International Journal of Colorectal Disease

, Volume 32, Issue 9, pp 1313–1319 | Cite as

Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone

  • Gaëtan-Romain Joliat
  • Jonathan Emery
  • Nicolas Demartines
  • Martin Hübner
  • Bertrand Yersin
  • Dieter Hahnloser
Original Article

Abstract

Purpose

Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis (uD) and can be performed for mild complicated diverticulitis (mcD). In several cases, outpatient treatment (OT) can be undertaken. This study assessed the 1-month failure rate of OT for uD/mcD compared to inpatient treatment (IT), and identified predictive factors for treatment failure.

Methods

All consecutive patients (2006–2012) diagnosed with uD/mcD by CT scan were retrospectively analyzed. Acute uD was defined as absence of the following: abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery. Acute mcD was defined as complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm. All patients received antibiotherapy. Treatment failure was defined as (re)hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization. All patients were contacted using a standardized questionnaire.

Results

Out of 540 uD/mcD, IT was offered to 369 patients (68%) and OT to 171 patients (32%). The IT group had higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP. Response rates to the questionnaire were 56% (IT) vs. 62% (OT), p = 0.18. Failure rates were 32% in IT vs. 10% in OT group, p < 0.01. Among the uD/mcD patients, admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon were risk factors for failure.

Conclusions

Outpatient treatment for uncomplicated/mild complicated diverticulitis is feasible and safe. Prognostic factors of failure necessitating closer follow-up were admission/CT time, Ambrosetti score of 4, and free air around the colon.

Keywords

Diverticulitis Outpatient treatment Treatment failure Antibiotics 

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Gaëtan-Romain Joliat
    • 1
  • Jonathan Emery
    • 1
  • Nicolas Demartines
    • 1
  • Martin Hübner
    • 1
  • Bertrand Yersin
    • 2
  • Dieter Hahnloser
    • 1
  1. 1.Department of Visceral SurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  2. 2.Emergency DepartmentLausanne University Hospital (CHUV)LausanneSwitzerland

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