Failure of nonoperative management in patients with acute diverticulitis complicated by abscess: a systematic review

Fowler, Hayley; Gachabayov, Mahir; Vimalachandran, Dale; Clifford, Rachael; Orangio, Guy R.; Bergamaschi, Roberto

doi:10.1007/s00384-021-03899-6

Cited by 12 publications

(12 citation statements)

References 63 publications

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“…The same study showed that the failure rate of nonoperative management, which included 38 studies (n = 2598), was 16.4%. In the same study, the failure rate for percutaneous drainage was 17% for pericolic and 44% for pelvic abscess [13].…”

Section: Diverticular Disease Of the Colon And#x2013; Recent Knowledge Of Physiopathology Endoscopic Approaches Clinical And Surgical Trementioning

confidence: 78%

Inflammatory Complication of Diverticular Disease

Reis¹,

Rodrigues²,

Filho³

et al. 2022

Diverticular Disease of the Colon - Recent Knowledge of Physiopathology, Endoscopic Approaches, Clinical and Surgical Treatment

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Diverticular disease is the most common morphological abnormality of the colon. It is increasing in prevalence proportionally to progressive aging and modern alimentary diet. The majority of the diverticular disease affects the sigmoid colon and the segmental inflammatory process can have different outcomes, from self-limited, low-grade inflammation to severe cases evolving to complications such as abscess, fistulas to different organs, free perforation and peritonitis, sepsis, intestinal obstruction, and hemorrhage. In this chapter, we will focus on a few of these complications—focal low-grade inflammation, intra-abdominal abscess, and fistulas.

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Section: Diverticular Disease Of the Colon And#x2013; Recent Knowledge Of Physiopathology Endoscopic Approaches Clinical And Surgical Trementioning

confidence: 78%

Inflammatory Complication of Diverticular Disease

Reis¹,

Rodrigues²,

Filho³

et al. 2022

Diverticular Disease of the Colon - Recent Knowledge of Physiopathology, Endoscopic Approaches, Clinical and Surgical Treatment

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show abstract

“… 68 The failure rate of percutaneous drainage as a nonoperative management for patients with pelvic abscess was three times higher than that for pericolic abscesses. 68 , 69 Hence, surgical treatment should be considered for abscesses in areas distant from colonic diverticulitis.…”

Section: Diverticulitismentioning

confidence: 95%

“…In cases of recurrent diverticulitis or persistent symptoms, the choice between surgery and conservative treatment is an important concern. The failure rates of nonoperative management for acute diverticulitis with complicated abscesses is 16.4%, and the failure rates have not significantly decreased in the last 30 years 68 . The failure rate of percutaneous drainage as a nonoperative management for patients with pelvic abscess was three times higher than that for pericolic abscesses 68,69 .…”

Section: Diverticulitismentioning

confidence: 99%

“…The failure rates of nonoperative management for acute diverticulitis with complicated abscesses is 16.4%, and the failure rates have not significantly decreased in the last 30 years 68 . The failure rate of percutaneous drainage as a nonoperative management for patients with pelvic abscess was three times higher than that for pericolic abscesses 68,69 . Hence, surgical treatment should be considered for abscesses in areas distant from colonic diverticulitis.…”

Section: Diverticulitismentioning

confidence: 99%

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Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

Shinmoto

Miyamoto

Yoshida

et al. 2022

Annals of Gastroent Surgery

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The development of new drugs for inflammatory bowel disease (IBD) is remarkable, and treatment strategies using multiple agents and various techniques are required; however, the treatment strategy is likely to be complex. Therefore, appropriate evaluation of traditional surgical treatment strategies and accurate knowledge of the efficacy and limitations of novel treatments are required. Total infectious complications were found to be associated with the use of corticosteroids and anti‐tumor necrosis factor‐α agents, but not with immunomodulators, anti‐integrin agents, and 5‐aminosalicylic acid. Regarding surgical procedures for IBD, conceived anastomosis methods, including Kono‐S for Crohn's disease stenosis, are associated with better outcomes than conventional techniques. Autologous cell transplantation for Crohn's fistulae has been shown to have a favorable outcome. Diverticulitis is increasing and will be treated more frequently in the future. Risk factors for the incidence of diverticulitis and differences in pathogenesis according to right or left side diverticulitis have been reported. Antibiotic therapy may be omitted for uncomplicated diverticulitis. Moreover, regarding surgical procedures, both bowel resection and anastomosis are associated with favorable short‐term outcomes, higher stoma closure rate, and superior medical economy compared to Hartmann's procedure. Risk factors for recurrence after diverticulitis surgery may provide better postoperative follow‐up. In this review, we explore the current topics of colorectal benign diseases, focusing on IBD and diverticulitis, based on clinical trials and meta‐analyses from 2020‐2021. This review consolidates the available knowledge and improves the quality of surgical procedures and perioperative management for IBD and diverticulitis.

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“…Nowadays, the uncomplicated diverticulitis (modified Hinchey 0 and IA, phlegmon, SUDD) is the most frequent diverticular condition, and it is commonly treated with antibiotics only, although recent studies demonstrated that in selected patients, antibiotics may not be necessary [ 19 ]. Nowadays, Non-Operative Treatment (NOT) is also considered for patients with complicated diverticulitis with abscess (modified Hinchey IB and II) [ 20 ], but this strategy is associated with a risk of failure (18.6%) [ 21 ] (Fig. 2 ).…”

Section: Indications For Non-operative Treatment or Surgerymentioning

confidence: 99%

State-of-the-art surgery for sigmoid diverticulitis

Cirocchi

Sapienza

Anania

et al. 2021

Langenbecks Arch Surg

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Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.

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Failure of nonoperative management in patients with acute diverticulitis complicated by abscess: a systematic review

Cited by 12 publications

References 63 publications

Inflammatory Complication of Diverticular Disease

Inflammatory Complication of Diverticular Disease

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

State-of-the-art surgery for sigmoid diverticulitis

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