Subject(s)
Arteriovenous Fistula , Embolization, Therapeutic , Wounds, Penetrating , Abdomen , Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnostic imaging , Humans , Liver/diagnostic imaging , Wounds, Penetrating/complications , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgeryABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Intestinal Obstruction/etiology , Mesenteric Artery, Superior/pathology , Superior Mesenteric Artery Syndrome/complications , Conservative Treatment , Intestinal Obstruction/diagnostic imaging , Mesenteric Artery, Superior/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Intestinal Obstruction/etiology , Mesenteric Artery, Superior/pathology , Superior Mesenteric Artery Syndrome/complications , Aged , Conservative Treatment , Humans , Intestinal Obstruction/diagnostic imaging , Male , Mesenteric Artery, Superior/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
AIM: The aim of this study was to analyze the results of nonoperative management of patients with perforated acute diverticulitis with extraluminal air and to identify risk factors that may lead to failure and necessity of surgery. METHODS: Methods included observational retrospective cohort study of patients between 2010 and 2015 with diagnosis of diverticulitis with extraluminal air and with nonoperative management initial. Patient demographics, clinical, and analytical data were collected, as were data related with computed tomography. Univariate and multivariate analyses with Wald forward stepwise logistic regression were performed to analyze results and to identify risk factors potentially responsible of failure of nonoperative management. RESULTS: Nonoperative management was established in 83.12% of patients diagnosed with perforated diverticulitis (64 of 77) with an overall success rate of 84.37%, a mean hospital stay of 11.98 ± 7.44 days and only one mortality (1.6%). Patients with pericolic air presented a greater chance of success (90.2%) than patients with distant air (61.5%). American Society of Anesthesiologists (ASA) grade III-IV (OR, 5.49; 95% CI, 1.04-29.07) and the distant location of air (OR, 4.81; 95% CI, 1.03-22.38) were the only two factors identified in the multivariate analysis as risk factors for a poor nonoperative treatment outcome. Overall recurrence after conservative approach was 20.4%; however, recurrence rate of patients with distant air was twice than that of patients with pericolic air (37.5 vs 17.39%). Only 14.8% of successfully treated patients required surgery after the first episode. CONCLUSION: Nonoperative management of perforated diverticulitis is safe and efficient. Special follow-up must be assumed in patients ASA III-IV and with distant air in CT.
Subject(s)
Diverticulitis, Colonic/therapy , Health Status , Intestinal Perforation/therapy , Adult , Air , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Conservative Treatment , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Female , Fluid Therapy , Humans , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Length of Stay , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Treatment FailureABSTRACT
No disponible
