Abstract
Aim
The aim of this study was to analyze the results of nonoperative management of patients with perforated acute diverticulitis with extraluminal air and to identify risk factors that may lead to failure and necessity of surgery.
Methods
Methods included observational retrospective cohort study of patients between 2010 and 2015 with diagnosis of diverticulitis with extraluminal air and with nonoperative management initial. Patient demographics, clinical, and analytical data were collected, as were data related with computed tomography. Univariate and multivariate analyses with Wald forward stepwise logistic regression were performed to analyze results and to identify risk factors potentially responsible of failure of nonoperative management.
Results
Nonoperative management was established in 83.12% of patients diagnosed with perforated diverticulitis (64 of 77) with an overall success rate of 84.37%, a mean hospital stay of 11.98 ± 7.44 days and only one mortality (1.6%). Patients with pericolic air presented a greater chance of success (90.2%) than patients with distant air (61.5%). American Society of Anesthesiologists (ASA) grade III-IV (OR, 5.49; 95% CI, 1.04–29.07) and the distant location of air (OR, 4.81; 95% CI, 1.03–22.38) were the only two factors identified in the multivariate analysis as risk factors for a poor nonoperative treatment outcome. Overall recurrence after conservative approach was 20.4%; however, recurrence rate of patients with distant air was twice than that of patients with pericolic air (37.5 vs 17.39%). Only 14.8% of successfully treated patients required surgery after the first episode.
Conclusion
Nonoperative management of perforated diverticulitis is safe and efficient. Special follow-up must be assumed in patients ASA III-IV and with distant air in CT.
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References
Morris AM, Regenbogen SE, Hardiman KM, Hendren S (2014) Sigmoid diverticulitis: a systematic review. JAMA 311(3):287. doi:10.1001/jama.2013.282025
Regenbogen SE, Hardiman KM, Hendren S, Morris AM (2014) Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 149(3):292–303. doi:10.1001/jamasurg.2013.5477
Moore FA, Moore EE, Burlew CC et al (2012) Western Trauma Association critical decisions in trauma. J Trauma Acute Care Surg 77(6):1. doi:10.1097/TA.0b013e31825ff7e4
Vennix S, Morton DG, Hahnloser D, Lange JF, Bemelman WA (2014) Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Color Dis 16(11):866–878. doi:10.1111/codi.12659
Stollman N, Smalley W, Hirano I (2015) American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology 149:1944–1949. doi:10.1053/j.gastro.2015.11.008
Fozard JBJ, Armitage NC, Schofield JB, Jones OM (2011) ACPGBI position statement on elective resection for diverticulitis. Color Dis 13(Suppl 3):1–11. doi:10.1111/j.1463-1318.2010.02531.x
Khalil H, Yoo J (2014) Colorectal emergencies: perforated diverticulitis (operative and nonoperative management). J Gastrointest Surg 18(4):865–868. doi:10.1007/s11605-013-2352-9
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(10000):1269–1277. doi:10.1016/S0140-6736(15)61168-0
Costi R, Cauchy F, Le Bian A, Honart J-F, Creuze N, Smadja C (2012) Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment. Surg Endosc 26(7):2061–2071. doi:10.1007/s00464-012-2157-z
Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54(6):663–671. doi:10.1007/DCR.0b013e31820ef759
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(7):875–881. doi:10.1097/DCR.0000000000000083
Sartelli M, Catena F, Ansaloni L et al (2016) WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg:1–15. doi:10.1186/s13017-016-0095-0
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Titos-García A and Aranda-Narváez JM contributed equally to this paper and drafted the manuscript; Titos-García A, Aranda-Narváez JM, and Romacho-López L designed the study; Titos-García A and Romacho-López L collected the data; Aranda-Narváez JM analyzed the data; González-Sánchez AJ, Cabrera-Serna I, and Santoyo-Santoyo J provided analytical oversight and supervised the study; all authors have read and approved the final version to be published.
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This study was reviewed and approved by the University Regional Hospital of Malaga Institutional Review Board.
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Titos-García, A., Aranda-Narváez, J.M., Romacho-López, L. et al. Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure. Int J Colorectal Dis 32, 1503–1507 (2017). https://doi.org/10.1007/s00384-017-2852-2
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DOI: https://doi.org/10.1007/s00384-017-2852-2