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Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västerås, Dept Radiol, Västerås, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.ORCID iD: 0000-0002-7056-670x
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1298-1303Article in journal (Refereed) Published
Abstract [en]

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

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 and extraluminal or free air 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 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h 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.

Place, publisher, year, edition, pages
2018. Vol. 53, no 10-11, p. 1298-1303
Keywords [en]
Colonic diverticulitis, perforated diverticulitis, computed tomography, surgery
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-377721DOI: 10.1080/00365521.2018.1520291ISI: 000457980900022PubMedID: 30353758OAI: oai:DiVA.org:uu-377721DiVA, id: diva2:1294787
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically approved

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Thorisson, ArnarHosseinali Khani, MaziarAndreasson, KarlSmedh, KennetChabok, Abbas

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