RESUMO
INTRODUCTION: acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. METHODS: an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. RESULTS: three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. CONCLUSIONS: in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.
Assuntos
Doença Diverticular do Colo , Diverticulite , Humanos , Estudos Prospectivos , Doença Aguda , Diverticulite/tratamento farmacológico , Antibacterianos/uso terapêutico , Assistência Ambulatorial , Doença Diverticular do Colo/tratamento farmacológico , Doença Diverticular do Colo/complicações , Resultado do TratamentoRESUMO
INTRODUCTION: acute diverticulitis is a very prevalent disease. The need for a more aggressive management in immunodeficient patients has not been established. We present the results of our unit with immunodeficient patients diagnosed with acute diverticulitis and their follow-up. OBJECTIVES: to assess the possibility that a conservative management in this group is as valid as in the immunocompetent population. METHODS: a retrospective analysis study was performed in our hospital. Forty immunodeficient patients (transplant, corticoid treatment, dialysis, oncologic, HIV patients) diagnosed with acute diverticulitis were analyzed. The patients were managed with a surgical or non-surgical treatment according to their status on admission. The main analyzed items were the severity of the acute episode and the need for surgical treatment compared to the cause of immunodeficiency. Other studied variables included follow-up results and recurrences. RESULTS: thirty-two of the 40 patients studied received a non-surgical treatment during the acute episode, eight required emergency surgery (seven had a Hartmann procedure and one underwent a colon resection and anastomosis). Transplant patients and those between 40 and 50 years old proved to be higher risk groups. Three patients subsequently required elective surgery due to complications. Twenty-four patients had uneventful recoveries. CONCLUSIONS: the frequency of complicated acute diverticulitis is higher in immunodeficient patients than that of the general population. Non-surgical treatment seems to be as safe as in immunocompetent patients. Younger and transplanted patients were higher risk groups for severe acute diverticulitis that required a more aggressive management initially.
Assuntos
Tratamento Conservador , Doença Diverticular do Colo/terapia , Hospedeiro Imunocomprometido , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colostomia/estatística & dados numéricos , Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Adenocarcinoma/patologia , Neoplasias do Colo/patologia , Tumor Rabdoide/patologia , Adenocarcinoma/química , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/uso terapêutico , Biomarcadores Tumorais , Diferenciação Celular , Quimioterapia Adjuvante , Colectomia , Neoplasias do Colo/química , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Terapia Combinada , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Humanos , Queratinas/análise , Masculino , Proteínas de Neoplasias/análise , Tumor Rabdoide/química , Tumor Rabdoide/tratamento farmacológico , Tumor Rabdoide/cirurgia , Proteína Supressora de Tumor p53/análise , Vimentina/análise , beta Catenina/análise , GencitabinaRESUMO
We present a case of acute appendicitis as a complication after an Endoscopic Submucosal Resection of a colonic polyp.