Incidence, outcome, and proposed management of isolated abscesses complicating acute left-sided colonic diverticulitis

Ambrosetti, P.; Robert, John; Witzig, J A; Mirescu, D; Gautard, R. de; Borst, F.; Rohner, A

doi:10.1007/bf02252998

Cited by 87 publications

(40 citation statements)

References 8 publications

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“…However, Ambrosetti et al 6,16 observed that both intraabdominal and pelvic abscesses were associated with a significant risk of surgery compared with a mesocolic abscess. The latter had a lower risk of requiring surgery once adequately drained.…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

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INTRODUCTION Diverticulitis is a common condition occasionally complicated by abscess formation. Small abscesses may be managed by antibiotic therapy alone but larger collections require drainage, ideally by the percutaneous route. This minimally invasive approach is appealing but there is little information regarding the long-term follow-up of patients managed in this way. To address this question, we looked at a consecutive series of patients who underwent percutaneous drainage in our institution.PATIENTS AND METHODS A retrospective study was performed of patients undergoing percutaneous drainage of a diverticular abscess from 1999-2007. RESULTS A total of 26 abscesses were identified in 16 patients. In 69% of cases, the abscess was located in the pelvis. The mean size of the abscesses was 8.5 ±0 .9 cm. Drainage was performed under CT (83%) or ultrasound guidance. The mean duration of drainage was 8 days. Fistula formation following drainage occurred in 38% of cases. Eight patients (mean age, 71 years) underwent subsequent surgical resection 9 days to 22 months (mean, 7 months) following initial presentation. Eight patients with significant co-morbid conditions were managed by percutaneous drainage only. The 1-year mortality was 20% and resulted from unrelated causes. The long-term stoma rate was 13%.CONCLUSIONS Percutaneous drainage can safely be performed in patients with a diverticular abscess. It can be used as a bridge before definitive surgery but also as a treatment option in its own right in high-risk surgical patients. We believe percutaneous drainage reduces the need for major surgery and reduces the risk of a permanent stoma.

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Section: Discussionmentioning

confidence: 99%

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

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“…Based on our previous and recent experience with 31 patients we think that the evolution of these abscesses is more related to their localization than to their size (mean size of mesocolic abscesses was 4.1 vs. 5.4 cm for pelvic abscesses) [34], Abdominal and pelvic abscesses have a more aggressive behavior since the 3 abdominal abscesses and 11 of the 13 pelvic abscesses required surgical treat ment. Therefore, for abdominal and pelvic abscesses we would recommend percutaneous drainage followed 4-6 weeks later by one-stage colectomy if possible.…”

Section: Discussionmentioning

confidence: 99%

Acute Left Colonic Diverticulitis: Management Controversies

Ambrosetti¹,

Robert²,

Witzig³

et al. 1993

Dig Surg

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Of 226 patients who entered a prospective study on acute left colonic diverticulitis, 66 (29%) were operated: 51 underwent a Hartmann’s procedure for diffuse peritonitis in 27 (52%), localized peritonitis in 14 (27%) and isolated abscess in 10 cases (21%). Overall, 31 patients (14%) had an isolated associated abscess (15 mesocolic, 13 pelvic and 3 abdominal) which was percuta-neously drained in 4 cases and operated in 10 cases. Of the 15 patients with mesocolic abscess, 12 (80%) were never operated. Two patients died postoper-atively (4%). Thirty-nine patients (81 %) had bowel continuity restored, with 1 postoperative death (2.5%). Continuity was reestablished in all patients under 79 years but in only 2 of 10 older patients (20%). Hartmann’s procedure remains an excellent option for diverticulitis with diffuse or localized peritonitis, in spite of the fact that most elderly patients ( > 80 years) keep their colosto-my. Isolated mesocolic associated abscess has most often a spontaneously favorable course.

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“…Small pericolic abscesses (Stage I) can often be treated conservatively with antibiotics and bowel rest (68). Their favorable prognosis may be attributed to a persistent fistula between the abscess and the colon, permitting spontaneous internal drainage.…”

Section: Complications Of Diverticulitismentioning

confidence: 99%