Outcomes of percutaneous drainage without surgery for patients with diverticular abscess

BACKGROUND: Data on percutaneous drainage followed by observation for diverticular abscess is scant. OBJECTIVE: The aim of this study is to assess outcomes of percutaneous drainage alone in the management of peridiverticular abscess. DESIGN: This is a retrospective study from a prospectivel...

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Main Authors:	Faisal, Elagili, Luca, Stocchi, Gokhan, Ozuner, David W, Dietz, Ravi P, Kiran
Format:	Article
Language:	English
Published:	Wolters Kluwer 2014
Subjects:	RD Surgery
Online Access:	http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/1/elagili%20outcome.pdf

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spelling	iium-697042019-04-11T02:36:33Z http://irep.iium.edu.my/69704/ Outcomes of percutaneous drainage without surgery for patients with diverticular abscess Faisal, Elagili Luca, Stocchi Gokhan, Ozuner David W, Dietz Ravi P, Kiran RD Surgery BACKGROUND: Data on percutaneous drainage followed by observation for diverticular abscess is scant. OBJECTIVE: The aim of this study is to assess outcomes of percutaneous drainage alone in the management of peridiverticular abscess. DESIGN: This is a retrospective study from a prospectively collected database. SETTING: This study was conducted in a high-volume, specialized colorectal surgery unit. PATIENTS: All patients with a diverticular abscess of at least 3 cm in diameter, treated between 2001 and 2012, who had prohibitive comorbidities or refused surgery after percutaneous drainage were included. MAIN OUTCOME MEASURES: The primary outcome measured was the treatment of diverticular abscess with percutaneous drainage alone. RESULTS: A total of 18 patients (11 surgery refusal, 7 comorbidity) were followed up until death, surgery for recurrent diverticulitis, or for a median of 90 (17–139) months. The median abscess size was 5 (3.8–10) cm, and the location was pelvic in 8 cases and intra-abdominal in 10. The mean duration of drainage was 20 ± 1.3 days, with the exception of 2 patients who only had aspiration of the abscess because of technical difficulty in drain placement. Three patients died of preexisting comorbidities between 2 and 8 months after percutaneous drainage. Seven of the surviving patients (7/15) experienced recurrent diverticulitis; 3 of these patients underwent surgery between 7 months and 7 years after the index percutaneous drainage. Of the remaining 4 cases of recurrence, one abscess was treated with repeat percutaneous drainage alone and 3 patients had uncomplicated diverticulitis treated with antibiotics. There were no significant associations between long-term failure of percutaneous drainage and the location of the abscess ( p = 0.54) or previous episodes of diverticulitis ( p = 0.9). LIMITATIONS: This study was limited because of its retrospective nature, its nonrandomized design, and its small sample size. CONCLUSIONS: Percutaneous drainage alone was successful in avoiding surgery in the majority of this selected patient population with sigmoid diverticular abscess. Future studies should assess the appropriate indications for a more liberal use of percutaneous drainage not followed by elective surgery. Wolters Kluwer 2014-03 Article PeerReviewed application/pdf en http://irep.iium.edu.my/69704/1/elagili%20outcome.pdf Faisal, Elagili and Luca, Stocchi and Gokhan, Ozuner and David W, Dietz and Ravi P, Kiran (2014) Outcomes of percutaneous drainage without surgery for patients with diverticular abscess. Diseases of the Colon & Rectum, 57 (3). pp. 331-336. ISSN 0012-3706 E-ISSN 1530-0358 https://journals.lww.com/dcrjournal/toc/2014/03000 10.1097/DCR.0b013e3182a84dd2
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD Surgery
spellingShingle	RD Surgery Faisal, Elagili Luca, Stocchi Gokhan, Ozuner David W, Dietz Ravi P, Kiran Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
description	BACKGROUND: Data on percutaneous drainage followed by observation for diverticular abscess is scant. OBJECTIVE: The aim of this study is to assess outcomes of percutaneous drainage alone in the management of peridiverticular abscess. DESIGN: This is a retrospective study from a prospectively collected database. SETTING: This study was conducted in a high-volume, specialized colorectal surgery unit. PATIENTS: All patients with a diverticular abscess of at least 3 cm in diameter, treated between 2001 and 2012, who had prohibitive comorbidities or refused surgery after percutaneous drainage were included. MAIN OUTCOME MEASURES: The primary outcome measured was the treatment of diverticular abscess with percutaneous drainage alone. RESULTS: A total of 18 patients (11 surgery refusal, 7 comorbidity) were followed up until death, surgery for recurrent diverticulitis, or for a median of 90 (17–139) months. The median abscess size was 5 (3.8–10) cm, and the location was pelvic in 8 cases and intra-abdominal in 10. The mean duration of drainage was 20 ± 1.3 days, with the exception of 2 patients who only had aspiration of the abscess because of technical difficulty in drain placement. Three patients died of preexisting comorbidities between 2 and 8 months after percutaneous drainage. Seven of the surviving patients (7/15) experienced recurrent diverticulitis; 3 of these patients underwent surgery between 7 months and 7 years after the index percutaneous drainage. Of the remaining 4 cases of recurrence, one abscess was treated with repeat percutaneous drainage alone and 3 patients had uncomplicated diverticulitis treated with antibiotics. There were no significant associations between long-term failure of percutaneous drainage and the location of the abscess ( p = 0.54) or previous episodes of diverticulitis ( p = 0.9). LIMITATIONS: This study was limited because of its retrospective nature, its nonrandomized design, and its small sample size. CONCLUSIONS: Percutaneous drainage alone was successful in avoiding surgery in the majority of this selected patient population with sigmoid diverticular abscess. Future studies should assess the appropriate indications for a more liberal use of percutaneous drainage not followed by elective surgery.
format	Article
author	Faisal, Elagili Luca, Stocchi Gokhan, Ozuner David W, Dietz Ravi P, Kiran
author_facet	Faisal, Elagili Luca, Stocchi Gokhan, Ozuner David W, Dietz Ravi P, Kiran
author_sort	Faisal, Elagili
title	Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
title_short	Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
title_full	Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
title_fullStr	Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
title_full_unstemmed	Outcomes of percutaneous drainage without surgery for patients with diverticular abscess
title_sort	outcomes of percutaneous drainage without surgery for patients with diverticular abscess
publisher	Wolters Kluwer
publishDate	2014
url	http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/ http://irep.iium.edu.my/69704/1/elagili%20outcome.pdf
first_indexed	2023-09-18T21:38:57Z
last_indexed	2023-09-18T21:38:57Z
_version_	1777413009957715968

Outcomes of percutaneous drainage without surgery for patients with diverticular abscess

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