Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications

Devaraj, Bikash; Liu, Wendy; Tatum, James M.; Cologne, Kyle G.; Kaiser, Andreas M.

doi:10.1097/dcr.0000000000000533

Cited by 85 publications

(45 citation statements)

References 26 publications

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“…Whilst our study suggests that elective colectomy may be over-utilized in some countries, its exact role remains controversial. The risk of recurrence after nonoperative management of diverticular abscess was found to be 61% in a study from the USA, suggesting a role for routine elective colectomy for these patients [26]. On the contrary, another study from New Zealand found a recurrence rate of 29% in similar patients, most of whom were managed nonoperatively [27].…”

Section: Discussionmentioning

confidence: 99%

Elective colectomy after acute diverticulitis: an international comparison

et al. 2019

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Aim Routine elective colectomy after acute diverticulitis is not recommended, yet significant numbers are still being performed. Amidst global concern over the rising costs of surgery and the value of healthcare, acute diverticulitis is a disease that is amenable to optimization of strategies for operative intervention. We aim to compare rates of elective colectomy after acute diverticulitis in the USA, England and Australia.Method Index unplanned admissions for acute diverticulitis were found from an international administrative dataset between 2008 and 2012 for hospitals in the USA, England and Australia. Recurrent unplanned admissions for acute diverticulitis and any subsequent elective admissions for colectomy were found between 2008 and 2014 to allow a minimum 2-year follow-up period. The primary outcome measured was elective colectomy rate. Secondary outcomes included rates of emergency operative intervention and recurrence. Multivariable analysis was performed to control for patient and disease factors.Results There were 7842 index unplanned admissions for acute diverticulitis over 4 years in selected hospitals from the USA, England and Australia. The elective colectomy rates were 13%, 5.4% and 3.4% for the USA, England and Australia, respectively. The propensity for elective colectomy was higher in the USA (OR 4.2, P < 0.001) and England (OR 1.8, P < 0.001) than in Australia. The recurrence rate in all patients with acute diverticulitis was 10% across the countries.Conclusion There is a higher propensity for elective colectomy after acute diverticulitis in the USA than in England and Australia. This highlights the possibilities for a less aggressive surgical approach to reduce resource utilization, but prospective analysis of information on quality of life is required to support this.What does this paper add to the literature? Rates of elective colectomy following acute diverticulitis are rarely measured. This international study from hospitals in the USA, England and Australia is the first to measure these rates and find a difference between them. This highlights the potential for performing fewer elective operations after acute diverticulitis, with implications for resource utilization in healthcare.

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Section: Discussionmentioning

confidence: 99%

Elective colectomy after acute diverticulitis: an international comparison

et al. 2019

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“…We did not consider factors such as body mass index, smoking or alcohol consumption, diet or the use of non‐steroidal anti‐inflammatory drugs in our analysis. However, some recent studies, including systematic reviews and meta‐analyses, agreed that AD recurrence (not the primary attack) was mainly influenced by young age, primary diverticulitis with abscess formation and prior episodes of AD, factors of which were all included in our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, up to 25% of these patients will experience the recurrence of AD, which further increases the medical costs and morbidities related to this condition. Among these cases, young age and the presence of diverticular abscesses have been suggested as risk factors related to disease recurrence . Several drugs, such as rifaximin, have been investigated in the hope of reducing the incidence of recurrent diverticulitis; however, their effects may be limited and their efficacy remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Among these cases, young age and the presence of diverticular abscesses have been suggested as risk factors related to disease recurrence. [6][7][8][9] Several drugs, such as rifaximin, have been investigated in the hope of reducing the incidence of recurrent diverticulitis; 10,11 however, their effects may be limited and their efficacy remains controversial. Therefore, measurements used to prevent the recurrence of diverticulitis are needed.…”

Section: Introductionmentioning

confidence: 99%

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Impact of barium enema on acute diverticulitis recurrence: A retrospective cohort study of 349 patients

Fernández

Rodríguez‐Ortiz

Garcilazo‐Arismendi

et al. 2017

J of Digest Diseases

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“…However, patients with a complicated initial presentation are more likely to have a second episode. In one series of 210 patients with a diverticular abscess, 60% had a second presentation that was frequently more severe than the initial presentation; 59% of these patients required surgery [15]. Furthermore, uncomplicated diverticulitis may not run a benign self-limiting course; up to 30% of patients without further episodes have ongoing abdominal symptoms labelled "smouldering" diverticulitis [16].…”

Section: Introductionmentioning

confidence: 99%

Current Controversies in the Management of Diverticulitis: A Review

Nally

Kavanagh

2018

Dig Surg

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Background: Symptomatic diverticular disease is challenging for patients, clinicians and health services. The prevalence increases with age and BMI and as such, the burden of this disease is set to increase with higher rates of acute presentations already documented. The natural history of recurrent episodes, complications and symptom progression is not fully understood. Furthermore, medical and surgical management strategies are under constant appraisal, debate and evolution. Methods: A review of the contemporary literature was performed to examine the emerging trend towards conservative treatment. Results: Routine use of in-patient, intravenous antibiotics may not be required and outpatient management is possible for certain patients. Universal colonoscopy examination after uncomplicated acute diverticulitis is controversial but is mandatory after complicated episodes. Recent, high-profile, clinical trials suggest that less aggressive surgical management of both acute and chronic presentations may be feasible in some cases. Conclusions: Diverticulitis is a common yet challenging topic that demands clinicians to provide an individualised yet evidence-based approach.

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Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications

Cited by 85 publications

References 26 publications

Elective colectomy after acute diverticulitis: an international comparison

Elective colectomy after acute diverticulitis: an international comparison

Impact of barium enema on acute diverticulitis recurrence: A retrospective cohort study of 349 patients

Current Controversies in the Management of Diverticulitis: A Review

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