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IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments

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Abstract

Background

In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon’s personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments.

Methods

IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter.

Results

Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51–74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5–10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann’s resection. However, the Hartmann’s resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate.

Conclusions

The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon’s personal preference.

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References

  1. Laméris W, Van Randen A, Van Gulik TM et al (2010) A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 53:896–904

    Article  PubMed  Google Scholar 

  2. Sartelli M, Moore FA, Ansaloni L et al (2015) A proposal for a CT driven classification of left colon acute diverticulitis. World J Emerg Surg 10:3

    Article  PubMed  PubMed Central  Google Scholar 

  3. Morris AM, Regenbogen SE, Hardiman KM et al (2014) Sigmoid diverticulitis: a systematic review. JAMA 311:287–297

    Article  CAS  PubMed  Google Scholar 

  4. Andeweg CS, Mulder IM, Felt-Bersma RJ et al (2013) Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 30:278–292

    Article  CAS  PubMed  Google Scholar 

  5. Hinchey EJ, Schaal PH, Richards MB (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109

    CAS  PubMed  Google Scholar 

  6. Laméris W, van Randen A, Bossuyt PMM et al (2008) Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 18:2498–2511

    Article  PubMed  Google Scholar 

  7. Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917

    Article  PubMed  Google Scholar 

  8. Neff CC, van Sonnenberg E (1989) CT of diverticulitis. Diagnosis and treatment. Radiol Clin North Am 27:743–752

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Mora Lopez L, Serra Pla S, Serra-Aracil X et al (2013) Application of a modified Neff classification to patients with uncomplicated diverticulitis. Colorectal Dis 15:1442–1447

    Article  CAS  PubMed  Google Scholar 

  11. Etzioni DA, Chiu VY, Cannom RR et al (2010) Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum 53(6):861–865. doi:10.1007/DCR.0b013e3181cdb243

    Article  PubMed  Google Scholar 

  12. Jackson JD, Hammond T (2014) Systematic review: outpatient management of acute uncomplicated diverticulitis. Int J Colorectal Dis 29:775–781

    Article  CAS  PubMed  Google Scholar 

  13. Rodríguez-Cerrillo M (2013) Treatment of elderly patients with uncomplicated diverticulitis, even with comorbidity, at home. Eur J Intern Med 24:430–432

    Article  PubMed  Google Scholar 

  14. Biondo S et al (2014) Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg 259:38–44

    Article  PubMed  Google Scholar 

  15. De Korte N, Kuyvenhoven JP, van der Peet DL et al (2012) Mild colonic diverticulitis can be treated without antibiotics. A case–control study. Colorectal Dis 14:325–330

    Article  PubMed  Google Scholar 

  16. Chabok A, Påhlman L, Hjern F et al (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99:532–539

    Article  CAS  PubMed  Google Scholar 

  17. Shabanzadeh DM, Wille-Jørgensen P (2012) Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev 11:CD009092

    PubMed  Google Scholar 

  18. Ambrosetti P, Chautems R, Soravia C et al (2005) Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum 48:787–791

    Article  PubMed  Google Scholar 

  19. Brandt D, Gervaz P, Durmishi Y et al (2006) Percutaneous CT scan guided drainage versus antibiotherapy alone for Hinchey II diverticulitis: a case–control study. Dis Colon Rectum 49:1533–1538

    Article  CAS  PubMed  Google Scholar 

  20. Siewert B, Tye G, Kruskal J et al (2006) Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 186:680–686

    Article  PubMed  Google Scholar 

  21. Singh B, May K, Coltart I et al (2008) The long-term results of percutaneous drainage of diverticular abscess. Ann R Coll Surg Engl 90:297–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kumar RR, Kim JT, Haukoos JS et al (2006) Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 49:183–189

    Article  PubMed  Google Scholar 

  23. Andersen JC, Bundgaard L, Elbrønd H et al (2012) Danish national guidelines for treatment of diverticular disease. Dan Med J 59:C4453

    PubMed  Google Scholar 

  24. Feingold D, Steele SR, Lee S et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57:284–294

    Article  PubMed  Google Scholar 

  25. Binda GA, Cuomo R, Laghi A et al (2015) Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines. Tech Coloproctol 19:615–626

    Article  CAS  PubMed  Google Scholar 

  26. Etzioni DA, Mack TM, Beart RW et al (2009) Diverticulitis in the United States: 1998–2005. Changing patterns of disease and treatment. Ann Surg 249:210–217

    Article  PubMed  Google Scholar 

  27. Ambrosetti P, Jenny A, Becker C et al (2000) Acute left colonic diverticulitis compared performance of computed tomography and water soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 43:1363–1367

    Article  CAS  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. Hong MK, Tomlin AM, Hayes IP et al (2015) Operative intervention rates for acute diverticulitis: a multicentre state-wide study. ANZ J Surg 85:734–738

    Article  PubMed  Google Scholar 

  30. Li D, Baxter NN, McLeod RS et al (2014) Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis. Dis Colon Rectum 57:1397–1405

    Article  PubMed  Google Scholar 

  31. Oberkofler CE, Rickenbacher A, Raptis DA et al (2012) A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 256:819–826

