Is it safe to send home an uncomplicated diverticulitis? The DIVER trial

Paolillo, Ciro; Spallino, Ilenia

doi:10.1007/s11739-014-1162-8

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…At present, the overall mesenteric vein thrombosis disease is rare [8] , because less than 10% are caused by mesenteric vein thrombosis, the incidence of intestinal ischemia in patients with acute mesenteric venous thrombosis need emergency surgery to remove mainly lies in whether patients with peritoneal irritation [9,10] , whether circulating shock, and whether a bloody ascites [11] , These three aspects to a certain extent determine whether patients need surgical treatment after admission. However, no speci c biomarkers [12] have been widely used in clinical practice to re ect patients' systemic in ammation, liver function, kidney function and other biomarkers. This study included 8 years of well-documented clinical data from grade III, GRADE A hospitals and concluded that white blood cell count was an independent risk factor for emergency enterectomy in patients with acute mesenteric venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis

Dai

et al. 2022

Preprint

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Objective: Acute mesenteric vein thrombosis (AMVT) is one of the acute abdominal diseases with onset, rapid progression, extensive intestinal necrosis, and requiring immediate surgical resection. The purpose of this study was to determine the risk factors of nosocomial intestinal resection in patients with AMVT. Methods: We retrospectively analyzed 64 patients with AMVT diagnosed by CTA in Affiliated Hospital of Kunming University of Science and Technology from January 2013 to December 2021. We compared patients who underwent intestinal resection (42 cases) with those who did not undergo intestinal resection (22 cases). The area under the ROC curve was evaluated and the forest map was drawn. Results: Among the 64 patients, 6 cases (9.38%) had a fever, 60 cases (93.75%) had abdominal pain, 9 cases (14.06%) had a history of diabetes, 8 cases (12.5%) had a history of deep vein thrombosis (DVT), and 25 cases (39.06%) had ascites suggested by B ultrasound or CT after admission. The mean age of all patients was (49.86±16.25) years. The mean age of patients in the enterectomy group was (47.71±16.20) years. The mean age of patients in the conservative treatment group (without enterectomy) was (53.95±15.90) years. In univariate analysis, there were statistically significant differences in leukocyte count (P=0.003), neutrophil count (P=0.001), AST(P=0.048), total bilirubin (P=0.047), fibrinogen (P= 0.022) and DD2 (P= 0.024) between the two groups. Multivariate logistic regression analysis showed that admission white blood cell count (OR=1.153, 95%CI: 1.039-1.280P =0.007) was an independent risk factor for intestinal resection in patients with AMVT. ROC curve showed that white blood cell count (AUC=0.759 95%CI: 0.620-0.897P =0.001 optimal threshold :7.815 sensitivity: 0.881 specificity: 0.636) had a good predictive value for emergency enterectomy for AMVT. Conclusions: Among patients with AMVT, patients with a higher white blood cell count at admission were more likely to have intestinal necrosis and require emergency enterectomy. This study is helpful for clinicians to accurately determine whether emergency intestinal resection is needed in patients with AMVT after admission, prevent further intestinal necrosis, and improve the prognosis of patients.

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Section: Discussionmentioning

confidence: 99%

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis

Dai

et al. 2022

Preprint

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“…Differently, the ASCRS suggested that ultrasound and magnetic resonance imaging (MRI) "can be useful alternatives in the initial evaluation of a patient with suspected AD" [9]. In the common clinical practice, these protocols may be not feasible [51]; in effect, the CT scan might be difficult to perform in every Emergency Department during the first 24 h after admission [49]. For this reason, multidisciplinary hospital teams should develop local protocols based on the available hospital resources.…”

