Purpose: Diverticular abscess is a common manifestation of acute complicated diverticulitis. We aimed to analyze the clinical course of patients with diverticular abscess initially treated conservatively.
Methods: All patients with diverticular abscess undergoing elective or urgent/emergency surgery from October 2004 to October 2022 were identified from our institutional database. Depending on the abscess size, patients were divided into group A (≤ 3 cm) and group B (> 3 cm). Conservative treatment failure was defined as clinical deterioration, persistent or recurrent abscess, or urgent/emergency surgery. Baseline characteristics and short-term perioperative outcomes were recorded and compared between both groups. Uni- and multivariate analyses were conducted to identify determinants of conservative treatment failure and overall ostomy formation.
Results: A total of 105 patients were enrolled into group A (n = 73) and group B (n = 32). Uni- and multivariate analyses revealed abscess size as the only significant factor of conservative therapy failure [OR 9.904; p < 0.0001], while overall ostomy formation was significantly affected by an increased body mass index (BMI) [OR 1.366; p = 0.026]. There were no significant differences in perioperative outcome with the exception of a longer total hospital stay in patients managed with abscess drainage compared to antibiotics alone prior surgery in group B (p = 0.045).
Conclusion: Abscess diameter > 3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. In this subgroup, the choice between primary drainage and antibiotics does not appear to influence outcome at the cost of prolonged hospital stay after drainage insertion.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245413 | PMC |
| http://dx.doi.org/10.1007/s00384-024-04682-z | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Colo-cutaneous fistula in the setting of complicated sigmoid diverticulitis previously managed with percutaneous drainage: a case report.
J Surg Case Rep
January 2025
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136, United States.
Colo-cutaneous fistulas are a rare complication of diverticular disease. Percutaneous drainage offers a promising alternative to surgical intervention in the management of complicated diverticular disease with abscess formation. Recent case studies and literature reviews support its efficacy in achieving abscess resolution and reducing the need for surgery.
View Article and Find Full Text PDFManagement of Lumbar Abscess Secondary to Colocutaneous Fistula From Complicated Diverticular Disease Using Negative Pressure Therapy.
Cureus
November 2024
Radiology, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla, Puebla, MEX.
Diverticular disease is a common gastrointestinal condition with rising prevalence. Complications, such as fistulas, are rare but significant, often requiring innovative treatment strategies. This case report examines the use of negative pressure wound therapy (NPWT) with instillation (VERAFLO®, KCI, an Acelity Company, San Antonio, Texas) and antiseptic solution (VASHE®, Urgo Medical North America LLC, Fort Worth, Texas) in treating a colocutaneous fistula secondary to complicated diverticular disease.
View Article and Find Full Text PDFAcute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report.
Cureus
October 2024
Surgery, Bakersfield Memorial, Bakersfield, USA.
Article Synopsis
- - Large bowel obstruction (LBO) is relatively rare, often caused by colorectal adenocarcinoma, and it typically presents with symptoms like abdominal pain, constipation, and nausea; a CT scan is crucial for diagnosis.
- - A case study of a 41-year-old male showed severe LBO after a hernia repair, requiring emergency surgery due to findings of a blocked sigmoid colon and complications like pneumatosis.
- - Diverticulitis, which is increasingly affecting younger individuals, can lead to bowel obstructions and serious complications; educating all patients about risk factors, including diet and surgical history, is important.
Complicated diverticulitis: Diagnostic precision and surgical solutions in a patient with chronic kidney disease.
Radiol Case Rep
January 2025
Northeast Georgia Health System, Northeast Georgia Medical Center, Trauma and Acute Care Surgery Department, 743 Spring Street NE Gainesville, GA 30501.
Article Synopsis
- Diverticulitis is an inflammation of the colon that can cause serious issues like perforation and abscess; a case of a 42-year-old female with chronic kidney disease illustrates this danger.
- Initial assessments showed high white blood cell counts and elevated creatinine levels, while a CT scan suggested perforated diverticulitis, leading to an urgent surgical procedure.
- Post-surgery, the patient faced complications that required further interventions, highlighting the importance of CT imaging for diagnosis and monitoring, along with ongoing care such as colonoscopies and dietary changes to manage her condition effectively.
Key Clinical Message: Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and should be included in the differential diagnosis of acute abdomen. The association between polymyalgia rheumatica and diverticular disease requires further research but may prompt clinicians to consider appropriate therapies in patients with both diseases.
Abstract: Jejunal diverticulosis is a sac-like outpouching of the intestinal wall that can cause complications such as diverticulitis, obstruction, abscess, perforation, or fistula formation.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!