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Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study

Thorisson, Arnar (author)
Uppsala universitet,Centrum för klinisk forskning, Västerås,Västmanland Hosp Västerås, Dept Radiol, Västerås, Sweden
Hosseinali Khani, Maziar, 1975- (author)
Uppsala universitet,Centrum för klinisk forskning, Västerås,Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden
Andreasson, Karl (author)
Uppsala universitet,Centrum för klinisk forskning, Västerås,Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden
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Smedh, Kennet (author)
Uppsala universitet,Centrum för klinisk forskning, Västerås,Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden
Chabok, Abbas, 1964- (author)
Uppsala universitet,Centrum för klinisk forskning, Västerås,Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden
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 (creator_code:org_t)
2018-10-24
2018
English.
In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:10-11, s. 1298-1303
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Objectives: The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air.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 and extraluminal or free air 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 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

Keyword

Colonic diverticulitis
perforated diverticulitis
computed tomography
surgery

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