Diverticular Abscess Managed With Long-term Definitive Nonoperative Intent Is Safe

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Nonoperative management is standard for diverticular abscess.
• The necessity of elective resection after initial treatment remains unclear.

Purpose of the Study:

• To evaluate long-term outcomes of expectant management following nonoperative treatment of diverticular abscess.
• To assess the safety and efficacy of continued nonoperative care for diverticular abscess.

Main Methods:

• Retrospective chart review with prospective telephone follow-up.
• Included adult patients with CT-documented acute sigmoid diverticulitis with abscess, managed nonoperatively (2000-2013).
• Primary outcome: emergency sigmoidectomy or death from recurrent diverticulitis.

Main Results:

• 73 patients underwent expectant management; median follow-up was 62 months.
• 30.1% experienced recurrent diverticulitis; 9.6% had complicated recurrence requiring elective sigmoidectomy.
• Only 2.7% required emergency sigmoidectomy for peritonitis; no mortality was observed.

Conclusions:

• Expectant, nonoperative management is a safe long-term strategy for diverticular abscess after initial successful nonoperative treatment.
• Low rates of surgery, especially emergency procedures, support this approach.
• Female gender and prior uncomplicated diverticulitis episodes were associated with recurrence.