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Elective operation after acute complicated diverticulitis: is it still mandatory?
Valérie Bridoux1, Marlène Antor1, Lilian Schwarz1
1Valérie Bridoux, Marlène Antor, Lilian Schwarz, Julien Cahais, Haitham Khalil, Francis Michot, Jean-Jacques Tuech, Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen Cedex, France.
World Journal of Gastroenterology
|July 11, 2014
Summary
Nonoperative management of complicated diverticulitis (CD) is safe and feasible for most patients. A conservative approach showed a low risk of recurrence in the medium term, with most patients remaining asymptomatic.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Abdominal Imaging
Background:
- Complicated diverticulitis (CD) often requires intervention.
- Nonoperative management strategies for CD are increasingly explored.
Purpose of the Study:
- To evaluate recurrence rates, patterns, and complications associated with nonoperative management of CD.
- To assess the safety and feasibility of conservative treatment for CD.
Main Methods:
- Retrospective analysis of 114 patients diagnosed with CD via computed tomography.
- CD definition included localized abscess, pelvic abscess, or extraluminal air.
- Follow-up involved telephone contact to assess elective surgeries, recurrences, and abdominal pain.
Main Results:
- Nine patients (8%) required surgery due to failed conservative therapy.
- Of 105 remaining patients, 24 (22.9%) underwent elective sigmoid resection.
- In 81 non-operated patients followed for a median of 32 months, 6 (7%) experienced recurrent diverticulitis without hospitalization; 84% were asymptomatic.
Conclusions:
- A conservative management approach for CD is feasible and safe in the majority of patients (71%).
- Nonoperative management is associated with a low medium-term risk of diverticulitis recurrence.
- Most patients treated nonoperatively remain asymptomatic or experience manageable symptoms.
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