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Diseases of the colon and rectum

Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients.


PMID 24901689

Abstract

The optimal treatment for diverticulitis with extraluminal air is controversial. The purpose of this research was to evaluate the safety and effectiveness of nonoperative treatment of acute diverticulitis with extraluminal air. This was a retrospective cohort. The study was conducted at an academic teaching hospital functioning as both a tertiary and secondary care referral center. All of the patients with CT-diagnosed acute perforated diverticulitis with extraluminal air from 2006 through 2010 were included in this study. Nonoperative treatment composed of intravenous antibiotics, bowel rest, and percutaneous drainage were the included interventions. The need for operative management and mortality were measured. A total of 132 patients underwent nonoperative treatment, whereas 48 patients were primarily operated on. Patients treated nonoperatively were divided into 3 groups on the basis of identified factors that independently predicted risk for failure: 1) patients with pericolic air (n = 82) without abscess had a 99% success rate with 0% mortality. 2) Patients with distant intraperitoneal air (n = 29) had a 62% success ratewith 0% mortality. Abundant distant intraperitoneal air and fluid in the fossa Douglas were identified as risk factors for failure. Patients without these risk factors had an 86% success rate with nonoperative management. 3) Patients with distant retroperitoneal air (n = 14) had a 43% success rate with 7% mortality. Comparison of nonoperative versus operative treatment cannot be made because of the study's retrospective nature. Nonoperative treatment of acute diverticulitis with extraluminal air is safe and effective in patients with a small amount of distant intraperitoneal air or pericolic air without clinical signs of peritonitis.