Elective operation after acute complicated diverticulitis:Is it still mandatory?

• Published in: World journal of gastroenterology : WJG 2014-07, Vol.20 (25), p.8166-8172
• Main Authors: Bridoux, Valérie, Antor, Marlène, Schwarz, Lilian, Cahais, Julien, Khalil, Haitham, Michot, Francis, Tuech, Jean-Jacques
• Format: Article
• Language: English
• Subjects: Abdominal Abscess - etiology; Abdominal Abscess - therapy; Abdominal Pain - etiology; Abdominal Pain - therapy; abscess; Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; classi; Colectomy - adverse effects; Combined Modality Therapy; Diverticular; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - diagnosis; Diverticulitis, Colonic - surgery; Diverticulitis, Colonic - therapy; Diverticulosis; Elective Surgical Procedures; Feasibility Studies; Female; Fluid Therapy - adverse effects; France; Hinchey; Hospitals, University; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Retrospective Study; Risk Assessment; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i25.8166

AIM: To investigate recurrence rates, patterns and complications after nonoperatively managed complicated diverticulitis(CD).METHODS: A retrospective study of patients treated for CD was performed. CD was defined on computed tomography by the presence of a localized abscess, pelvic abscess or extraluminal air. For follow-up, patients were contacted by telephone. Numbers of elective surgeries, recurrences and abdominal pain were analyzed.RESULTS: A total of 114 patients(median age 57 years(range 29-97)), were admitted for CD. Nine patients required surgical intervention for failure of conservative therapy(Hartmann’s procedure: n = 6; resection and colorectal anastomosis: n = 3). Of the 105 remaining patients, 24(22.9%) underwent elective sigmoid resection. The 81(71%) non-operated patients were all contacted after a median follow-up of 32 mo(4-63). Among them, six had developed a recurrent episodeof diverticulitis at a median follow-up of 12 mo(6-36); however, no patient required hospitalization. Sixtyeight patients(84%) were asymptomatic and 13(16%) had recurrent abdominal pain.CONCLUSION: Conservative policy is feasible and safe in 71% of cases, with a low medium-term recurrence risk.