Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;49(5):2225-2233.
doi: 10.1007/s00068-022-01922-1. Epub 2022 Mar 9.

Conservative management of complicated colonic diverticulitis: long-term results

Gennaro Perrone  1 , Mario Giuffrida  2 , Antonio Tarasconi  1 , Gabriele Luciano Petracca  1 , Alfredo Annicchiarico  3 , Elena Bonati  3 , Giorgio Rossi  1 , Fausto Catena  1
Affiliations

Conservative management of complicated colonic diverticulitis: long-term results

Gennaro Perrone et al. Eur J Trauma Emerg Surg. 2023 Oct.

Abstract

Background: The management of recurrent diverticulitis after initial non-operative treatment remains controversial. Recurrences after medical treatment have been described up to 36% but only 3 to 5% develop complicated disease.

Aim: To investigate the effectiveness of conservative treatment during a prolonged follow-up after first episode of complicated diverticulitis.

Methods: This retrospective single-center study describes the conservative management and outcomes of 207 with complicated acute colonic diverticulitis treated at Parma University Hospital from 1 January 2012 until 31 December 2019. The follow-up was performed until December 2020. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis.

Results: We enrolled 207 patients (118 males, 89 females). The mean age was 59 ± 14.5 years. CT scan of the abdomen was always performed. Almost all patients were treated with bowel rest and antibiotics (98.5%). Percutaneous drainage of abscessed diverticulitis was performed 12 times (5.7%). Average follow-up was 48 ± 28.8 months. 79 patients had new episodes of diverticulitis (38.1%) and 23 patients had high severity new episodes (11.1%). 11 patients underwent surgery (7.7%). Lower CT-Stages showed a higher recurrence rate (P = 0.002). Grade III diverticulitis showed a lower recurrence rate (P = 0.007). Patients with chronic NSAID use showed a higher incidence of high severity new episodes (P = 0.039). No recurrence rate differences were noted among patients with or without home therapy (P > 0.05).

Conclusions: Non-operative treatment is an effective and safe option in selected patients with complicated diverticulitis. The recurrence's severity is generally lower than the previous episodes and this can justify the conservative management.

Keywords: Acute diverticulitis; Antibiotic therapy; Complicated diverticulitis; Conservative management; Conservative treatment; General surgery.

PubMed Disclaimer

References

    1. Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A, Melville D, Maxwell JD. Diverticular disease of the colon–on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003;17(9):1189–95. https://doi.org/10.1046/j.1365-2036.2003.01551.x (PMID: 12752356). - DOI - PubMed
    1. Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol. 2011;17(12):1600–5. https://doi.org/10.3748/wjg.v17.i12.1600.PMID:21472127 (PMCID: PMC3070132). - DOI - PubMed - PMC
    1. Paterson HM, Arnott ID, Nicholls RJ, Clark D, Bauer J, Bridger PC, Crowe AM, Knight AD, Hodgkins P, Solomon D, Dunlop MG. Diverticular disease in Scotland: 2000–2010. Colorectal Dis. 2015;17(4):329–34. https://doi.org/10.1111/codi.12811 (PMID: 25359603). - DOI - PubMed
    1. Jamal Talabani A, Lydersen S, Endreseth BH, Edna TH. Major increase in admission- and incidence rates of acute colonic diverticulitis. Int J Colorectal Dis. 2014;29(8):937–45. https://doi.org/10.1007/s00384-014-1888-9 (Epub 2014 May 8. PMID: 24802814; PMCID: PMC4101254). - DOI - PubMed - PMC
    1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009;136(3):741–54. https://doi.org/10.1053/j.gastro.2009.01.015 . - DOI - PubMed

LinkOut - more resources