Management of sigmoid diverticular abscess by surgeons and gastroenterologists: a French survey

Sigmoid diverticulitis with abscess (Hinchey I or II), is routinely managed non-surgically, with antibiotic therapy. However, specific treatment parameters, including antibiotic class, route of administration, and duration, are still debated and poorly standardized. To assess current clinical practices among French surgeons and gastroenterologists in the management of sigmoid diverticulitis with abscess (Hinchey I or II). An anonymous, five-item online survey was distributed to members of the French surgical network and the GETAID gastroenterology group, as well as to gastroenterologists outside GETAID between September 2023 and December 2024. The questionnaire addressed antibiotic therapy, route of administration, duration of therapy, and indications for CT-guided abscess drainage. A total of 73 responses were received (43,3% response rate): 60.2% from surgeons and 39.8% from gastroenterologists. Preferred antibiotic therapy was third-generation cephalosporin and metronidazole (50.6%). In the majority (82.2% of respondents), antibiotic therapy was initiated intravenously and followed up with an oral formulation. The mean duration of antibiotic therapy was 10.7 days, with surgeons prescribing shorter courses on average (9.88 days) than gastroenterologists (12.13 days). The preferred duration of intravenous antibiotic therapy was 2 days. For percutaneous drainage, 42.5% of respondents recommended systematic drainage, whereas 57.5% indicated requesting drainage only when symptoms worsened. Clinical practice regarding antibiotic therapy for diverticular abscess reveals heterogeneity. The only strong consensus concerns the sequential use of intravenous followed by oral antibiotic therapy. The results of this survey can now be used to design a randomized controlled trial.