The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh, Baljit; May, K; Coltart, Iona; Moore, NR; Cunningham, Chris

doi:10.1308/003588408x285928

Cited by 79 publications

(51 citation statements)

References 17 publications

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“…Since the introduction of broad-spectrum antibiotics and improvement in US- and CT-guided percutaneous drainage techniques, alternatives to surgery have become available. Conservative treatment with antibiotics is successful in up to 73% (95% CI: 66.3-78.9) of patients presenting with an abscess of less than 4-5 cm in diameter (level C [16,18,100,101,102,103,104]). When conservative treatment fails, percutaneous drainage should be performed, which is successful in up to 81% (95% CI: 73.7-89.1) of patients (level C [15,16,100,101,102,103,104]).…”

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

“…Conservative treatment with antibiotics is successful in up to 73% (95% CI: 66.3-78.9) of patients presenting with an abscess of less than 4-5 cm in diameter (level C [16,18,100,101,102,103,104]). When conservative treatment fails, percutaneous drainage should be performed, which is successful in up to 81% (95% CI: 73.7-89.1) of patients (level C [15,16,100,101,102,103,104]). The risk of failure of conservative treatment is higher in patients with abscesses larger than 4-5 cm than in patients with smaller abscesses (level C [15,16,100,101,102,103,104]).…”

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

“…When conservative treatment fails, percutaneous drainage should be performed, which is successful in up to 81% (95% CI: 73.7-89.1) of patients (level C [15,16,100,101,102,103,104]). The risk of failure of conservative treatment is higher in patients with abscesses larger than 4-5 cm than in patients with smaller abscesses (level C [15,16,100,101,102,103,104]).…”

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

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Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

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Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

Section: Treatment Of Complicated Diverticulitismentioning

confidence: 99%

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Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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“…Percutaneous drainage of an abscess caused by diverticulitis is probably the most common cause for the formation of a colocutaneous fistula in this setting. Resolution of the inflammatory process may culminate with spontaneous closure of the fistulae [98]. However, spontaneous fistula closure is not the main aim of treatment.…”

Section: Large Bowel Fistulaementioning

confidence: 99%

Uncommon acquired fistulae involving the digestive system: summary of data

Ashkenazi

Olsha

Kessel

et al. 2011

Eur J Trauma Emerg Surg

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“…In this report, we present a patient with colonic diverticular disease Type III according to Hinchey classification mimicking subcutaneous abscess and despite effective antiinflammatory therapy and drainage resulting colocutanous fistula. However, internal fistulas of diverticular diseases are well-defined in literature, colocutaneous fistulas well not documanted after percutane drainage of a cutanous abscess [1][2][3].…”

mentioning

confidence: 99%

Colocutanous fistula after percutanous drainage in a patient with diverticular disease

Yıldırım¹,

Yakan²

2017

Surg Rehabil

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We would like to draw readers attention to colocutanous fistulas,notable rare in this letter. In this report, we present a patient with colonic diverticular disease Type III according to Hinchey classification mimicking subcutaneous abscess and despite effective antiinflammatory therapy and drainage resulting colocutanous fistula. However, internal fistulas of diverticular diseases are well-defined in literature, colocutaneous fistulas well not documanted after percutane drainage of a cutanous abscess [1][2][3].A 63-year-old man with a faecal fistula in the left lower anterior abdominal region was admitted to our Department of Surgery. The patient's chief complaint is abdominal pain and low-output fecal purulent discharge from a fistula tract (Figure 1). Three days before presentation, the patient was felt colicky pain in the lower left abdominal quadrant. After the pain persisted and, on the following day, it intensified and was accompanied by a recorded fever of 38 º C. He has not noted any changes in his bowel movements. The patient has not taken any medication for the abdominal pain.His past medical history included diabetes mellitus, and no significant any disease. He had percutaneous drainage with the diagnosis of subcutanous abscess 28 days ago in an Invaziv Radiology Section of a different hospital. CT showed peridiverticular abscess formation sprawling into the rectus abdominis muscle and subcutanous planes.With these imaging findings in hand, we considered a colocutaneous fistula triggered by percutaneous drainage of an abscess originated perforated diverticular disease. As a result,we performed laparotomy which revealed a mass that sigmoid colon herniation originating from a inflamed diverticulitis through the posterior rectus sheath in the left lower abdominal wall and cutaneous fistula formation. We reduced the mass containing inflamed colon segment, and performed segmenter colon resection with end-to-end colocolic anastomosis. We curetted fistula tract, and sutured the posterior fascia of the rectus muscle. The patient was discharged on the 7 th postoperative day of the surgery. At followup examination after three months the patient was in good condition. Histologic examination of the speciman showed no malignancy.In our view,differential diagnosis is an important entity for abdominal skin abscess. We think that, surgical resection of fistulised segment is reserved for those Grade III diverticulitis. Drainage with imaging studies must be applied to prevent unwanted local and systemic complications.

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The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Cited by 79 publications

References 17 publications

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Uncommon acquired fistulae involving the digestive system: summary of data

Colocutanous fistula after percutanous drainage in a patient with diverticular disease

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