Diverticulitis in immunodeficient patients: our experience in the management of high-risk patients

espanolIntroduccion: la diverticulitis aguda es una enfermedad con una gran prevalencia y la necesidad de un manejo mas agresivo en pacientes inmunodeprimidos no ha quedado claramente consensuada. Objetivos: valorar la posibilidad de que el manejo conservador en este grupo sea tan valido como en la poblacion inmunocompetente. Metodos: presentamos un estudio analitico retrospectivo llevado a cabo en nuestro hospital. Se analizaron 40 pacientes inmunodeprimidos (trasplantados, tratamiento corticoideo, tratamiento renal sustitutivo, oncologicos, VIH positivos en situacion de inmunodepresion) diagnosticados de diverticulitis aguda. Los pacientes siguieron manejo no quirurgico o tratamiento quirurgico urgente segun su situacion clinica al ingreso. Las principales medidas estudiadas han sido la gravedad del cuadro agudo y la necesidad de tratamiento quirurgico segun la causa de inmunodepresion. Resultados: de 40 pacientes estudiados, 32 fueron manejados de forma conservadora en el momento agudo, con necesidad de intervencion quirurgica urgente en ocho casos (siete intervenciones de Hartmann y una reseccion con anastomosis), siendo el grupo de los trasplantados y los pertenecientes al rango de edad 40-50 anos los de mayor riesgo. Tres pacientes requirieron intervencion de forma programada por complicaciones posteriores. Veinticuatro pacientes evolucionaron sin complicaciones. Conclusiones: la proporcion de diverticulitis aguda complicada es superior que en la poblacion general. El tratamiento no quirurgico parece tan seguro como en la poblacion inmunocompetente. Los pacientes mas jovenes y los trasplantados constituyen los principales grupos de riesgo para sufrir un cuadro grave que precise un manejo mas agresivo de manera inicial. EnglishIntroduction: acute diverticulitis is a very prevalent disease. The need for a more aggressive management in immunodeficient patients has not been established. We present the results of our unit with immunodeficient patients diagnosed with acute diverticulitis and their follow-up. Objectives: to assess the possibility that a conservative management in this group is as valid as in the immunocompetent population. Methods: a retrospective analysis study was performed in our hospital. Forty immunodeficient patients (transplant, corticoid treatment, dialysis, oncologic, HIV patients) diagnosed with acute diverticulitis were analyzed. The patients were managed with a surgical or non-surgical treatment according to their status on admission. The main analyzed items were the severity of the acute episode and the need for surgical treatment compared to the cause of immunodeficiency. Other studied variables included follow-up results and recurrences. Results: thirty-two of the 40 patients studied received a non-surgical treatment during the acute episode, eight required emergency surgery (seven had a Hartmann procedure and one underwent a colon resection and anastomosis). Transplant patients and those between 40 and 50 years old proved to be higher risk groups. Three patients subsequently required elective surgery due to complications. Twenty-four patients had uneventful recoveries. Conclusions: the frequency of complicated acute diverticulitis is higher in immunodeficient patients than that of the general population. Non-surgical treatment seems to be as safe as in immunocompetent patients. Younger and transplanted patients were higher risk groups for severe acute diverticulitis that required a more aggressive management initially.