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World Journal of Surgery

, Volume 41, Issue 7, pp 1890–1895 | Cite as

Failure of Conservative Treatment of Acute Diverticulitis with Extradigestive Air

  • P. A. Colas
  • E. Duchalais
  • Q. Duplay
  • V. Serra-Maudet
  • S. Kanane
  • C. Ridereau-Zins
  • E. Lermite
  • C. Aubé
  • A. Hamy
  • A. VenaraEmail author
Original Scientific Report

Abstract

Background

Medical management for perforated diverticulitis without abscess or peritonitis (PDwAP) has a success rate of 40–70%. Identifying patients with a risk of medical treatment failure would improve outcomes. The aim of this study was to identify the risk factors for failure of medical treatment in patients admitted with PDwAP.

Methods

This multicenter retrospective observational study included all consecutive patients admitted for PDwAP and not surgically treated over a 7-year period. Peritonitis classified on the Hinchey scale was excluded. Potential clinical, biological and radiological risk factors for medical treatment failure were collected and compared between the group of patient with a failure of medical treatment (F) and the group in which treatment did not fail. Data were collected at referral.

Results

Ninety-one patients were included, and 29 had a failure of treatment (31.9%). The median heart rate was different between the two groups (p < 0.001), at approximately 100/min in the F group. A blood level of C-reactive protein (CRP) ≥150 mg/mL was associated with a higher rate of failure (p = 0.021), but it was not confirmed in multivariate analysis. Pneumoperitoneum ≥5 mm and intraperitoneal liquid located in the pouch of Douglas were more likely to be present in the F group (respectively, p = 0.001 and p < 0.001). A multivariate analysis showed independent risk factors as being the highest pneumoperitoneum diameter >5 mm (OR 5.193; p = 0.015) and peritoneal fluid location in the pouch of Douglas (OR 4.103; p = 0.036).

Conclusion

The severity of sepsis (tachycardia and CRP ≥150 mg/mL) and of imaging signs (pneumoperitoneum ≥5 mm and peritoneal fluid in the pouch of Douglas) were risk factors for medical treatment failure of PDwAP requiring special supervision so as not to lose time in undertaking surgical management.

Keywords

Peritonitis Anastomotic Leakage Diverticulitis Peritoneal Fluid Acute Diverticulitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflict of interests

The authors received no financial support for this study. The authors declare no conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • P. A. Colas
    • 1
    • 2
  • E. Duchalais
    • 3
  • Q. Duplay
    • 1
    • 2
  • V. Serra-Maudet
    • 4
  • S. Kanane
    • 5
  • C. Ridereau-Zins
    • 7
  • E. Lermite
    • 1
    • 2
    • 6
  • C. Aubé
    • 2
    • 6
    • 7
  • A. Hamy
    • 1
    • 2
    • 6
  • A. Venara
    • 1
    • 2
    • 6
    • 8
    Email author
  1. 1.Department of Visceral SurgeryUniversity Hospital of AngersAngers Cedex 9France
  2. 2.LUNAMUniversity of ANGERSAngersFrance
  3. 3.Department of Visceral SurgeryUniversity Hospital of NantesNantesFrance
  4. 4.Department of Visceral SurgeryHospital of Le MansLe MansFrance
  5. 5.Department of Visceral SurgeryHospital of CholetCholet CedexFrance
  6. 6.Laboratory HIFIH, UPRES EA 3859UFR Sciences MédicalesAngersFrance
  7. 7.Department of Imaging and DiagnosisUniversity Hospital of AngersAngers Cedex 9France
  8. 8.UMR INSERM U1235-TENSNantesFrance

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