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Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients
Ville J Sallinen1, Panu J Mentula, Ari K Leppäniemi
1Department of Abdominal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Background:
The optimal treatment for diverticulitis with extraluminal air is controversial.
Objective:
The purpose of this research was to evaluate the safety and effectiveness of nonoperative treatment of acute diverticulitis with extraluminal air.
Design:
This was a retrospective cohort.
Settings:
The study was conducted at an academic teaching hospital functioning as both a tertiary and secondary care referral center.
Patients:
All of the patients with CT-diagnosed acute perforated diverticulitis with extraluminal air from 2006 through 2010 were included in this study.
Interventions:
Nonoperative treatment composed of intravenous antibiotics, bowel rest, and percutaneous drainage were the included interventions.
Main Outcome Measures:
The need for operative management and mortality were measured.
Results:
A total of 132 patients underwent nonoperative treatment, whereas 48 patients were primarily operated on. Patients treated nonoperatively were divided into 3 groups on the basis of identified factors that independently predicted risk for failure: 1) patients with pericolic air (n = 82) without abscess had a 99% success rate with 0% mortality. 2) Patients with distant intraperitoneal air (n = 29) had a 62% success ratewith 0% mortality. Abundant distant intraperitoneal air and fluid in the fossa Douglas were identified as risk factors for failure. Patients without these risk factors had an 86% success rate with nonoperative management. 3) Patients with distant retroperitoneal air (n = 14) had a 43% success rate with 7% mortality.
Limitations:
Comparison of nonoperative versus operative treatment cannot be made because of the study's retrospective nature.
Conclusions:
Nonoperative treatment of acute diverticulitis with extraluminal air is safe and effective in patients with a small amount of distant intraperitoneal air or pericolic air without clinical signs of peritonitis.
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