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  • Operative Surgery Is Rarely Required in the Acute Management of Diverticulitis in the Modern Era

    Author(s)
    Dissanayake, Bhanuka
    Burstow, Matthew J
    Jeyakumar, Arunan
    Yuide, Peter J
    Gundara, Justin
    Chua, Terence C
    Griffith University Author(s)
    Dissanayake, Bhanuka
    Year published
    2020
    Metadata
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    Abstract
    Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database ...
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    Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016–2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender (P = 0.039), increased length of hospital stay (P < 0.001), temperature ≥37.5 (P = 0.025), increased white cell count (P < 0.001), and elevated C-reactive protein (P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diver-ticulitis with sepsis or peritonitis.
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    Journal Title
    The American Surgeon
    Volume
    86
    Issue
    4
    DOI
    https://doi.org/10.1177/000313482008600426
    Subject
    Clinical sciences
    Science & Technology
    Life Sciences & Biomedicine
    Surgery
    ACUTE SURGICAL UNIT
    RANDOMIZED CLINICAL-TRIAL
    Publication URI
    http://hdl.handle.net/10072/396864
    Collection
    • Journal articles

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