By vgreene, 8 December, 2020 Don t routinely recommend probiotics mesalamine 6 or rifaximin to prevent recurrence1 4
By vgreene, 8 December, 2020 Evaluate pt related factors 5 6 not of recurrences when considering elective colectomy 2 4 5 consider complications eg abscess fistula stricture 1 severity of episodes pt s circumstances comorbidities 2 3 5 per ASCRS ESCP immunocompromise or young age sho
By vgreene, 8 December, 2020 R O occult malignancy w colonoscopy after recovery from medically treated complicated dz esp abscess per WSES 5 if not recently done 1 3 5 timing after 6 8wk per AGA 2 after 4 6wk per WSES 5 after 6wk per ESC 4 Pts w uncomplicated dz do not need f u colon
By vgreene, 8 December, 2020 Suggest avoiding non aspirin NSAIDs when possible don t advise against aspirin for secondary ASCVD prevention2 3
By vgreene, 8 December, 2020 Advise diet lifestyle changes to prevent recurrence wt loss 1 2 smoking cessation 1 2 vigorous physical activity 1 3 darr meat intake 1 high fiber diet suggested by AGA 2 3 but little evidence per ESCP 4 don t advise against dietary seeds nuts popcorn str
By vgreene, 8 December, 2020 Consider increased risk of occult CA in pts w h o complicated dz diet lifestyle changes warranted to prevent recurrence elective resection not routine reserve for select pts based on presence of certain complications severity of dz comorbidity etc
By vgreene, 8 December, 2020 Consider laparoscopic lavage only in very select pts w diffuse peritonitis 3 4 rec d against in pts w feculent peritonitis 2 reasonable per ESCP 3 but inferior to colectomy in purulent peritonitis uarr need for 2nd procedure per ASCRS2
By vgreene, 8 December, 2020 Consider percutaneous drainage if abscess 3 cmASC ESC 4 5 cm per WSES WSE due to high abx failure rate consider trial of abx alone vs surgical intervention if not clinically possibleWSE
By vgreene, 8 December, 2020 Consider staged damage control strategy DCS in selected unstable pts w perforation diffuse peritonitis4
By vgreene, 8 December, 2020 Use Hartmann s procedure in critically ill pts in select pts w multiple comorbidities 3 4 per ASCRS decision to restore bowel continuity should incorporate pt factors intraoperative factors surgeon pref2
