Conservative management of acute perforated diverticulitis: A systematic review

Abstract

OBJECTIVE: Acute perforated diverticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis, however, a large proportion of patients are clinically stable with localized peritonitis. This review aims to examine this specific group of patients by reviewing their outcomes of conservative management. METHODS: A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non-operative treatment for acute perforated diverticulitis were synthesized and tabulated. RESULTS: Of 479 patients, 412 patients (86%) were successfully managed non-operatively. Sixty-five patients (13.6%) failed non-operative treatment and underwent operative surgical management, and two patients died (0.4%). Emergency surgery includes a Hartmann operation (51%), resection with anastomosis with or without stoma (27%), laparoscopic lavage (18%) and surgical drainage (4%). The success rate of conservative management was 92.4% and 71.4% for patients with pericolic and distant free air respectively. Treatment failure was associated with a high volume of free air, distant free air and presence of an abscess. CONCLUSIONS: Conservative management is safe and successful in patients with acute perforated diverticulitis without generalized peritonitis. Early recognition of patients who demonstrate clinical signs of persistent perforation is important to ensure the success of this strategy.