Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis, and can be performed for mild complicated diverticulitis.
In several cases, outpatient treatment can be undertaken.
Dr Martin Hübner and colleagues from Germany assessed the 1-month failure rate of outpatient treatment for uncomplicated/mild complicated diverticulitis compared to inpatient treatment, and identified predictive factors for treatment failure.
All consecutive patients diagnosed with uncomplicated/mild complicated diverticulitis by CT scan were retrospectively analyzed.
The team defined acute uncomplicated diverticulitis as absence of abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery.
Acute mild complicated diverticulitis was defined as complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm.
|Failure rates were 32% in inpatient treatment|
|International Journal of Colorectal Disease|
All patients received antibiotherapy.
Treatment failure was defined as hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization.
The team contacted all patients using a standardized questionnaire.
Out of 540 uncomplicated/mild complicated diverticulitis, inpatient treatment was offered to 369 patients, and outpatient treatment to 171 patients.
The team observed that the inpatient treatment group had higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP.
Response rates to the questionnaire were 56% with inpatient treatment vs 62% with outpatient treatment.
Failure rates were 32% in inpatient treatment vs 10% in the outpatient group.
Among the uncomplicated/mild complicated diverticulitis patients, admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon were risk factors for failure.
Dr Hübner’s team comments, “Outpatient treatment for uncomplicated/mild complicated diverticulitis is feasible and safe.”
“Prognostic factors of failure necessitating closer follow-up were admission/CT time, Ambrosetti score of 4, and free air around the colon.”