Section: Discussionmentioning

confidence: 99%

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis

et al. 2019

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Background In Western countries, the incidence of acute diverticulitis (AD) is increasing. Patients with uncomplicated diverticulitis can undergo a standard antibiotic treatment in an outpatient setting. The aim of this systematic review was to assess the safety and efficacy of the management of acute diverticulitis in an outpatient setting. Methods A literature search was performed on PubMed, Scopus, Embase, Central and Web of Science up to September 2018. Studies including patients who had outpatient management of uncomplicated acute diverticulitis were considered. We manually checked the reference lists of all included studies to identify any additional studies. Primary outcome was the overall failure rates in the outpatient setting. The failure of outpatient setting was defined as any emergency hospital admission in patients who had outpatient treatment for AD in the previous 60 days. A subgroup analysis of failure was performed in patients with AD of the left colon, with or without comorbidities, with previous episodes of AD, in patients with diabetes, with different severity of AD (pericolic air and abdominal abscess), with or without antibiotic treatment, with ambulatory versus home care unit follow-up, with or without protocol and where outpatient management is a common practice. The secondary outcome was the rate of emergency surgical treatment or percutaneous drainage in patients who failed outpatient treatment. Results This systematic review included 21 studies including 1781 patients who had outpatient management of AD including 11 prospective, 9 retrospective and only 1 randomized trial. The meta-analysis showed that outpatient management is safe, and the overall failure rate in an outpatient setting was 4.3% (95% CI 2.6%-6.3%). Localization of diverticulitis is not a selection criterion for an outpatient strategy (p 0.512). The other subgroup analyses did not report any factors that influence the rate of failure: previous episodes of acute diverticulitis (p = 0.163), comorbidities (p = 0.187), pericolic air (p = 0.653), intra-abdominal abscess (p = 0.326), treatment according to a registered protocol (p = 0.078), type of follow-up (p = 0.700), type of antibiotic treatment (p = 0.647) or diabetes (p = 0.610). In patients who failed outpatient treatment, the majority had prolonged antibiotic therapy and only few had percutaneous drainage for an abscess (0.13%) or surgical intervention for perforation (0.06%). These results should be interpreted with some caution because of the low quality of available data. Conclusions The outpatient management of AD can reduce the rate of emergency hospitalizations. This setting is already part of the common clinical practice of many emergency departments, in which a standardized protocol is followed. The data reported suggest that this management is safe if associated with an accurate selection of patients (40%); but no subgroup analysis demonstrated significant differences between groups (such as comorbidities, previous episode, diabetes). The main limitations of t...

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“…18 The majority of Experts agree that the accuracy of US is limited in obese patients when inflammation is minimal or air is present in the colon, and correlated with the examiner's expertise. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Multicentric study will certainly be needed of focus on the role of US. The American College of Radiology recommends abdominal and pelvic CT with IV contrast (rating 9) in patients with suspected AD.…”

Section: An Imaging Strategymentioning

confidence: 99%

“…Indeed, prospective randomized, case-control and retrospective cohort study shown no benefit for the use of antibiotics in the treatment of uncomplicated AD, suggesting that its use should be reserved for the treatment of complicated disease. [23][24][25] An increasingly conservative approach changed also the surgery. The old simple rule of 2 attacks, then operate is gone, the patients with pericolic air or small fluid collection should be managed by antibiotic therapy, abscesses having a diameter of more than 4 cm are best treated by percutaneous drainage.…”

Section: The Managementmentioning

confidence: 99%

A three-step approach to patients with suspected acute diverticulitis in the emergency department: An interdisciplinary algorithm proposal

et al. 2018

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Patients with acute abdominal pain due to acute colonic diverticulitis are a frequent cause of hospital admission. Diverticuar disease increases with age. In Western populations, diverticular disease is diagnosed in 50% individuals over 70 years and 80% over 85 years of age. The identification of patients with acute diverticulitis is a considerable challenge, since numerous other acute abdominal conditions mimic its clinical characteristics. Another problem is the atypical presentation in older patients. A high index of suspicion in the setting of a compatible history and physical examination serves as the cornerstone of early diagnosis. The purpose of this review is to underline the importance of an intimately integrate multidisciplinary approach between emergency physicians, radiologists and surgeons.

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Is it safe to send home an uncomplicated diverticulitis? The DIVER trial

Cited by 4 publications

References 4 publications

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis

A three-step approach to patients with suspected acute diverticulitis in the emergency department: An interdisciplinary algorithm proposal

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