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Conservative management of complicated colonic diverticulitis: long-term results

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Abstract

Background

The management of recurrent diverticulitis after initial non-operative treatment remains controversial. Recurrences after medical treatment have been described up to 36% but only 3 to 5% develop complicated disease.

Aim

To investigate the effectiveness of conservative treatment during a prolonged follow-up after first episode of complicated diverticulitis.

Methods

This retrospective single-center study describes the conservative management and outcomes of 207 with complicated acute colonic diverticulitis treated at Parma University Hospital from 1 January 2012 until 31 December 2019. The follow-up was performed until December 2020. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis.

Results

We enrolled 207 patients (118 males, 89 females). The mean age was 59 ± 14.5 years. CT scan of the abdomen was always performed. Almost all patients were treated with bowel rest and antibiotics (98.5%). Percutaneous drainage of abscessed diverticulitis was performed 12 times (5.7%). Average follow-up was 48 ± 28.8 months. 79 patients had new episodes of diverticulitis (38.1%) and 23 patients had high severity new episodes (11.1%). 11 patients underwent surgery (7.7%). Lower CT-Stages showed a higher recurrence rate (P = 0.002). Grade III diverticulitis showed a lower recurrence rate (P = 0.007).

Patients with chronic NSAID use showed a higher incidence of high severity new episodes (P = 0.039).

No recurrence rate differences were noted among patients with or without home therapy (P > 0.05).

Conclusions

Non-operative treatment is an effective and safe option in selected patients with complicated diverticulitis. The recurrence’s severity is generally lower than the previous episodes and this can justify the conservative management.

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Data availability

The original dataset generated during the current study is available from the corresponding author on reasonable request.

Abbreviations

ACD:

Acute colonic diverticulitis

NSAID:

Nonsteroidal anti-inflammatory drug

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Authors and Affiliations

  1. Department of Emergency Surgery, Parma University Hospital, Parma, Italy

    Gennaro Perrone, Antonio Tarasconi, Gabriele Luciano Petracca, Giorgio Rossi & Fausto Catena

  2. General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Via A. Gramsci 14, 43126, Parma, Italy

    Mario Giuffrida, Alfredo Annicchiarico & Elena Bonati

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  1. Gennaro Perrone
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Perrone, G., Giuffrida, M., Tarasconi, A. et al. Conservative management of complicated colonic diverticulitis: long-term results. Eur J Trauma Emerg Surg 49, 2225–2233 (2023). https://doi.org/10.1007/s00068-022-01922-1

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