Acute Diverticulitis: Imaging and Percutaneous Drainage

Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.

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Diverticular Abscess Presenting as an Incarcerated Inguinal Hernia

The American Surgeon ◽

10.1177/000313480507100306 ◽

2005 ◽

Vol 71 (3) ◽

pp. 208-209 ◽

Cited By ~ 7

Author(s):

Josh Greenberg ◽

Tracey D. Arnell

Keyword(s):

Inguinal Hernia ◽

Percutaneous Drainage ◽

Acute Diverticulitis ◽

Sigmoid Resection ◽

Amyand’S Hernia ◽

Open Drainage ◽

Incarcerated Inguinal Hernia ◽

Laparoscopic Sigmoid Resection ◽

Urgent Surgery

Acute diverticulitis may present with an abscess that is usually pericolonic or pelvic and can be treated with urgent surgery or percutaneous drainage. We present a case of a diverticular abscess presenting as a left inguinal hernia. This is analogous to an Amyand's hernia in which an inflamed appendix is found in a right inguinal hernia. The patient presented was managed with open drainage of the hernia and subsequent laparoscopic sigmoid resection in the same hospitalization.

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

The American Surgeon ◽

10.1177/000313482008600426 ◽

2020 ◽

Vol 86 (4) ◽

pp. 308-312 ◽

Cited By ~ 1

Author(s):

Bhanuka Dissanayake ◽

Matthew J. Burstow ◽

Arunan Jeyakumar ◽

Peter J. Yuide ◽

Justin Gundara ◽

...

Keyword(s):

Percutaneous Drainage ◽

Acute Diverticulitis ◽

White Cell Count ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Complicated Diverticulitis ◽

Related Factors ◽

Uncomplicated Diverticulitis ◽

Operative Surgery ◽

Surgical Unit

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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Percutaneous drainage for hinchey Ib and II acute diverticulitis with abscess improves outcomes

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2019.18602 ◽

2019 ◽

Vol 30 (11) ◽

pp. 976-983 ◽

Cited By ~ 1

Author(s):

David R. Rosen ◽

◽

Emily G. Pott ◽

Kyle G. Cologne ◽

Sang W. Lee ◽

...

Keyword(s):

Percutaneous Drainage ◽

Acute Diverticulitis

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Current Options for the Emergency Management of Diverticular Disease and Options to Reduce the Need for Colostomy

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0037-1607961 ◽

2018 ◽

Vol 31 (04) ◽

pp. 229-235 ◽

Cited By ~ 2

Author(s):

Dimitra Theodoropoulos

Keyword(s):

Emergency Management ◽

Diverticular Disease ◽

Percutaneous Drainage ◽

Acute Diverticulitis ◽

Laparoscopic Lavage ◽

Surgical Options ◽

Bowel Continuity ◽

Restoration Of Bowel Continuity

AbstractThis article reviews the current options and recommendations for the emergency management of acute diverticulitis, including the spectrum of antibiotics, percutaneous drainage, laparoscopic lavage, and surgical options for resection with the restoration of bowel continuity.

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Trends and Outcomes of Acute Diverticulitis in Inflammatory Bowel Disease: A Propensity-matched National Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab017 ◽

2021 ◽

Author(s):

Rajat Garg ◽

Abdul Mohammed ◽

Amandeep Singh ◽

Miguel Regueiro ◽

Benjamin Click

Keyword(s):

Inflammatory Bowel Disease ◽

Hospital Mortality ◽

Bowel Disease ◽

Percutaneous Drainage ◽

Surgical Intervention ◽

Acute Diverticulitis ◽

National Study ◽

Total Cost ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) may be at increased risk for acute diverticulitis (AD) complications due to luminal inflammation and immune modifying medications. We aimed to assess outcomes of acute diverticulitis in patients with IBD. Methods A propensity-matched analysis of the National Inpatient Sample database was performed to assess outcomes of AD in adult patients (older than 18 years) from 2004 to 2013 with and without IBD. Outcomes included in-hospital mortality, need for percutaneous drainage, surgery, venous thromboembolism (VTE), total cost, and length of stay (LOS). A subgroup analysis comparing patients with Crohn’s disease (CD) and ulcerative colitis (UC) was performed. Results After propensity matching, compared with non-IBD patients (n = 15,015); Patients with IBD (n = 15,106) did not have significantly higher rate of mortality and surgical intervention but had significantly higher rates of percutaneous drainage (4% vs 3.4%; P = 0.002), VTE (1.1% vs 0.7%; P < 0.001), longer LOS (P < 0.001), and total cost (P < 0.001). Compared with CD, UC was associated with significantly higher rates of surgical intervention (20.3% vs 19%; P = 0.04), in-hospital mortality (1.4% vs 0.4%; P < 0.001), VTE (1.6% vs 0.7%; P < 0.001), total cost ($41,672 ± $61,358 vs $33,951 ± $54,376; P < 0.001), and LOS (6.4 ± 6.4 vs 5.7 ± 5.3; P < 0.001). From 2004 to 2013, there was a significant increase of IBD (range 0.5% to 0.8%; P = < 0.001) in AD patients with overall stable mortality (0.5% to 1.0%; P = 0.47) of AD in patients with IBD. Conclusions Patients with IBD are at increased risk of complicated diverticulitis and worse outcomes compared with matched controls. Optimal AD management strategies in IBD are needed.

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