Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure

García, Alberto Titos; Aranda-Narváez, José Manuel; Romacho-López, Laura; González-Sánchez, Antonio Jesús; Cabrera-Serna, Isaac; Santoyo-Santoyo, Julio

doi:10.1007/s00384-017-2852-2

Cited by 32 publications

(41 citation statements)

References 13 publications

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“…Perforated diverticulitis has a higher possibility to become complicated diverticulitis, and complicated diverticulitis accompanied by peritonitis with perforation, intra-abdominal abscess, and fistula formation is well known to require longer hospitalization [ 11 12 13 ]. Our study showed a result similar to that of previous studies: that is, a perforation finding on the CT scan was a statistically significant factor associated with a hospital stay of longer than 6 days.…”

Section: Discussionmentioning

confidence: 99%

“…Bowel rest is also required for patients with severe symptomatic diverticulitis [ 11 12 13 ]. For such patients, the recommendation is that they stay in an NPO state until symptoms and clinical signs improve.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown that the operation rates for acute diverticulitis in Western and Eastern countries are different. A 5%–10% elective operation rate has been reported in Eastern countries whereas a 15% rate has been reported in Western countries [ 3 7 11 14 ]. Researchers have explained this difference between Western and Eastern countries as being due to various reasons, such as disease pathophysiology, age distribution of incidence, location of the disease, ethnicity, and dietary habits.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

et al. 2018

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PurposeThe aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.MethodsWe retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).ResultsIn the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).ConclusionWe suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

et al. 2018

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“…After excluding six studies that did not fulfill the primary end‐point, two studies that were duplicates and three with insufficient data to meet the end‐point. Finally, six studies were included for review . The flowchart of study enrollment is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

Conservative management of acute perforated diverticulitis: A systematic review

Chua

Jeyakumar

et al. 2020

J of Digest Diseases

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Objective Acute perforated diverticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis; however, a large proportion of patients are clinically stable with localized peritonitis. This article aimed to examine this specific group of patients by reviewing the outcomes of their conservative management. Methods A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non‐operative treatment for acute perforated diverticulitis were synthesized and tabulated. Results Of 479 patients, 407 (85%) were successfully managed non‐operatively. In total 70 (14.6%) patients failed non‐operative treatment and underwent operative surgical management, and two (0.4%) died. Emergency surgery includes a Hartmann's operation (40%) and resection with anastomosis with or without stoma (24%), laparoscopic lavage (16%) and surgical drainage (20%). The success rate of conservative management was 94.0% and 71.4% for patients with pericolic and distant free air, respectively. Treatment failure was associated with a high volume of free air, distant free air and the presence of abscess. Conclusions Conservative management is safe and successful in patients with acute perforated diverticulitis without generalized peritonitis. The early recognition of patients who show clinical signs of persistent perforation is important to ensure the success of this strategy.

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“…Thirty-five patients were excluded because at re-evaluation, no extraluminal air was observed ( n = 25) or the extraluminal air was located more than 5 cm of the affected segment ( n = 10). After exclusion of two duplicate patients, a total of 109 patients were included in the present study; 39 patients from the DIABOLO 14 trial and 70 patients from the retrospective single-centre cohort. Baseline characteristics are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Conservative Treatment in Diverticulitis Patients with Pericolic Extraluminal Air and the Role of Antibiotic Treatment

Bolkenstein

Dijk

Consten

et al. 2019

Journal of Gastrointestinal Surgery

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BackgroundRecently published studies advocate a conservative approach with observation and antibiotic treatment in diverticulitis patients with pericolic air on computed tomography (CT). The primary aim of this study was to assess the clinical course of initially conservatively treated diverticulitis patients with isolated pericolic air and to identify risk factors for conservative treatment failure. The secondary aim was to assess the outcome of non-antibiotic treatment.MethodsPatient data from a retrospective cohort study on risk factors for complicated diverticulitis were combined with data from the DIABOLO trial, a randomised controlled trial comparing non-antibiotic with antibiotic treatment in patients with uncomplicated diverticulitis. The present study identified all patients with Hinchey 1A diverticulitis with isolated pericolic air on CT. Pericolic air was defined as air located < 5 cm from the affected segment of colon. The primary outcome was failure of conservative management which was defined as need for percutaneous abscess drainage or emergency surgery within 30 days after presentation. A multivariable logistic regression of clinical, radiological and laboratorial parameters with respect to treatment failure was performed.ResultsA total of 109 patients were included in the study. Fifty-two (48%) patients were treated with antibiotics. Nine (8%) patients failed conservative management, seven (13%) in the antibiotic treatment group and two (4%) in the non-antibiotic group (p = 0.083). Only (increased) CRP level at presentation was an independent predictor for treatment failure.ConclusionsConservative treatment in diverticulitis patients with isolated pericolic air is a suitable treatment strategy. Moreover, non-antibiotic treatment might be reasonable in selected patients.

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Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure

Abstract: Nonoperative management of perforated diverticulitis is safe and efficient. Special follow-up must be assumed in patients ASA III-IV and with distant air in CT.

Cited by 32 publications

References 13 publications

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

Conservative management of acute perforated diverticulitis: A systematic review

Conservative Treatment in Diverticulitis Patients with Pericolic Extraluminal Air and the Role of Antibiotic Treatment

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