Skip to main content

Advertisement

SpringerLink
Log in

Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

An Erratum to this article was published on 19 June 2015

Abstract

Purpose

The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period.

Methods

A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months.

Results

In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 × 109, respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4 %) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6 %) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients.

Conclusion

Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ambrosetti P, Grossholz M, Becker C, Terrier F, Morel P (1997) Computed tomography in acute left colonic diverticulitis. Br J Surg 84(4):532–534

    Article  CAS  PubMed  Google Scholar 

  2. Biondo S, Lopez Borao J, Millan M, Kreisler E, Jaurrieta E (2012) Current status of the treatment of acute colonic diverticulitis: a systematic review. Color Dis Off J Assoc Coloproctology Great Brit Ireland 14(1):e1–e11

    Article  CAS  Google Scholar 

  3. Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME (2007) Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 22(9):1360–1368

    Article  PubMed  Google Scholar 

  4. Tursi A (2004) Acute diverticulitis of the colon—current medical therapeutic management. Expert Opin Pharmacother 5(1):55–59

    Article  CAS  PubMed  Google Scholar 

  5. Maconi G, Barbara G, Bosetti C, Cuomo R, Annibale B (2011) Treatment of diverticular disease of the colon and prevention of acute diverticulitis: a systematic review. Dis Colon Rectum 54(10):1326–1338

    Article  PubMed  Google Scholar 

  6. Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K, AS Group (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99(4):532–539

    Article  CAS  PubMed  Google Scholar 

  7. Isacson D, Andreasson K, Nikberg M, Smedh K, Chabok A (2014) No antibiotics in acute uncomplicated diverticulitis: does it work? Scand J Gastroenterol 5:1–6

    Google Scholar 

  8. de Korte N, Kuyvenhoven JP, van der Peet DL, Felt-Bersma RJ, Cuesta MA, Stockmann HB (2012) Mild colonic diverticulitis can be treated without antibiotics. A case-control study. Color Dis Off J Assoc Coloproctology Great Brit Ireland 14(3):325–330

    Article  Google Scholar 

  9. Biondo S, Golda T, Kreisler E, Espin E, Vallribera F, Oteiza F et al (2014) Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg 259(1):38–44

    Article  PubMed  Google Scholar 

  10. Ambrosetti P, Becker C, Terrier F (2002) Colonic diverticulitis: impact of imaging on surgical management—a prospective study of 542 patients. Eur Radiol 12(5):1145–1149

    Article  CAS  PubMed  Google Scholar 

  11. Mizuki A, Nagata H, Tatemichi M, Kaneda S, Tsukada N, Ishii H et al (2005) The out-patient management of patients with acute mild-to-moderate colonic diverticulitis. Aliment Pharmacol Ther 21(7):889–897

    Article  CAS  PubMed  Google Scholar 

  12. Ridgway PF, Latif A, Shabbir J, Ofriokuma F, Hurley MJ, Evoy D et al (2009) Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis. Color Dis Off J Assoc Coloproctology Great Brit Ireland 11(9):941–946

    Article  CAS  Google Scholar 

  13. Park HC, Kim BS, Lee BH (2011) Management of right colonic uncomplicated diverticulitis: outpatient versus inpatient management. World J Surg 35(5):1118–1122

    Article  PubMed  Google Scholar 

  14. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ et al (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143(5):1179–1187, e1-3

    Article  PubMed Central  PubMed  Google Scholar 

  15. Papagrigoriadis S, Debrah S, Koreli A, Husain A (2004) Impact of diverticular disease on hospital costs and activity. Color Dis Off J Assoc Coloproctology Great Brit Ireland 6(2):81–84

    Article  CAS  Google Scholar 

  16. Mills AM, Holena DN, Kallan MJ, Carr BG, Reinke CE, Kelz RR (2013) Effect of insurance status on patients admitted for acute diverticulitis. Color Dis Off J Assoc Coloproctology Great Brit Ireland 15(5):613–620

    Article  CAS  Google Scholar 

  17. Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 357(20):2057–2066

    Article  CAS  PubMed  Google Scholar 

  18. Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217

    Article  PubMed  Google Scholar 

  19. Patient Care Committee of the Society for Surgery of the Alimentary Tract (SSAT) (1999) Surgical treatment of diverticulitis. J Gastrointest Surg Off J Soc Surg Alimentary Tract 3(2):212–213

    Article  Google Scholar 

  20. Kohler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13(4):430–436

    Article  CAS  PubMed  Google Scholar 

  21. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294

    Article  PubMed  Google Scholar 

  22. Fozard JB, Armitage NC, Schofield JB, Jones OM (2011) ACPGBI position statement on elective resection for diverticulitis. Color Dis Off J Assoc Coloproctology Great Brit Ireland 13(Suppl 3):1–11

    Article  Google Scholar 

  23. Unlu C, Gunadi PM, Gerhards MF, Boermeester MA, Vrouenraets BC (2013) Outpatient treatment for acute uncomplicated diverticulitis. Eur J Gastroenterol Hepatol 25(9):1038–1043

    Article  PubMed  Google Scholar 

  24. Etzioni DA, Chiu VY, Cannom RR, Burchette RJ, Haigh PI, Abbas MA (2010) Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum 53(6):861–865

    Article  PubMed  Google Scholar 

  25. Friend K, Mills AM (2011) Is outpatient oral antibiotic therapy safe and effective for the treatment of acute uncomplicated diverticulitis? Ann Emerg Med 57(6):600–602

    Article  PubMed  Google Scholar 

  26. The Standards Task Force, American Society of Colon and Rectal Surgeons (2000) Practice parameters for sigmoid diverticulitis. Surg Laparosc Endosc Percutan Tech 10(3):142–148

    Google Scholar 

  27. Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97(6):952–957

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr H. Laurell for including patients from the Mora Hospital.

Conflict of interest

The authors declare that they have no competing interests.

Source of funding

This study was supported by a research grant from Uppsala-Örebro Regional Research Fund, Sweden.

Author information

Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, SE-72189, Västerås, Sweden

    D. Isacson, K. Andreasson, M. Nikberg, K. Smedh & A. Chabok

  2. Department of Radiology, Västmanland’s Hospital Västerås, Västerås, Sweden

    A. Thorisson

  3. Centre for Clinical Research of Uppsala University, Västmanland’s Hospital Västerås, Västerås, Sweden

    D. Isacson, A. Thorisson, M. Nikberg, K. Smedh & A. Chabok

Authors
  1. D. Isacson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Thorisson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Andreasson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Nikberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Smedh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Chabok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Isacson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Isacson, D., Thorisson, A., Andreasson, K. et al. Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study. Int J Colorectal Dis 30, 1229–1234 (2015). https://doi.org/10.1007/s00384-015-2258-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2258-y

Keywords

Search

Navigation