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Nonoperative management of perforated diverticulitis with extraluminal air is safe

Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients, reports the most recent issue of the Diseases of the Colon & Rectum.

News image

The optimal treatment for diverticulitis with extraluminal air is controversial.

Dr Ville Sallinen and colleagues evaluated the safety and effectiveness of nonoperative treatment of acute diverticulitis with extraluminal air.

The team performed a retrospective cohort 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 team's main outcomes measures included the need for operative management and mortality were measured.

Patients with pericolic air without abscess had a 99% success rate
Diseases of the Colon & Rectum

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.

The researchers observed that patients with pericolic air without abscess had a 99% success rate with 0% mortality, and patients with distant intraperitoneal air had a 62% success rate with 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.

The team found that patients with distant retroperitoneal air had a 43% success rate with 7% mortality.

Comparison of nonoperative versus operative treatment cannot be made because of the study’s retrospective nature.

Dr Sallinen's team commented, "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."

Dis Colon Rectum 2014: 57(7): 875–881
13 June 2014

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