Diverticular abscesses: percutaneous drainage.

Neff, C C; vanSonnenberg, Eric; Casola, Giovanna; Wittich, G R; Hoyt, David B.; Halasz, N A; Martini, D J

doi:10.1148/radiology.163.1.3823429

Cited by 117 publications

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“…In general, most studies describe a diverticular abscess amenable to percutaneous drainage as in the range 4-15 cm in diameter. 14,15 Clinical practice guidelines for diverticulitis from the American Society of Colon and Rectal Surgeons suggest that an abscess <2c m can resolve with intravenous antibiotic treatment. 8 The literature suggests that whilst diverticular abscesses may be common, only a small percentage are deemed suitable for percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

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The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

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INTRODUCTION Diverticulitis is a common condition occasionally complicated by abscess formation. Small abscesses may be managed by antibiotic therapy alone but larger collections require drainage, ideally by the percutaneous route. This minimally invasive approach is appealing but there is little information regarding the long-term follow-up of patients managed in this way. To address this question, we looked at a consecutive series of patients who underwent percutaneous drainage in our institution.PATIENTS AND METHODS A retrospective study was performed of patients undergoing percutaneous drainage of a diverticular abscess from 1999-2007. RESULTS A total of 26 abscesses were identified in 16 patients. In 69% of cases, the abscess was located in the pelvis. The mean size of the abscesses was 8.5 ±0 .9 cm. Drainage was performed under CT (83%) or ultrasound guidance. The mean duration of drainage was 8 days. Fistula formation following drainage occurred in 38% of cases. Eight patients (mean age, 71 years) underwent subsequent surgical resection 9 days to 22 months (mean, 7 months) following initial presentation. Eight patients with significant co-morbid conditions were managed by percutaneous drainage only. The 1-year mortality was 20% and resulted from unrelated causes. The long-term stoma rate was 13%.CONCLUSIONS Percutaneous drainage can safely be performed in patients with a diverticular abscess. It can be used as a bridge before definitive surgery but also as a treatment option in its own right in high-risk surgical patients. We believe percutaneous drainage reduces the need for major surgery and reduces the risk of a permanent stoma.

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Section: Discussionmentioning

confidence: 99%

“…Fistula rate in patients undergoing percutaneous drainage has been reported to range from 29-63%. 14,15 In these series, a sinogram was routinely performed following drainage to delineate any fistula. Our results did not show any association with abscess location and development of fistula.…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

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“…Using a statewide hospital discharge database, Salem et al [25] demonstrated that the odds of percutaneous abscess drainage for complicated diverticulitis increased 7% per year be- tween 1987 and 2001, and that emergency colectomies concomitantly decreased 2% per year. The two series most often quoted regarding CT scan-guided drainage of diverticular abscesses report success rates of 74% 80% [26,27]. However, in the series reported by Schechter et al [26], only 10 of the 133 patients had a proven complicated diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the series reported by Schechter et al [26], only 10 of the 133 patients had a proven complicated diverticulitis. In the seminal paper by Neff et al [27], 16 patients with diverticular abscesses were included, and it is unclear exactly how many were true Hinchey II patients. Therefore, the current standard for percutaneous drainage of Hinchey II diverticulitis has little, if any, evidence-based support, although its use is obviously increasing, in parallel with the development of interventional radiology techniques.…”

Section: Discussionmentioning

confidence: 99%

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

et al. 2006

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Background: Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis. Methods: The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed. Results: A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality. Conclusion: Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The current results demonstrate that percutaneous abscess drainage is an effective initial therapeutic approach for patients with Hinchey II diverticulitis, and that emergency surgery should be avoided whenever possible.

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“…She presented with slight symptoms, was carefully monitored, did not require any percutaneous drainage, and must be considered an exception to the rule of early exploration. A conservative approach, combined with percutaneous drainage as a temporary or definite mea sure, is also applicable in patients not fit for surgerv [13,14].…”

Section: Conservative Treatmentmentioning

confidence: 99%

Perforated Duodenal Diverticulum; Experience with 8 Patients

Hammarström¹,

Holmin²,

Ihse³

1996

Dig Surg

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Despite the alarming symptoms of perforated duodenal diverticula, they are sometimes diagnosed late or even overlooked, reflecting a 13% mortality rate in recent decades. Between 1980 and 1989 8 patients with perforated duodenal diverticula who had had abdominal symptoms for 1 h to 3 days prior to admission with acute and gradual onset in 5 and 3 of them, respectively, were diagnosed and treated in our department. Six patients (4 women and 2 men; age range 61-81 years) were operated on without any mortality 3 (n = 3), 8 (n = 1), and 16 (n = 1) h after admission, but 2 of these were reexplored 1 and 5 days later, respectively, because the perforation was overlooked initially. The 6th patient had surgery 13 days after admission when a retroduodenal abscess was revealed, the origin of which was a perforated duodenal diverticulum. A 73-year-old woman was treated conservatively, and 1 51-year-old man had a diverticulum perforation and subsequent surgery during the postoperative period after a raphe procedure for perforated duodenal ulcer. Two patients had postoperative cardiopulmonary failure and were kept mechanically ventilated for 3 and 4 weeks, respectively. The patient subjected to delayed surgery had a complicated postoperative course but has recovered fully. The last patient with numerous reoperations, intensive care with assisted ventilation for 3 months, and anuria for 5 months has recovered except for an incisional hernia and chronic abdominal pain. The hospital stay was 9 and 12 days and 2, 5, 5, and 13 weeks in 6 patients, respectively, and 13 months in 1 patient. The conservatively treated patient was discharged after 3 weeks.

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Diverticular abscesses: percutaneous drainage.

Cited by 117 publications

References 0 publications

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

Perforated Duodenal Diverticulum; Experience with 8 Patients

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