Non-operativemanagement of perforated diverticulitis with extraluminal or free air

• Objectives The aim of this study was to describe characteristics and results of non-operative   management for patients presenting with computed tomography (CT) verified perforated diverticulitis. Methods All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.Results Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 hours was performed in 29 (21%). Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. Non-operative management was more likely to fail in patients with a simultaneous abscess (67% compared to 16%, p = 0.013). More than one third of patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 hours from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.Conclusions Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.

Nyckelord

Radiology

Radiologi

Kirurgi

Surgery

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