Editing Diverticular disease (section)

== '''Management - elective diverticular disease''' ==

=== Lifestyle interventions ===

** High fibre diet (>30g per      day) - high in fruits, vegetables, whole grains - this might prevent the      initial disease, but does this really reduce further attacks once      diverticulosis is present? No evidence at the moment.
** Lots of water
** Avoid foods high in fat
** Quit smoking
** Lose weight
** Reduce meat intake
** It is completely unproven      that avoiding seeds, corn and nuts helps in any way

=== Elective surgery for patients     with prior diverticular attack ===

** Base recommendation on      patient factors, not number of attacks
** Following first episode of      acute uncomplicated diverticulitis, 10-35% will have another episode
** After more episodes, the      chance of recurrence increases significantly
** Recurrences in general tend      to follow the severity of the initial episode
** Complicated recurrence after      recovery from uncomplicated episode is actually rare (6%), even in young      patients - young age is not an indication for surgery necessarily
** Should be done 6+ weeks down      the track
** '''Firm      indications for colectomy:''' 
*** Fistula
*** Obstruction
*** Stricture
** '''Relative      indications for colectomy:'''
*** Mesocolic abscess >5cm       and pelvic abscess treated medically generally need definitive surgical       resection due to recurrence rate >40%
*** Patients requiring       percutaneous drainage are more likely to require more interventions in       the future - consider elective colectomy
*** Immunosuppressed patients       have a lower threshold for elective surgery, but no firm data on where       exactly that threshold lies. Some say after first episode, others say       wait.
** Surgery is sigmoid colectomy
*** Proximal margin should be       in soft pliable bowel, but not necessarily removing all proximal       diverticula
*** Distal anastomosis should       be in upper rectum