Cataldo De Palma (Rozzano / IT), Simone Giudici (Rozzano / IT), Alessia Frascarelli (Rozzano / IT), Paolo Enrico Meneghesso (Rozzano / IT), Salvatore Esposito (Rozzano / IT), Davide Zulian (Rozzano / IT), Martina Ceolin (Rozzano / IT), Bruno Branciforte (Rozzano / IT), Simona Mei (Rozzano / IT), Andrea Brocchi (Rozzano / IT), Antonella Ardito (Rozzano / IT), Daniele Del Fabbro (Rozzano / IT)
Abstract text (incl. references and figure legends)
INTRODUCTION: Conservative treatment is the first-line therapy for acute complicated diverticulitis (ACD) but failure may represent a challenge in terms of hospitalization, medical costs, morbidities and mortality. The aim of this study was to evaluate failure rates following nonoperative management of acute complicated diverticulitis and to examine possible predictive factors for conservative treatment failure.
MATERIALS & METHODS: We retrospectively analysed 164 patients with diagnosis of diverticulitis admitted in Humanitas Research Hospital DEA from 1 January 2017 to 31 December 2021. Patient demographics, blood inflammatory markers, radiological findings, management and outcomes were evaluated.
RESULTS: A total of 164 patients were admitted, 34 had uncomplicated diverticulitis and 130 had ACD. Of those with ACD, 18 patients underwent urgent surgery and 112 (WSES 1a n=54, 1b n=19, 2a n=31, 2b n=8) underwent conservative treatment, composed of intravenous antibiotics with or without percutaneous drainage. Twenty-three patients (20.5%) failed conservative treatment. Univariate analysis revealed that male patients, obesity (BMI>30), ASA>2 and pericolic abscess greater than 4 cm on CT scan, were significantly associated with conservative treatment failure. Multivariate analysis proved that obesity [OR 2,92; 95%CI 1,104 - 7,702; p-value 0,046] and pericolic abscess > 4 cm [OR 3,66; 95%CI 1,386 - 9,672; p-value 0,014], were possible predictive factors of conservative treatment failure.
CONCLUSIONS: Nonoperative treatment of ACD is safe and effective. Radiological findings in association with patient clinical characteristics could help estimate the probability of conservative treatment failure.
REFERENCES:
Sartelli M et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020
FIGURE LEGENDS:
1 Analysis flowchart
2 Univariate analysis of patients and radiological characteristics
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