Hinchey Ia acute diverticulitis with isolated pericolic air on CT imaging; to operate or not? A systematic review

Karentzos, Alexandros; Ntourakis, Dimitrios; Tsilidis, Konstantinos K.; Tsoulfas, Georgios; Papavramidis, Theodossis S.

doi:10.1016/j.ijsu.2020.11.019

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…All data were in agreement with previous scientific publications. [44][45][46] In 2018, Van Dijk et al's systematic review 44 identified a 94% success rate for the NOM patients presenting with only pericolic extraluminal free air with AD (7 out of 195). Data were confirmed by our analysis of pericolic subgroup, where we found a 93.1% success rate (1574 successfully treated patients).…”

Section: Discussionmentioning

confidence: 99%

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Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Morini,

Zizzo,

Tumiati

et al. 2024

World j. surg.

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IntroductionColonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low‐quality evidence.MethodsWe performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest.ResultsA total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery.ConclusionNOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.

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Section: Discussionmentioning

confidence: 99%

“…In 2021, Karentzos et al 46 carried out an updated systematic review dealing with success rate of conservative treatment for patients with AD and only pericolic extraluminal free air. Of the 411 examined patients, 390 were successfully treated with NOM (94.9%).…”

Section: Referencesmentioning

confidence: 99%

Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Morini,

Zizzo,

Tumiati

et al. 2024

World j. surg.

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“…Conservative treatment of stage Ia acute diverticulitis with sequestered air around the colon is safe, feasible, and effective in 95% of such cases [ 18 ], as well as in cases with a distant intra-abdominal air in small amount or local air around the colon but without signs of peritonitis [ 19 ]. In the case of pericolic air without clinical signs, successful antibiotic treatment reaches up to 94% [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

Current Aspects on the Management of Perforated Acute Diverticulitis: A Narrative Review

Pavlidis¹,

Pavlidis²

2022

Cureus

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Unhealthy nutritional habits and the current western lifestyle have led to an increased incidence of acute diverticulitis, which mainly affects older patients. However, the disease course in younger patients might be more severe. It has a continued increase in surgical practice, as it is the most common clinical condition encountered in the emergencies. Diagnosis and management have changed over the past decade. C-reactive protein > 170 mg/L represents the cut-off point between moderate and severe diverticulitis, and a CT scan is mandatory. It demands urgent surgical management and has high morbidity and mortality rate, especially in immunosuppressed patients, reaching up to 25%. According to the contemporary guidelines, there have been certain indications for conservative management and re-evaluation (administration of antibiotics, CT-guided drainage of the abscess, when it is > 4 cm). They include pericolic air bubbles or a small amount of fluid, absence of abscess within a distance of 5 cm from the affected bowel or abscess ≤4 cm. In other cases, Hartmann’s sigmoidectomy is the procedure of choice. An alternative choice, nowadays, is resection and primary anastomosis with or without diverting stoma, especially in younger patients. Laparoscopic lavage only versus primary resection has been performed in severe cases of Hinchey III or IV. Damage control surgery, possible open abdomen, and reoperation are recommended in severe sepsis. Hinchey’s classification may not be absolutely adequate, and several modifications have been proposed. Current classification criteria (CRP, qSOFA score) are more appropriate. The decision-making must be individualized depending on the hemodynamic status (septic shock), age, comorbidity, immune status, intraoperative findings, and MPI (Mannheim peritonitis index).

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“…Cependant, les évidences sont limitées, et l'air libre comme seul critère ne devrait pas être considéré comme étant suffisant pour poser l'indication à une chirurgie. Une revue systématique récente de 9 études observationnelles incluant 411 patients a montré que la prise en charge non chirurgicale de la diverticulite aiguë Hinchey Ia (épaississement pariétal et inflammation péri-colique) avec de l'air péri-colique localisé était faisable avec un taux d'échec de seulement 5.1 % [20]. Il faut toutefois relever que la présence d'une grande quantité de gaz intrapéritonéal ou rétropéritonéal à distance, même en l'absence de péritonite clinique, est associée à un taux d' échec élevé (jusqu'à 60 %) de traitement conservateur [21].…”

Section: Que Faire En Cas De Pneumopéritoine Lors D'une Diverticulite Aiguë?unclassified

Prise en charge de la diverticulite aiguë

Martín

Hahnloser

Faes

2021

Schweiz. Gastroenterol.

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RésuméLa prévalence de la maladie diverticulaire colique est en augmentation au niveau mondial, ce qui est probablement en lien avec des changements de mode de vie. Bien qu’elle reste plus fréquente chez les patients âgés, une augmentation spectaculaire de son incidence a été observée dans les groupes d’âge plus jeunes ces dernières années. La diverticulite aiguë est une des conditions cliniques les plus fréquemment rencontrées par les médecins généralistes, les gastroentérologues ainsi que les chirurgiens. Comment diagnostiquer, classifier, et prendre en charge cette pathologie? Le but de cette revue est de présenter un aperçu des preuves existantes et de décrire son management.

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Hinchey Ia acute diverticulitis with isolated pericolic air on CT imaging; to operate or not? A systematic review

Cited by 9 publications

References 23 publications

Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Current Aspects on the Management of Perforated Acute Diverticulitis: A Narrative Review

Prise en charge de la diverticulite aiguë

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