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MINI REVIEW article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1500053
This article is part of the Research Topic Diverticulitis - A Neglected Disease Despite its Clinical Burden View all 4 articles
FISTULATING DIVERTICULITIS: A DISTINCT CLINICAL ENTITY
Provisionally accepted- 1 IASO General Hospital, Athens, Greece
- 2 DIVISION OF INTERNAL MEDICINE AND GASTROENTEROLOGY, Cristo Re Hospital, Rome, Sicily, Italy
- 3 Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome - Italy, ROME, Italy
Introduction: Diverticular disease of the colon has several phenotypes ranging from asymptomatic diverticulosis to complicated diverticulitis with bowel perforation or bleeding. The factors determining the phenotype and the wide range of clinical presentations are unknown. The formation of fistulas associated with diverticulitis is recognised and treated as per ad hoc indications. We hypothesized that the formation of fistulas in diverticular disease is of such range and variable anatomic features that they may be addressed as a distinct form of the condition, Fistulating Diverticulitis (FD).We present a narrative review based on fifty years publications on diverticulitis-associated fistulas, common and uncommon. There is abundant literature on common fistulas such as colovesical and colovaginal but there is less knowledge on rare ones, such as coloenteric, colocutaneous and genitourinary fistulas. The management of most of those fistulas is surgical which is in contrast with the trend of conservative management which is predominant in acute or chronic diverticulitis.The epidemiological and histological evidence support the hypothesis that FD may be a feature of chronic DD which requires individual management. The histopathology has overlapping features with Crohn's disease. It is yet unknown what underlying immunity or genetic factors may be affecting the clinical presentation of those patients towards fistulation. We support that there is adequate published evidence to characterise a distinct phenotype of Fistulating Diverticulitis (FD) that can involve the entire GI tract and other organs. The surgical guidelines may require to be modified to treat this small but important group with predominantly surgical treatment.
Keywords: Diverticulitis, Fistula, Diverticular disease, Surgery, Colovesical fistula, Colovaginal fistula, Enterocutaneous fistula, colofallopian fistula
Received: 22 Sep 2024; Accepted: 14 Feb 2025.
Copyright: © 2025 PAPAGRIGORIADIS, BRANDIMARTE and TURSI. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
SAVVAS PAPAGRIGORIADIS, IASO General Hospital, Athens, Greece
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