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Non-operativemanagement of perforated diverticulitis with extraluminal or free air
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.ORCID iD: 0000-0002-7056-670x
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(English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Article in journal (Other academic) Submitted
Abstract [en]

Objectives The aim of this study was to describe characteristics and results of non-operative   management for patients presenting with computed tomography (CT) verified perforated diverticulitis.

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 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 hours was performed in 29 (21%). Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. Non-operative management was more likely to fail in patients with a simultaneous abscess (67% compared to 16%, p = 0.013). More than one third of patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 hours 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.

National Category
Medical and Health Sciences
Research subject
Radiology; Surgery
Identifiers
URN: urn:nbn:se:uu:diva-356629OAI: oai:DiVA.org:uu-356629DiVA, id: diva2:1236466
Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-08-03Bibliographically approved
In thesis
1. Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
Open this publication in new window or tab >>Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to expand the current knowledge regarding the advantages and limitations of computed tomography (CT) for patients with acute diverticulitis and evaluate outpatient treatment for uncomplicated diverticulitis.

Paper I: A retrospective evaluation of 602 patients with reported uncomplicated diverticulitis. Scans were re-evaluated and the degree of inflammation was graded. Signs of complications or other diseases were also noted. No radiological findings on CT could predict the development of complications or recurrence in patients with uncomplicated diverticulitis. However, 44 patients (7.3%) had signs of complicated diverticulitis that had been overlooked on the initial assessment. Despite small complications and a non-antibiotic treatment, the majority of patients recovered without incident, further strengthening the non-antibiotic treatment strategy.

Paper II: A retrospective analysis of conservative treatment for perforated diverticulitis (n = 136) during a 5-year period. Twenty-nine of 136 patients were operated on within 24 h and not candidates for conservative management. Patients more than 75 years old, immunosuppressed patients, patients with free intraperitoneal air or free fluid in the abdominal cavity were at higher risk for emergency surgery within the first 24 h. Conservative treatment was successful in 101 of 107 patients (94%) when attempted. The presence of simultaneous abscess increased the risk for conservative treatment failure.

Paper III: The aim of this prospective study was to determine if a non-enhanced low-dose CT was as sensitive as standard CT with intravenous (IV) contrast for patients with suspected acute diverticulitis. The included patients underwent both types of CT examinations. CT images were graded by three independent radiologists for the presence of diverticulitis, complications or other findings that could explain the patient’s symptoms. Sensitivity, specificity and both intra- and inter-reader agreement for low-dose CT were very high. Therefore, we recommend this examination for suspected diverticulitis.

Paper IV: In this prospective study, 155 consecutive patients with CT-verified acute uncomplicated diverticulitis were treated as outpatients without antibiotics. Overall, only four patients (2.6%) returned to the hospital because of treatment failure, all of whom were hospitalized and received antibiotics. Outpatient treatment of uncomplicated diverticulitis is safe and recommended in selected patients.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1483
Keywords
Colonic diverticulitis, complicated diverticulitis, computed tomography, low-dose CT
National Category
Medical and Health Sciences
Research subject
Radiology; Surgery
Identifiers
urn:nbn:se:uu:diva-356710 (URN)978-91-513-0397-0 (ISBN)
Public defence
2018-09-28, Aulan, entrance 21,, Västmanlands Hospital, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2018-09-05 Created: 2018-08-03 Last updated: 2018-09-10

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Thorisson, ArnarNikberg, MaziarAndreasson, KarlSmedh, KennetChabok, Abbas

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