[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-272520-105":59,"doc-detail-272520-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","perforated-colonic-diverticulum-in-old-age-surgical-or-medical-management","Perforated colonic diverticulum in old age: surgical or medical management?","","Perforation of a colonic diverticulum is presented as a frequent surgical emergency in older adults, with management choices varying by physiologic reserve. The article explains diverticulosis, its age-related epidemiology, dietary associations, and the pathway from diverticulitis to bleeding, stricture, and colonic perforation. Evidence is reviewed comparing operative care with minimally invasive or medical conservative strategies, emphasizing diagnosis, initial assessment, imaging, and best practice for elderly patients.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/perforated-colonic-diverticulum-in-old-age-surgical-or-medical-management/272520/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/perforated-colonic-diverticulum-in-old-age-surgical-or-medical-management/272520.png","ImageObject",300,407,{"name":92,"@type":93},"Pentious","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-15",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is perforated colonic diverticulum considered an emergency in older people?","Question",{"text":113,"@type":114},"Perforation is described as a common surgical emergency, particularly in older adults, due to rapid progression to acute and potentially fatal complications such as generalized fecal peritonitis.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What factors are associated with a lower prevalence of diverticulosis?",{"text":118,"@type":114},"Studies cited link higher intake of fibre, fruits and vegetables, and wholemeal bread with a substantially lower prevalence of diverticulosis.",{"name":120,"@type":111,"acceptedAnswer":121},"How does the article recommend making an initial diagnosis in frail elderly patients?",{"text":122,"@type":114},"A good initial assessment is emphasized: detailed history, careful physical examination, and awareness that frail patients may present with non-specific symptoms like delirium; key findings include tenderness patterns and supportive lab signs such as leukocytosis and fever.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},272520,1789465720,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144},1374404730887,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Perforated colonic diverticulum in old age: surgical or medical management?  \nPerforation of a colonic diverticulum is a common surgical emergency particularly in older people. Surgical treatments result in the best outcomes for patients with good functional and physiological status, but for frailer patients there are minimally invasive and medical alternatives. This article considers the evidence for the different options.  \nThe term diverticulosis refers to the presence of  \ndiverticulae or outpouchings ofthe colonic mucosa and sub-mucosa. These pockets of mucosa prolapse through weaknesses in the muscle layers in the wall of the colon at the points where blood vessels penetrate the colonic smooth muscle. Diverticulosis is uncommon before the age of 40 years and increases in incidence after that age (Comparato et al, 2007) . Diverticulae are more often found in the sigmoid colon, probably as a consequence of the higher intraluminal pressure there.  \nEpidemiological studies have identified dietary factors as potential explanations for the large geographical variations in the disease. A high intake of fibre, fruits and vegetables and wholemeal bread is associated with a 40–50% lower prevalence (Manousos et al, 1985; Aldoori et al, 1994) .  \nUp to one-third people over the age of 45 years and two thirds of the population over the age of 85 years were affected by diverticulosis in the mid-1990s (Robertset al, 1995) . There is evidence that the incidence ofcomplications of diverticular disease has risen in parallel with the overall prevalence. For example, in Finland the annual incidence of a perforated sigmoid diverticulum has increased from 2.4 per 100 000 in 1986 to 3.8 per 100 000 in 2000 (Makela et al, 2002) .  \nAlthough most patients with diverticulosis are asymptomatic, around 20% will develop symptoms attributable to the condition and it is then usually called diverticular disease. Diverticulitis is the most common complication, which is thought to occur when faeces block diverticulae which then become inflamed. This in turn can lead to a number of acute and long-term sequelae including bleeding, fibrosis with stricture formation and, most seriously of all, colonic perforation. Perforation can result in localized purulent collections or, with larger perforations, generalized faecal peritonitis. In one large analysis of perforated diverticulitis there was a mortality rate of 6% for purulent peritonitis and 35% for faecal peritonitis (Eggenberger, 1999) .  \nFor many years most patients with a perforated colonic diverticulum have been treated operatively. However, surgery for the condition is associated with a significant mortality risk (Wayne et al, 2000; Kulah et al, 2003), and there has been debate about the best surgical technique to use in order to minimize the postoperative  \nmortality. For most patients with non-perforated, nonobstructed acute diverticulitis there is a broad consensus that a non-surgical approach offers the best treatment at all ages (Eggenberger, 1999; Broderick-Villa et al, 2005; Comparato et al, 2007) . In cases of perforation and generalized peritonitis surgery is the best option for the majority of patients (Smirniotis et al, 1992; Rohr et al, 1994; Faltyn and Jungwirth, 1996; Isbister, 1997; Funariu et al, 2006; Pavlidis et al, 2006; Richter et al, 2006) .  \nHowever, some patients are too frail to undergo major surgery and require a conservative approach to therapy. There is a contention among some clinicians that very frail patients have better outcomes if colonic perforation caused by diverticulitis is managed medically, or with minimally invasive interventions. This article summarizes the evidence for such a conservative approach and outlines the best clinical practice for elderly patients with diverticulitis and colonic perforation with peritonitis.  \nReview methods  \nSearches were conducted of Medline/PubMed, the Cochrane library and Excerpta Medica databases from 1970–2008. Search phrases ","cbCairKr9I89S4Py","https://ap.wps.com/l/cbCairKr9I89S4Py","pdf",111332,"English","# Perforated colonic diverticulum in old age: surgical or medical management?\n## Epidemiology and risk factors\n## Complications and outcomes\n## Treatment strategies: operative, minimally invasive, and conservative\n## Review methods\n## Making the diagnosis: assessment, labs, and imaging","[{\"question\":\"Why is perforated colonic diverticulum considered an emergency in older people?\",\"answer\":\"Perforation is described as a common surgical emergency, particularly in older adults, due to rapid progression to acute and potentially fatal complications such as generalized fecal peritonitis.\"},{\"question\":\"What factors are associated with a lower prevalence of diverticulosis?\",\"answer\":\"Studies cited link higher intake of fibre, fruits and vegetables, and wholemeal bread with a substantially lower prevalence of diverticulosis.\"},{\"question\":\"How does the article recommend making an initial diagnosis in frail elderly patients?\",\"answer\":\"A good initial assessment is emphasized: detailed history, careful physical examination, and awareness that frail patients may present with non-specific symptoms like delirium; key findings include tenderness patterns and supportive lab signs such as leukocytosis and fever.\"}]","Perforated colonic diverticulum in old age: surgical or medical management? | PDF",13]