title: Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases.
abstract: BACKGROUND
  This study aims to investigate possible risk factors for diverticulitis in kidney transplant recipients affected by colonic diverticulosis.
  
  
  RESULTS
  We investigated 717 patients transplanted between 2000 and 2010. Diverticular disease was endoscopically diagnosed in 17 of 717 examined patients. Eight patients were diagnosed with autosomal dominant polycystic kidney disease (ADPKD); 9 of 17 patients underwent emergency surgery. We performed Hartmann's procedure on all patients, with a second stage performed at least 6 months later.
  
  
  CONCLUSIONS
  Although the incidence of colonic diverticular perforation in kidney transplanted patients is similar to that observed in the general population, perforation in immunosuppressed patients is associated with a higher morbidity/mortality rate. In our study, the incidence of perforation is 1.25% (9 of 717), with almost half of the cases observed in patients with ADPKD (4 of 9). Such an observation is consistent with published data, in which patients with ADPKD are reported to more frequently develop colonic diverticulosis and its complications. One possible explanation might be related to a belated diagnosis of diverticulitis, which could initially simulate an inflammatory disease as a consequence of renal cysts. Also, steroids seem to be a predisposing factor for colonic perforation in these patients.
  
  
  CONCLUSIONS
  A timely surgery can significantly reduce mortality. In cases of elective surgery, mortality and morbidity are similar to those of immunocompetent patients; accordingly, this is the goal to be pursued. Early signs and symptoms are often masked by immunosuppressive therapy. In these patients, surgeons should always perform (1) abdominal computed tomography scanning and, in the presence of diverticulitis, reduce or withdraw immunosuppressive therapy; and (2) early surgery, with Hartmann's procedure being, in our opinion, the best choice. Before transplantation, elective surgery for colonic resection should be considered in patients with ADPKD or with a history of 1 or more episodes of acute diverticulitis who then regressed with medical therapy.
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy. Electronic address: alexscotti@inwind.it.
authors.forename: A
authors.initials: A
authors.lastname: Scotti
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Santangelo
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Federico
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Carrano
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: La Tessa
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Carlomagno
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: D G
authors.initials: DG
authors.lastname: Palmieri
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Calogero
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Piantadosi
authors.affiliation: Department of Surgical Sciences and Nephrology; University Federico II of Naples, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Renda
mesh_terms: D000368:Aged; D004238:Diverticulitis / Q000209:etiology* / Q000601:surgery; D043963:Diverticulosis, Colonic / Q000150:complications*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000175:diagnosis / Q000601:surgery; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids