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
. 2024 Aug;48(8):2000-2015.
doi: 10.1002/wjs.12244. Epub 2024 Jun 6.

Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Andrea Morini  1 , Maurizio Zizzo  1 , David Tumiati  1 , Federica Mereu  1 , Diego Bernini  2 , Massimiliano Fabozzi  1
Affiliations

Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review

Andrea Morini et al. World J Surg. 2024 Aug.

Abstract

Introduction: Colonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low-quality evidence.

Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest.

Results: A total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery.

Conclusion: NOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.

Keywords: acute diverticulitis; extaluminal air; non‐operative management.

PubMed Disclaimer

References

REFERENCES

    1. Strate, L. L., and A. M. Morris. 2019. “Epidemiology, Pathophysiology, and Treatment of Diverticulitis.” Gastroenterology 156(5): 1282–1298.e1. https://doi.org/10.1053/j.gastro.2018.12.033.
    1. Wheat, C. L., and L. L. Strate. 2016. “Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States from 2000 to 2010.” Clinical Gastroenterology and Hepatology 14(1): 96–103. https://doi.org/10.1016/j.cgh.2015.03.030.
    1. Yamamichi, N., T. Shimamoto, Y. Takahashi, Y. Sakaguchi, H. Kakimoto, R. Matsuda, Y. Kataoka, et al. 2015. “Trend and Risk Factors of Diverticulosis in Japan: Age, and Lifestyle/metabolic‐Related Factors May Cooperatively Affect on the Colorectal Diverticula Formation.” PLoS One 10(4): e0123688. https://doi.org/10.1371/journal.pone.0123688.
    1. Painter, N. S., and D. P. Burkitt. 1975. “Diverticular Disease of the Colon, a 20th Century Problem.” Clinics in Gastroenterology 4(1): 3–21. https://doi.org/10.1016/s0300‐5089(21)00094‐8.
    1. Parks, T. G. 1975. “Natural History of Diverticular Disease of the Colon.” Clinics in Gastroenterology 4(1): 53–69. https://doi.org/10.1016/s0300‐5089(21)00097‐3.

Publication types

LinkOut - more resources