Operative rates in acute diverticulitis with concurrent small bowel obstruction

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Surgery

Background:

• Diverticulitis prevalence has increased, with concurrent large bowel diverticulitis (LBD) and small bowel obstruction (SBO) being a rare complication.
• Limited recent literature and no official guidelines exist for managing combined LBD and SBO.
• Existing data primarily consists of small case series from the 1950s.

Purpose of the Study:

• To compare outcomes for patients with concurrent LBD and SBO versus LBD alone.
• To assess the need for surgical intervention in patients with combined LBD and SBO.

Main Methods:

• Retrospective case-control study with 5:1 matching.
• Patients with LBD and SBO were compared to patients with LBD alone.
• Demographics, comorbidities, and Hinchey classification were used for matching.

Main Results:

• Concurrent LBD and SBO significantly increased the likelihood of surgical intervention (OR 4.2, p<0.001).
• Patients with combined diagnoses were more likely to undergo open surgery (p<0.001).
• A longer length of stay (LOS) was observed for patients with LBD and SBO (mean +3.2 days, p=0.003).

Conclusions:

• Patients with concurrent LBD and SBO have a higher failure rate with non-operative management.
• Earlier surgical intervention may be beneficial, potentially reducing LOS and improving outcomes.
• The findings suggest a need for updated clinical recommendations for managing these complex cases.