How Can We Manage the Therapeutic Approach of Acute Diverticulitis Regarding the Number of Attacks?

Abstract

Aim:The risk of acute diverticulitis (AD) increases with each attack and the decision of therapeutic management is getting more complicated. We aimed to investigate the effective features of the number of attacks.Method:Two hundred thirty six patients with AD defined by computerized tomography were retrospectively analyzed according to the number of attacks (1, 2, and ≥3).Results:45.8% patients were female. The mean age was 58.3±12.7 years old, mean body mass index was 28.8±6.5 kg/m2. Elective colonoscopy of AD was mostly localized in the left colon (p<0.05). The majority of the patients had a conservative treatment regardless of several attacks (81.4%). The percentage of patients received a conservative treatment (83.6% vs 81.1% and 75.5%) and radiological abscess drainage (10.5% vs 5.7% vs 6.1%) were higher in the patients with first attack (p=0.012). The percentage of patients undergone abscess drainage by open surgery (0.7% vs, 5.7% vs 12.2%) was higher in the patients with ≥3 attacks, while the number of segmental colon resection (7.5% vs 61% vs 5.2%) was higher in the patients with 2 attacks (p=0.012). The increase in Hinchey classification had an impact on the invasive interventions regarding the clinical parameters of AD [odds ratio (OR): 0.052; 95% confidence interval (CI): 0.022-0.126; p<0.001]. The patients with older age were more likely to be treated with surgical interventions (OR: 0.960; 95% CI: 0.918-1.003; p=0.07).Conclusion:The increases in Hinchey classification with older age has a potential impact among the invasive abscess drainage and surgical intervention regarding the severity of each attack of AD.

Keywords

• abdominal abscesses
• acute diverticulitis
• colonoscopy