Outpatient Versus Hospitalization Management for Uncomplicated Diverticulitis

Biondo, Sebastiano; Golda, Thomas; Kreisler, Esther; Espín, Eloy; Vallribera, Francesc; Oteiza, Fabiola; Cazador, Antonio Codina; Pujadas, Marcel; Flor, Blas

doi:10.1097/sla.0b013e3182965a11

Cited by 167 publications

(99 citation statements)

References 24 publications

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“…A recent randomized trial comparing outpatient and inpatient management of such patients found no differences between the two groups in terms of treatment failures or quality of life [2]. However, outpatient management of uncomplicated diverticulitis is not feasible in every hospital, as it requires rapid access to CT scanning, in order to confirm the diagnosis prior to discharge, and facilities for frequent outpatient follow-up.…”

Section: Management Of Acute Uncomplicated Diverticulitismentioning

confidence: 99%

“…Only around a quarter of individuals with colonic diverticular disease will ever develop symptoms, usually in the form of acute diverticulitis [2]. Acute diverticulitis occurs when the mouth of a diverticulum becomes blocked with inspissated faeces, resulting in localized inflammation and bacterial proliferation; it commonly presents with abdominal pain and tenderness in the left iliac fossa, but right-sided symptoms may be present if the inflamed diverticular segment is on the right side of the colon or if there is a long, mobile sigmoid loop.…”

Section: Introductionmentioning

confidence: 99%

“…Colonic diverticular disease is a common condition, which increases in frequency with age, affecting up to two thirds of individuals in Western countries by the age of 80 years [1,2]. Diverticulosis can affect any part of the colon, and although left-sided diverticulosis is more common in Europe and North America: the right colon is more commonly affected in Japan, Singapore and China [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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Section: Management Of Acute Uncomplicated Diverticulitismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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“…A further study of 132 patients with CT proven uncomplicated acute diverticulitis randomised treatment in the community or hospital admission demonstrated no difference in failure rates of treatment between the two groups, but found lower costs in the community treated group. 58 The use of mesalazine in patients with uncomplicated symptomatic diverticular disease has been proposed with a recent randomised trial reporting a nonsignificant reduction in median lower abdominal pain in the mesalazine group. 59 Reliable identification of patients with acute diverticulitis who may be safely treated in the community is required and further research is needed in this area to maximise the potential benefits of avoiding hospital admission for patients and to reduce health care costs.…”

Section: Risk Stratificationmentioning

confidence: 99%

Review article: the pathogenesis and management of acute colonic diverticulitis

Humes

Spiller

2014

Aliment Pharmacol Ther

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SummaryBackgroundAcute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years.AimTo review the current understanding of the aetiology and treatment of acute diverticulitis.MethodsA search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis.ResultsThere are 75 hospital admissions per year for acute diverticulitis per 100 000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7‐year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti‐inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in‐hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited.ConclusionsFurther high‐quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence‐based.

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“…Since the cost of medical care was three times higher in the inpatient group than that in the outpatient group, colonic diverticulitis patients without any complications should opt for outpatient care for reasons of safety and cost-effectiveness. 5 The treatment decision should be based on the patient's clinical physiological state; therefore, biochemical and hematological markers can help us detect systemic inflammation. A CT scan is useful to diagnose acute abdominal conditions; however, it is expensive and radiation exposure is an important concern.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil to Lymphocyte Count Ratio Has a Close Association With Severe Acute Colonic Diverticulitis in Patients Undergoing Surgical Treatment

Kim

Moon

Yoon

et al. 2017

International Surgery

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Objective: To investigate the diagnostic potential of neutrophil-to-lymphocyte count ratio (NLCR) for acute diverticulitis. Summary of Background Data: We evaluated NLCR in patients with acute colonic diverticulitis who were treated with conservative and surgical treatments. Methods: A total of 205 patients who underwent surgical treatment or conservative management of acute diverticulitis between 2012 and 2016 were reviewed. Patients' age; sex; hospital days; co-morbidity; complication; period of use of antibiotics; treatment method; body temperature; and initial laboratory results such as neutrophil count, lymphocyte count, NLCR, and serum levels of C-reactive protein (CRP) were assessed. Results: The median ages of the conservative and surgical treatment groups were 46 and 68 years, respectively. Median CRP and glucose levels were high in acute colonic diverticulitis patients who underwent surgical treatment (P < 0.001, P < 0.001). Albumin level was low in the surgical treatment group (P < 0.001). NLCR was significantly different in both groups (conservative management vs surgical treatment, 4.1 mg/L versus 8.5 mg/L; P < 0.001). Median white blood cells was 11.36 × 109/L in the conservative management group and 14.0 × 109/L in the surgical treatment group, with no significance (P = 0.071). Multivariate analysis revealed that NLCR >10.21 [odds ratio (OR) = 5.613, P = 0.022]; CRP >17.23 mg/L (OR = 4.241, P = 0.006); and albumin ≤3.5 (OR = 4.192, P = 0.036) were significant for acute colonic diverticulitis patients. Conclusion: NLCR, CRP, and albumin levels were significantly associated with acute colonic diverticulitis in the surgical treatment group, and NLCR was the most powerful predictive marker of severe acute colonic diverticulitis.

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Outpatient Versus Hospitalization Management for Uncomplicated Diverticulitis

Cited by 167 publications

References 24 publications

Management of Acute Diverticulitis and its Complications

Management of Acute Diverticulitis and its Complications

Review article: the pathogenesis and management of acute colonic diverticulitis

Neutrophil to Lymphocyte Count Ratio Has a Close Association With Severe Acute Colonic Diverticulitis in Patients Undergoing Surgical Treatment

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