    Article  PubMed  Google Scholar 

  32. Binda GA, Serventi A, Puntoni M et al (2015) Primary anastomosis versus Hartmann’s procedure for perforated diverticulitis with peritonitis: an impracticable trial. Ann Surg 261:116–117

    Article  Google Scholar 

  33. Schultz JK, Yaqub S, Wallon C et al (2015) Laparoscopic lavage vs primary resection for acute perforated diverticulitis: the SCANDIV randomized clinical trial. JAMA 314:1364–1375

    Article  CAS  PubMed  Google Scholar 

  34. Vennix S, Musters GD, Mulder IM et al (2015) Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet 386:1269–1277

    Article  PubMed  Google Scholar 

  35. Morris AM (2015) Laparoscopic peritoneal lavage for perforated diverticulitis: in search of evidence. Lancet 386:1219–1221

    Article  PubMed  Google Scholar 

  36. Angenete E, Thornell A, Burcharth J et al (2016) Laparoscopic lavage is feasible and safe for the treatment of perforated diverticulitis with purulent peritonitis: the first results from the randomized controlled trial DILALA. Ann Surg 263:117–122

    Article  PubMed  Google Scholar 

  37. Di Saverio S, Birindelli A, Catena F et al (2016) The ladies trial: premature termination of the LOLA arm and increased adverse events incidence after laparoscopic lavage may be influenced by inter-hospital and inter-operator variability? Take-home messages from a center with laparoscopic colorectal expertise. Int J Surg 36(Pt A):118–120. doi:10.1016/j.ijsu.2016.10.016

    Article  Google Scholar 

  38. Sartelli M, Abu-Zidan FM, Ansaloni L et al (2015) The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg 10:35

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hawser SP, Bouchillon SK, Hoban DJ et al (2010) Incidence and antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae with extended-spectrum beta-lactamases in community- and hospital-associated intra-abdominal infections in Europe: results of the 2008 study for monitoring antimicrobial resistance trends (SMART). Antimicrob Agents Chemother 54:3043–3046

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Yigit H, Queenan AM, Anderson GJ et al (2001) Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 45:1151–1161

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Nordmann P, Poirel L (2014) The difficult-to-control spread of carbapenemase producers among enterobacteriaceae worldwide. Clin Microbiol Infect 20:821–830

    Article  CAS  PubMed  Google Scholar 

  42. Munoz-Price LS, Poirel L, Bonomo RA et al (2013) Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 13:785–796

    Article  PubMed  PubMed Central  Google Scholar 

  43. Broderick-Villa G, Burchette RJ, Collins JC et al (2005) Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 140:576–583

    Article  PubMed  Google Scholar 

  44. Ritz JP, Lehmann KS, Frericks B et al (2011) Outcome of patients with acute diverticulitis: multivariate analysis of risk factors for free perforation. Surgery 149:606–613

    Article  PubMed  Google Scholar 

  45. Wieghard N, Geltzeiler CB, Tsikitis VL (2015) Trends in the surgical management of diverticulitis. Ann Gastroenterol 28:25–30

    PubMed  PubMed Central  Google Scholar 

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IPOD study Collaborative Working Group Collaborators (IPOD study Group)

Gabriele Anania, Emanuele Caproli, Marcello Gasparrini, Pierpaolo Bordoni, Andrea Lucchi, Stefano Scabini, Biagio Picardi, Giuliano Sarro, Alice Piccinini, Natalino Bedin, Alessandro Bussotti, Renato De Angelis, Gian Luca Baiocchi, Antonella Andreotti, Nicola Cillara, Barbara Petronio, Sergio Grimaldi, Alessia Biancafarina, Dario Somenzi, Andrea Costanzi, Alberto Marvaso, Alfonso Canfora, Giorgio Vasquez, Carlo Chiodo, Mario Nano, Angelo Cavicchi, Alberto Ruffato, Paolo Baccari, Roberto Polastri, Patrizia Marsanic, Giuseppe Portale, Luca Gordini, Hariscine K Abongwa, Michela Pili, Luca Turati, Vittoria Nusca, Gianluca Guercioni, Leonardo Andrea Delogu, Umberto Robustelli, Danilo Piras, Fernando Serventi, Daniela Prando, Antonio Brunelli, Bruno Zani, Salvatore Pintaldi, Augusto Verzelli, Silvia Mulas, Gianmaria Confalonieri, Giuditta Spagni, Antonio Crucitti, Andrea Sagnotta, Stefania Fiume, Francesco Balestra, Matteo Gatti, Emilio Eugeni, Amedeo Carraro, Michele Genna, Lucio Taglietti, Antonio Azzinnaro, Stefano Ferfoglia, Giuseppe Miranda, Giuseppe Tirone, Pietro Luparello, Stefano Berti, Roberta Tutino, Andrea De Manzoni Garberini, Francesco Roscio, Valeria Maglione, Mauro Podda, Giovanna Ioia, Fabrizio Cantore, Franco Mazzalai, Francesco Cortesi, Giacomo Arcuri, Giovanni Bellanova, Massimo Beltramo, Antonella Chessa, Massimiliano Coppola, Davide Gozzo, Asaf Harbi, Edoardo Minciotti, Francesco Pata, Giovanni Pinna, Mario Testini, Serafino Vanella.

