Diverticular Abscess Managed With Long-term Definitive Nonoperative Intent Is Safe.
Dis Colon Rectum
; 59(7): 648-55, 2016 Jul.
Article
em En
| MEDLINE
| ID: mdl-27270517
ABSTRACT
BACKGROUND:
Initial nonoperative management of diverticular abscess has become the standard of care; however, the need for elective resection after this index episode is unclear.OBJECTIVE:
The purpose of this study was to assess the long-term outcomes of expectant management after initial nonoperative treatment of diverticular abscess.DESIGN:
This was a retrospective chart review with prospective telephone follow-up of patients. SETTINGS The study was conducted at a large tertiary academic colorectal surgery practice in Canada. PATIENTS Adult patients with CT-documented acute sigmoid diverticulitis complicated by abscess managed nonoperatively from 2000 to 2013 were included.INTERVENTIONS:
Long-term definitive nonoperative management of diverticular abscess. MAIN OUTCOMEMEASURES:
The primary outcome was emergency sigmoidectomy or death from recurrent diverticulitis. Secondary outcomes were recurrent diverticulitis and elective sigmoidectomy for diverticulitis.RESULTS:
Of 135 patients with acute diverticulitis complicated by abscess, a total of 73 patients were managed with nonoperative intent and long-term expectant management. The median follow-up was 62 (Q1 to Q3 28-98) months. After resolution of the index episode, 22 patients [30.1% (95% CI, 19.6%-40.6%)] experienced a recurrent episode of diverticulitis at a median of 23 (range, 9-40) months. Two patients [2.7% (95% CI, -1.0% to 6.4%)] had a recurrent episode with peritonitis that required sigmoidectomy with stoma at 6 and 64 months. Both patients underwent reversal after 4 and 8 months. Seven [9.6% (95% CI, 2.8%-16.4%)] patients experienced a complicated recurrence and underwent an elective sigmoidectomy [median time to colectomy, 33 (range, 16-56) months]. Thirteen patients [17.8% (95% CI, 9.0%-26.6%)] experienced an uncomplicated recurrence, all of whom were managed with continued nonoperative intent [median follow-up, 81 (range, 34-115) months]. No mortality occurred. On multivariate logistic regression, female gender (p = 0.048) and a previous episode of uncomplicated diverticulitis before the index diverticular abscess (p = 0.020) were associated with a recurrent episode.LIMITATIONS:
This study was limited by its retrospective design and modest sample size.CONCLUSIONS:
After initial successful nonoperative management of diverticulitis with abscess, expectant management with nonoperative intent is a safe long-term option with low rates of surgery, especially in the emergency setting. See Video, Supplemental Digital Content 1, on the nonoperative management of diverticular abscess at http//links.lww.com/DCR/A234.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças do Colo Sigmoide
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Assistência ao Convalescente
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Abscesso Abdominal
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Doença Diverticular do Colo
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Conduta Expectante
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article