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Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study.
- Source :
-
Surgical endoscopy [Surg Endosc] 2024 Jun; Vol. 38 (6), pp. 3180-3194. Date of Electronic Publication: 2024 Apr 17. - Publication Year :
- 2024
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Abstract
- Background: This multicentre case-control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.<br />Methods: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.<br />Results: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23).<br />Conclusions: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Case-Control Studies
Middle Aged
Risk Factors
Aged
Diverticulitis, Colonic therapy
Diverticulitis, Colonic diagnostic imaging
Diverticulitis, Colonic surgery
Abdominal Abscess therapy
Abdominal Abscess etiology
Abdominal Abscess diagnostic imaging
Abdominal Abscess surgery
Acute Disease
Adult
Abscess therapy
Abscess diagnostic imaging
Abscess surgery
Conservative Treatment methods
Drainage methods
Treatment Failure
Tomography, X-Ray Computed
Anti-Bacterial Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 38
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 38632117
- Full Text :
- https://doi.org/10.1007/s00464-024-10793-z