Advertisement

Do All Patients Require Resection After Successful Drainage of Diverticular Abscesses?

  • Christopher T. Aquina
  • Fergal J. Fleming
  • Jason Hall
  • Neil HymanEmail author
Surgical Debates
  • 86 Downloads

The surgical approach to sigmoid diverticulitis has undergone major changes over the past two decades. Many of the beliefs about the natural history of both complicated and uncomplicated diverticulitis have been reassessed. Acute diverticulitis is complicated by abscess formation in approximately 15–40% of patients. Small abscesses may be treated with antibiotics alone and larger collections generally require concomitant drainage. Percutaneous drainage of diverticular abscesses is a well-established modality, commonly converting a multistage approach requiring an intestinal stoma to a single-stage resection with anastomosis.

Traditionally, surgical resection has been advocated after resolution of a diverticular abscess with antibiotics and/or drainage. However, it is not clear that all patients who have complete clinical and radiologic resolution of an abscess need to undergo prophylactic surgery. Certainly, these patients do not want to go through this experience again (or worse), but...

Keywords

Diverticulitis Diverticular abscess Surgery 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Rose J, Parina R P, Faiz, O, Chang, DC, Talamini MA. Long-term outcomes after initial presentation of diverticulitis. Ann Surg 2015; 262 (6): 1046–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Devaraj B, Liu W, Tatum, J, Cologne, K, Kaiser AM. Medically treated diverticular abscess associated with high risk of recurrence and disease complications. Dis Colon Rectum 2016; 59 (3): 208–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Lamb, M. N. K. A. M., Elective resection versus observation after nonoperative management of complicated diverticulitis with abscess: A systematic review and meta-analysis. Dis Colon Rectum 2014; 57 (12): 1430–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Aquina CT, Becerra AZ, Xu Z, Justiniano CF, Noyes K, Monson JRT, Fleming FJ. Population-based study of outcomes following an initial acute diverticular abscess. Br J Surg 2019;106(4):467–76.CrossRefPubMedGoogle Scholar
  5. 5.
    Gregersen R, Andresen K, Burcharth J, Pommergaard HC, Rosenberg J. Long-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study. Int J Colorectal Dis 2018;33(4):431–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Lambrichts DPV, Bolkenstein HE, van der Does D, Dieleman D, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg 2019;106(4):458–466.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 2014;57(3):284–94.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE)University of Rochester Medical CenterRochesterUSA
  2. 2.Department of SurgeryBoston University Medical CenterBostonUSA
  3. 3.Department of SurgeryUniversity of Chicago MedicineChicagoUSA

Personalised recommendations