%, respectively. Following partial cystectomy, patients should have three monthly cystoscopy and urinary cytology for the first 24 months followed by 6-monthly cystoscopy for year 3 and 4 and then yearly for life. Cross-sectional imaging should be performed every 3–6 months for the first 2–3 years and then annually for 5 years. Full article

Accounting for 15–30% of colorectal cancer cases, the serrated pathway remains poorly characterized compared to the adenoma–carcinoma sequence. It involves sessile serrated lesions as precursors and is characterized by BRAF mutations (BRAF^V600E), CpG island hypermethylation, and microsatellite instability (MSI). Using label-free proteomics, we compared normal tissue margins from patients with diverticular disease, sessile serrated lesions, low-grade adenomas, and high-grade adenomas. We identified S100A14 as significantly overexpressed in sessile serrated lesions compared to low-grade adenomas, high-grade adenomas, and normal tissues. This overexpression was confirmed by immunohistochemical scoring in an independent cohort. Gene expression analyses of public datasets showed higher S100A14 expression in BRAF^V600E-mutated and MSI-H colorectal cancers compared to microsatellite stable BRAF^wt tumors. This finding was confirmed by immunohistochemical scoring in an independent colorectal cancer cohort. Furthermore, single-cell RNA sequencing analysis from the Human Colon Cancer Atlas revealed that S100A14 expression in tumor cells positively correlated with the abundance of tumoral CD8⁺ cytotoxic T cells, particularly the CD8⁺ CXCL13⁺ subset, known for its association with a favorable response to immunotherapy. Collectively, our results demonstrate for the first time that S100A14 is a potential biomarker of serrated neoplasia and further suggests its potential role in predicting immunotherapy responses in colorectal cancer. Full article

Diverticulosis is characterized by sac-like bulges of the mucosa through weakened portions of the intestinal wall, and is a common pathology observed in adult patient populations. The majority of diverticular disease and associated complications, such as inflammation of diverticula, form within the colon, with less frequent cases of diverticular disease observed in the small bowel. We present the case of a 48-year-old female who presented to the emergency department with a two-day history of abdominal pain, fever, and nausea. Upon admission, vital signs indicated fever and laboratory analysis demonstrated elevated white blood cell count. The patient’s workup included a computed tomography (CT) scan of the abdomen which revealed diffuse small bowel diverticulitis with surrounding inflammation, lymph node enlargement, and bowel wall thickening. CT scan of the abdomen with evidence of diverticula in the bowel wall is diagnostic of diverticulosis. Treatment could include bowel rest, clear liquid diet, broad-spectrum antibiotics, or surgical intervention. This case emphasizes the importance of CT imaging and consideration of broad differential diagnosis in patients presenting with abdominal pain due to the rare presentation of small bowel diverticulitis and aims to contribute to the current understanding and treatment of clinically significant diverticular pathologies. Full article

Background: Diverticulosis is defined as the presence of diverticula in the intestinal tract. While asymptomatic in most cases, severe complications can arise. The precise etiology of diverticulosis is still being investigated, but its correlation to dietary exposures has been proven. While certain diet recommendations have cemented themselves throughout the years, others seem to be always disputed. Nut consumption has been highly questioned among researchers and clinicians alike for decades. Objectives: This review aims to examine all available data regarding nut consumption and diverticulosis. Methods: We performed a systematic literature review from various databases (PubMed, Web of Science, Embase, and the Cochrane Library). We followed a multi-modal approach, incorporating both qualitative and quantitative techniques to assess and evaluate studies that investigated nut exposure and diverticulosis. Results: Nine observational studies encompassing over two million person-years were included. The qualitative synthesis and risk-of-bias assessments align with a neutral to modestly protective effect of moderate nut intake. Analysis of nut-specific cohorts revealed no significant increase in diverticulitis risk (HR 0.89, 95% CI 0.71–1.12). A sensitivity analysis including a prudent dietary pattern yielded a significant risk reduction (HR 0.75, 0.58–0.97). Dose–response modelling indicated a linear 5% reduction in risk per additional weekly serving. Robustness checks (leave-one-out analysis, tripping point analysis, etc.) confirmed the stability of these findings, with no single study unduly influencing the pooled estimates. Conclusions: Although limitations are present, current evidence suggests that moderate nut consumption is safe and may be protective against diverticulosis, while showing no adverse effect on diverticulitis incidence. Full article