Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study

• Published in: Techniques in coloproctology Vol. 28; no. 1; p. 50
• Main Authors: Aubert, M., Tradi, F., Chopinet, S., Duclos, J., Le Huu Nho, R., Hardwigsen, J., Pirro, N., Mege, D.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Acute Disease; Adult; Aged; Antibiotics; Anticoagulants; Cardiovascular disease; Clinical outcomes; Colorectal Surgery; Consensus Article; Conservative Treatment - methods; Diverticulitis; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - therapy; Drainage - methods; Female; Gastroenterology; Health risks; Humans; Intervention; Male; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Multivariate analysis; Proctology; Retrospective Studies; Risk Factors; Surgery; Surgical techniques; Treatment Failure; Antibiotics; Extraluminal air; Percutaneous drainage; Diverticulitis; Emergent sigmoidectomy; Conservative treatment
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-024-02928-0

Background
Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure.
Methods
A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission.
Results
Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (
n
 = 9/10, 90% versus
n
 = 47/83, 57%,
p
 = 0.007), associated with cardiovascular disease (
n
 = 6/10, 60% versus
n
 = 10/83, 12%,
p
 = 0.002), American Society of Anesthesiologists (ASA) score of 3–4 (
n
 = 4/7, 57% versus 6/33, 18%,
p
 = 0.05), under anticoagulant and antiplatelet (
n
 = 6/10, 60% versus
n
 = 11/83, 13%,
p
 = 0.04) and steroid or immunosuppressive therapy (
n
 = 3/10, 30% versus 5/83, 6%,
p
 = 0.04), and with distant pneumoperitoneum location (
n
 = 7/10, 70% versus
n
 = 14/83, 17%,
p
 = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2–21],
p
 = 0.002).
Conclusions
Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.