Long-Term Outcome of Mesocolic and Pelvic Diverticular Abscesses of the Left Colon: A Prospective Study of 73 Cases

Ambrosetti, P.; Chautems, Roland; Soravia, Claudio; Peiris-Waser, Nyali; Terrier, François

doi:10.1007/s10350-004-0853-z

Cited by 191 publications

(127 citation statements)

References 22 publications

(23 reference statements)

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…However, Ambrosetti et al 6,16 observed that both intraabdominal and pelvic abscesses were associated with a significant risk of surgery compared with a mesocolic abscess. The latter had a lower risk of requiring surgery once adequately drained.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…2,3 Studies have shown that the incidence of an abscess complicating an episode of diverticulitis ranges from 17-19%. [4][5][6] The American Society of Colon and Rectal Surgeons recommended that small mesocolic abscesses can be treated with intravenous antibiotics. 7,8 In contrast, large abscesses may be drained percutaneously or by an open procedure.…”

mentioning

confidence: 99%

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

View full text Add to dashboard Cite

show abstract

“…In addition, well-localized fluid collections of appropriate density and consistency (i.e., lack of extensive loculations) may be drained percutaneously with acceptable morbidity and mortality [74][75][76][77][78].…”

Section: Statementmentioning

confidence: 99%

Management of Intra-Abdominal Infections

Moore

2016

Common Problems in Acute Care Surgery

View full text Add to dashboard Cite

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

show abstract

“…A study of the long-term outcomes of diverticular abscesses reported that 15 % of patients with a mesocolic abscess required surgery during their first admission compared with 39 % of patients with pelvic abscesses [21]. After a median follow-up period of 43 months, 42 % of patients managed non-operatively for their mesocolic abscess went on to require surgical intervention compared with 53 % of those with a pelvic abscess.…”

Section: Management Of Diverticular Abscessesmentioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

View full text Add to dashboard Cite

Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

show abstract

Long-Term Outcome of Mesocolic and Pelvic Diverticular Abscesses of the Left Colon: A Prospective Study of 73 Cases

Abstract: Considering the poor outcome of pelvic abscess associated with acute left-sided colonic diverticulitis, percutaneous drainage followed by secondary colectomy seems justified. Mesocolic abscess by itself is not an absolute indication for colectomy.

Cited by 191 publications

References 22 publications

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Management of Intra-Abdominal Infections

Management of Acute Diverticulitis and its Complications

Contact Info

Product

Resources

About