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. 2024 Apr 25;28(1):50.
doi: 10.1007/s10151-024-02928-0.

Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study

M Aubert  1 , F Tradi  2 , S Chopinet  3 , J Duclos  3 , R Le Huu Nho  3 , J Hardwigsen  3 , N Pirro  3 , D Mege  3
Affiliations

Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study

M Aubert et al. Tech Coloproctol. .

Abstract

Background: Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure.

Methods: A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission.

Results: Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002).

Conclusions: Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.

Keywords: Antibiotics; Conservative treatment; Diverticulitis; Emergent sigmoidectomy; Extraluminal air; Percutaneous drainage.

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References

    1. Sandler RS, Everhart JE, Donowitz M et al (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122:1500–1511. https://doi.org/10.1053/gast.2002.32978 - DOI - PubMed
    1. El-Sayed C, Radley S, Mytton J et al (2018) Risk of recurrent disease and surgery following an admission for acute diverticulitis. Dis Colon Rectum 61:382–389. https://doi.org/10.1097/DCR.0000000000000939 - DOI - PubMed
    1. Shahedi K, Fuller G, Bolus R et al (2013) Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 11:1609–1613. https://doi.org/10.1016/j.cgh.2013.06.020 - DOI - PubMed - PMC
    1. Bridoux V, Antor M, Schwarz L et al (2014) Elective operation after acute complicated diverticulitis: Is it still mandatory? World J Gastroenterol 20:8166–8172. https://doi.org/10.3748/wjg.v20.i25.8166 - DOI - PubMed - PMC
    1. Sallinen VJ, Mentula PJ, Leppäniemi AK (2014) Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon Rectum 57:875–881. https://doi.org/10.1097/DCR.0000000000000083 - DOI - PubMed

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