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Systematic review of failure of nonoperative management in complicated sigmoid diverticulitis with abscess

  • Systematic Reviews and Meta-analyses
  • Published:
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Abstract

Purpose

The aim of this systematic review was to determine the rates of failure following nonoperative management for acute sigmoid diverticulitis complicated by abscess.

Methods

Pubmed and Medline were systematically searched by two independent researchers. Studies reporting outcomes of nonoperative management of diverticulitis with abscess revealed on CT scan were included. The endpoint of the study was failure of nonoperative management which included relapse and recurrence. Relapse was defined as development of additional complications such as peritonitis or obstruction that required urgent surgery during index admission or readmission within 30 days. Recurrence was defined as development of symptoms after an asymptomatic period of 30–90 days following nonoperative management. Nonoperative management included nil per os, intravenous fluids and antibiotics, CT-guided percutaneous drainage, and/or total parenteral nutrition.

Results

Twenty-four of 844 studies yielded by literature search totaling 12,601 patients were eligible for inclusion. Pooled relapse rate was 18.9%. The pooled rate of recurrence of acute diverticulitis was found to be 25.5%. 60.9% of recurrences were complicated diverticulitis. Failure rate appeared to be significantly increased in patients undergoing percutaneous drainage for distant abscess as compared with pericolic abscess (51% vs. 18%; p = 0.0001).

Conclusion

The rate of failure of nonoperative management was 44.4%. The rate of relapse at 30 days following nonoperative management was at 18.9%. Distant abscesses were associated with significantly increased rates of relapse compared with pericolic abscesses. The rate of recurrence following nonoperative management was 25.5% at the mean follow-up of 38 months.

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Authors and Affiliations

  1. Section of Colorectal Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Taylor Pavilion, Suite D-361, 100 Woods Road, Valhalla, NY, 10595, USA

    H. Lee, M. Gachabayov, A. Rojas & Roberto Bergamaschi

  2. Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria

    D. M. Felsenreich

  3. Clinic of Colorectal and Minimally Invasive Surgery, Sechenov Medical University, Moscow, Russia

    P. Tsarkov

Authors
  1. H. Lee
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  2. M. Gachabayov
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  3. A. Rojas
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  4. D. M. Felsenreich
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  5. P. Tsarkov
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  6. Roberto Bergamaschi
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Contributions

All authors have contributed to the following: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Roberto Bergamaschi.

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Lee, H., Gachabayov, M., Rojas, A. et al. Systematic review of failure of nonoperative management in complicated sigmoid diverticulitis with abscess. Langenbecks Arch Surg 405, 277–281 (2020). https://doi.org/10.1007/s00423-020-01872-5

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  • DOI: https://doi.org/10.1007/s00423-020-01872-5

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