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Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study

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Abstract

Background

Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure.

Methods

A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission.

Results

Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3–4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2–21], p = 0.002).

Conclusions

Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Digestive Surgery, Aix Marseille Univ, APHM, CHU Timone, Marseille, France

    M. Aubert, S. Chopinet, J. Duclos, R. Le Huu Nho, J. Hardwigsen, N. Pirro & D. Mege

  2. Department of Radiology, Aix Marseille Univ, APHM, CHU Timone, Marseille, France

    F. Tradi

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  1. M. Aubert
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  2. F. Tradi
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  3. S. Chopinet
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  4. J. Duclos
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  5. R. Le Huu Nho
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  6. J. Hardwigsen
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  7. N. Pirro
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  8. D. Mege
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Contributions

M.A. and D.M did the conception and design of the work; the acquisition, the analysis and the interpretation of data for the work; F.T. did the acquisition and interpretation of radiological data. All authors reviewed the manuscript and approved the final version to be published.

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Correspondence to M. Aubert.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendmnentsor comparable ethical standard.

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Aubert, M., Tradi, F., Chopinet, S. et al. Acute diverticulitis with extraluminal air: is conservative treatment sufficient? A single-center retrospective study. Tech Coloproctol 28, 50 (2024). https://doi.org/10.1007/s10151-024-02928-0

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