Author information

Authors and Affiliations

  1. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  2. Department of Surgery, Galliera Hospital, Genoa, Italy

    Gian Andrea Binda

  3. Department of General Surgery, ULSS 3, Bassano Del Grappa (VI), Italy

    Francesco Brandara

  4. Department of General Surgery, Humanitas Gradenigo, Turin, Italy

    Andrea Borasi

  5. Department of Surgery, Santo Stefano Hospital, Prato, Italy

    Francesco Feroci

  6. Department of Surgery, Cannizzaro Hospital, Catania, Italy

    Salvatore Vadalà

  7. Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy

    Francesco M. Labricciosa

  8. Department of General Surgery, University of Bologna, Bologna, Italy

    Arianna Birindelli

  9. Department of Surgery, Brotzu Hospital, Cagliari, Italy

    Gianluigi Luridiana

  10. Department of Surgery, Rimini Hospital, Rimini, Italy

    Federico Coccolini

  11. General Surgery, Emergency and Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy

    Salomone Di Saverio

  12. Department of Emergency Surgery, Maggiore Hospital, Parma, Italy

    Fausto Catena

  13. Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Luca Ansaloni

  14. Unit of General Surgery, AUSL VT, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy

    Fabio Cesare Campanile

  15. Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy

    Ferdinando Agresta

  16. Department of Surgery, Vittorio Emanuele Hospital, Catania, Italy

    Diego Piazza

Authors
  1. Massimo Sartelli
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  2. Gian Andrea Binda
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  3. Francesco Brandara
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  4. Andrea Borasi
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  5. Francesco Feroci
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  6. Salvatore Vadalà
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  7. Francesco M. Labricciosa
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  8. Arianna Birindelli
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  9. Gianluigi Luridiana
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  10. Federico Coccolini
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  11. Salomone Di Saverio
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  14. Fabio Cesare Campanile
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  16. Diego Piazza
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Consortia

IPOD study Collaborative Working Group

  • Gabriele Anania
  • , Emanuele Caproli
  • , Marcello Gasparrini
  • , Pierpaolo Bordoni
  • , Andrea Lucchi
  • , Stefano Scabini
  • , Biagio Picardi
  • , Giuliano Sarro
  • , Alice Piccinini
  • , Natalino Bedin
  • , Alessandro Bussotti
  • , Renato De Angelis
  • , Gian Luca Baiocchi
  • , Antonella Andreotti
  • , Nicola Cillara
  • , Barbara Petronio
  • , Sergio Grimaldi
  • , Alessia Biancafarina
  • , Dario Somenzi
  • , Andrea Costanzi
  • , Alberto Marvaso
  • , Alfonso Canfora
  • , Giorgio Vasquez
  • , Carlo Chiodo
  • , Mario Nano
  • , Angelo Cavicchi
  • , Alberto Ruffato
  • , Paolo Baccari
  • , Roberto Polastri
  • , Patrizia Marsanic
  • , Giuseppe Portale
  • , Luca Gordini
  • , Hariscine K Abongwa
  • , Michela Pili
  • , Luca Turati
  • , Vittoria Nusca
  • , Gianluca Guercioni
  • , Leonardo Andrea Delogu
  • , Umberto Robustelli
  • , Danilo Piras
  • , Fernando Serventi
  • , Daniela Prando
  • , Antonio Brunelli
  • , Bruno Zani
  • , Salvatore Pintaldi
  • , Augusto Verzelli
  • , Silvia Mulas
  • , Gianmaria Confalonieri
  • , Giuditta Spagni
  • , Antonio Crucitti
  • , Andrea Sagnotta
  • , Stefania Fiume
  • , Francesco Balestra
  • , Matteo Gatti
  • , Emilio Eugeni
  • , Amedeo Carraro
  • , Michele Genna
  • , Lucio Taglietti
  • , Antonio Azzinnaro
  • , Stefano Ferfoglia
  • , Giuseppe Miranda
  • , Giuseppe Tirone
  • , Pietro Luparello
  • , Stefano Berti
  • , Roberta Tutino
  • , Andrea De Manzoni Garberini
  • , Francesco Roscio
  • , Valeria Maglione
  • , Mauro Podda
  • , Giovanna Ioia
  • , Fabrizio Cantore
  • , Franco Mazzalai
  • , Francesco Cortesi
  • , Giacomo Arcuri
  • , Giovanni Bellanova
  • , Massimo Beltramo
  • , Antonella Chessa
  • , Massimiliano Coppola
  • , Davide Gozzo
  • , Asaf Harbi
  • , Edoardo Minciotti
  • , Francesco Pata
  • , Giovanni Pinna
  • , Mario Testini
  •  & Serafino Vanella

Corresponding author

Correspondence to Salomone Di Saverio.

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Sartelli, M., Binda, G.A., Brandara, F. et al. IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments. World J Surg 41, 851–859 (2017). https://doi.org/10.1007/s00268-016-3800-y

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