Faculty Bibliography

BACKGROUND:The treatment paradigm for acute diverticulitis is changing. There is an increasing trend towards managing patients with uncomplicated diverticulitis in the community. AIMS/OBJECTIVE:The aim of this study was to analyse how acute diverticulitis is managed in our institution and also to analyse national data pertaining to treatment of acute diverticulitis. METHODS:A prospective database of all patients admitted to our institution over a 2-year period (2014-2016) with acute diverticulitis was maintained. Severity of disease, treatment received and average length of stay (LOS) were analysed for all patients. Contemporaneous hospital inpatient enquiry (HIPE) data was interrogated to analyse current management for acute diverticulitis at a national level. RESULTS:One hundred twenty-six patients were admitted to our institution with acute diverticulitis during the study period (inpatient stay = €1277/night). Of patients, 59.5% had uncomplicated diverticulitis while 40.5% had complicated disease. The median LOS was 4 (range 1-34) days and 8 (range 2-51) days in the uncomplicated and complicated group, respectively. Based on HIPE data, there were 11,357 patients with uncomplicated diverticulitis and 526 patients with complicated diverticulitis admitted to Irish hospitals in the year 2015. Nationally, the median LOS for those with uncomplicated diverticulitis was 3 (range 1-142) days and for those with complicated diverticulitis the median LOS was 7 (range 1-308) days. Projected total cost for hospital stay nationally for uncomplicated diverticulitis amounted to €43.5 million for the year 2015. CONCLUSIONS:At present, uncomplicated diverticulitis in Ireland is not being managed as per evidence-based guidelines. Changing practice could result in significant cost savings for surgical departments.

Sinus bradycardia and associated isorhythmic AV dissociation may be seen during dobutamine stress echocardiography. This phenomenon is usually considered a benign peri-procedural event and is thought to be secondary to the Bezold-Jarisch reflex, with profound heart rate decrease secondary to a marked increased in vagal efferent discharge. To the best of our knowledge, dobutamine stress echocardiography unmasking clinically relevant sinus node dysfunction has never been reported. We report a case of a 50-year-old man presenting with chest pain and a history of syncope, who had worsening sinus bradycardia with isorhythmic AV dissociation during dobutamine stress echocardiography. An invasive electrophysiological study revealed marked sinus node dysfunction. The patient was referred for the insertion of a permanent pacemaker for sinus node dysfunction, chronotropic incompetence and symptomatic bradycardia. Dobutamine-associated bradycardia may not always be a benign peri-procedural physiologic effect, as in this case it may unmask clinically significant sinus node dysfunction.