Diagnostic and treatment strategy in complicated colon diverticulitis

Acute diverticulitis is a disease with a wide clinical spectrum, ranging from a phlegmon (stage I a) to localized abscesses (stages I b and II), to free perforation with purulent (stage III) or feculent (stage IV) peritonitis. The planned therapy of colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. While there is a little debate about the best treatment for mild episodes, uncertainty persists about the optimal management for severe episodes and complicated diverticulitis

Acute Necrotizing Pancreatitis (ANP)

Necrosis of the pancreas and the peripancreatic tissue is present in 10-20% of patients with acute pancreatitis (AP) and is the reason for the high levels of morbidity and mortality rate in these cases. In the initial phase of acute necrotizing pancreatitis (ANP), the most important moments in the treatment are permanent correction of fluid and electrolyte imbalance, early enteral nutrition, ERCP in patients with cholangitis and increased pressure in the biliary tract, and patient admission in intensive care unit. When pancreatic and peripancreatic necroses become infected, surgical treatment is an optimal option, which, if possible, should be delayed till the fourth week after the onset of the disease. The type of surgery also experienced changes - from a classic open approach, with the introduction of wide drainage for postoperative lavage, through half-open techniques with subsequent repeated laparotomy, to a percutaneous drainage with a subsequent access to the retroperitoneum to perform minimally invasive necrectomy