Management of acute diverticulitis in Covid 19 times. Our experience.

during the SARS-COV-2 coronavirus pandemic and patients diagnosed the previous


Introduction
Acute diverticulitis is a disease to be taken care of by the emergency department.It is characterized by left lower quadrant pain, fever, nausea or vomiting, and analytical parameters of infection (leukocytosis, increased C-reactive protein).These symptoms occur because of the inflammation/infection of the bowel wall.It has been a significant increase in the frequency of illness worldwide.There is a current incidence in the USA of approximately 180/100,000 people per year [1,2].
Once there are signs of illness, an abdominal CT with contrast, which is the chosen radiological study, is performed to confirm the assessment.It allows us to differentiate the degree of complication.
Up to 10 % of patients will require surgical treatment for complicated diverticulitis [3].Currently, the modified Hinchey Classification is used to break down the degree of complication to know how to proceed (Table 1) [4].

Material and methods
The

Results
From March 14 to June 21, 2020, 11 patients were diagnosed with acute diverticulitis compared to the 28 in the same period in 2019. The

Conclusion
The present study represents the trend and evolution of acute diverticulitis during the SARS-COV-2 pandemic.The incidence of acute diverticulitis was lower, although patients with higher severity (Hinchey III and IV) were registered.This situation probably caused surgical treatment to displace conservative treatment in these patients during the pandemic period.Conservative treatment (antibiotherapy and drainage) has been displaced by surgical treatment in this period.
Likewise, no additional differences were observed due to COVID analysis consisted of a retrospective observational study including all patients diagnosed with acute diverticulitis during the SARS-COV-2 coronavirus pandemic (period from March 14 to June 21, 2020).The comparison was made between patients diagnosed in our center during the same period for both years (population catchment area, 243,000 inhabitants).The technique used to diagnose all the patients were contrast-enhanced abdominopelvic CT.All the patients underwent blood tests on admission and were screened for COVID 19 disease with PCR.The degree of diverticulitis was classified according to the Hinchey classification.The following variables were studied and analyzed: sex; age; Hinchey grade; treatment; morbimortality and mean hospital stay.The data was tabulated in a Microsoft® Office Excel 2007 spreadsheet.The SPSS program was used for the statistical study.
Quiroga-Valcárcel A, Sánchez-Gollarte A, Allaoua-Moussaoui Y, Mendoza-Moreno F, et al.Management of acute diverticulitis in COVID 19 times.Our experience.J Med Case Rep Case Series 2(4): https://doi.org/10.38207/jmcrcs20210023It is a disease that can range from mild to potentially severe, depending on which its treatment may vary.For a long time, antibiotic treatment has been the treatment of choice for mild acute diverticulitis; however, some studies have shown that dietary changes alone can resolve it p [8,9].In our study, we can observe how the number of consultations of mild patients decreased without a very significant increase in the number of consultations of severe cases.We could deduce that a large percentage of patients with mild symptoms resolved without antibiotic treatment.Another scenario that has occurred during this pandemic is the increase in the number of more severe patients, probably due to the delay in consulting the emergency department for fear of becoming infected by the coronavirus.As these are more severe forms of presentation, treatment has had to be more aggressive.The type of surgery performed during periods outside the pandemic has been less aggressive, such as abundant lavage of the abdominal cavity and drainage.However, sigmoidectomy type surgery with a terminal stoma (Hartmann Procedure) has gained prominence in this world pandemic.This surgery is performed in Hinchey III and IV patients[10,11].There is data that links Hinchey III and IV patients up to an 8.7 % mortality rate [10] but, in our center, the mortality rate has been 0 %, which leads us to believe that morbidity has not increased due to causes unrelated to the diverticular disease itself.

Table 1 :
The treatment will vary accordingly to the degree of involvement.According to the Hinchey classification, the treatment ranges from antibiotherapy on an outpatient basis to major surgery.Surgical treatment can range from percutaneous drainage, laparoscopic drainage to surgical resection (sigmoidectomy and terminal stoma) (

Table 2 :
On the other hand, this year 2020 we have experienced a SARS-COV-2 coronavirus pandemic (period between March 14 th and June 21 st , 2020).

of Medical Case Reports and Case Series ISSN: 2692-9880
Citation: Quiroga-Valcárcel A, Sánchez-Gollarte A, Allaoua-Moussaoui Y, Mendoza-Moreno F, et al.Management of acute diverticulitis in COVID 19 times.Our experience.J Med Case Rep Case Series 2(4): https://doi.org/10.38207/jmcrcs20210023The coronavirus is an RNA+ virus and belongs to the Coronaviridae family.Even though the main cause is a primary respiratory illness, the clinical presentation can range from no symptoms to septic shock and death.The first reported outbreak was in Wuhan, China, in December 2019.By March 2020, about 96,000 cases of coronavirus disease 2019 (COVID-19) and 3300 deaths had been reported [5].The Community of Madrid was one treatment methods.So far, treatments with potent antiretrovirals such as remdesivir, or lopinavir/ritonavir, chloroquine have been tried... Without concluding in any successful scientific evidence.Currently, vaccines have already been marketed and are beginning to be dispensed in Spain, but there are still some uncertainties to be resolved such as long-term side effects, or duration of immunity, among others.

Table 3 :
Acute diverticulitis is a very frequent pathology in the emergency setting.