Diverticulitis Sigmoid diverticulitis is a common disease of the

Diverticulitis Sigmoid diverticulitis is a common disease of the Western World and results in a significant number of hospital admissions. Antibiotics are the standard of care for uncomplicated diverticulitis. Percutaneous drainage is the intervention of choice for simple uniloculated abscesses. It has a success

rate of more than 80%, but it may have a high failure rate in cases of complex multiloculated or inaccessible abscesses [49]. The use of antibiotics and percutaneous drainage in the management of diverticular abscesses EPZ-6438 purchase facilitates single stage operation to perform subsequently an elective sigmoidectomy. Ambrosetti et al. [50] studied retrospectively 73 patients with diverticular abscesses with a follow up of 43 months and found that 59% of the patients needed surgery either during the acute admission or as an elective procedure. The other patients

did not need surgical intervention after conservative treatment either with or without percutaneous drainage. The study also compared the mesocolic abscesses with the pelvic ones. Pelvic abscesses exhibited an aggressive behaviour and therefore needed to be rapidly drained find more percutaneously and were likely to require surgery. Brandt et al. [51] retrospectively compared patients with CT confirmed abscesses, treated by antibiotics alone and patient treated by antibiotics with percutaneous drainage. The patients treated with antibiotics alone achieved an outcome similar to patients treated with percutaneous drainage. The average abscess size was 4 cm in the antibiotic only group and 6 cm in percutaneous group. Failure rate of percutaneous drainage in this series was 33%. Siewert et al. [52] reported that antibiotics alone were effective in resolving acute symptoms for abscess size less than 3 cm. Urgent surgery for colonic diverticula perforations is indicated in patients with large or/and multiloculated diverticular abscesses inaccessible to percutaneous drainage or in whom clinical symptoms persist after CT guided percutaneous drainage, diverticulitis associated with free perforation and purulent or

fecal diffuse peritonitis. There is still controversy about the optimal surgical management of colonic diverticular disease, complicated by peritonitis. Hartmann’s resection very has been considered the procedure of choice in patients with generalized peritonitis and remains a safe technique for emergency colectomy in perforated diverticulitis, especially in elderly patients with multiple co-morbidities [53]. More recently, some reports have suggested that primary resection and anastomosis is the preferred approach to diverticulitis, even in the presence of diffuse peritonitis [54, 55]. In 2006 a sistematic review by Constantinides et al. [56] about primary resection with anastomosis vs. Hartmann’s procedure in nonelective surgery for acute colonic diverticulitis was published.

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