Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e31828545e3
Original Contribution: Benign Colorectal Disease

Percutaneous Drainage of Colonic Diverticular Abscess: Is Colon Resection Necessary?

Gaertner, Wolfgang B. M.S., M.D.1; Willis, David J. M.D.2; Madoff, Robert D. M.D.1; Rothenberger, David A. M.D.1; Kwaan, Mary R. M.P.H., M.D.1; Belzer, George E. M.D.2; Melton, Genevieve B. M.A., M.D.1

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BACKGROUND: Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended.

OBJECTIVE: The aim of this study was to review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention.

DESIGN: This was an observational study.

SETTINGS: This investigation was conducted at a tertiary care academic medical center and a single-hospital health system.

PATIENTS: Patients treated for symptomatic colonic diverticular abscess from 2002 through 2007 were included.

MAIN OUTCOME MEASURES: The primary outcomes measured were complications, recurrence, and colectomy-free survival.

RESULTS: Two hundred eighteen patients underwent percutaneous drainage of colonic diverticular abscesses. Thirty-two patients (15%) did not undergo subsequent colonic resection. Abscess location was pelvic (n = 9) and paracolic (n = 23), the mean abscess size was 4.2 cm, and the median duration of percutaneous drainage was 20 days. The comorbidities of this group of patients included severe cardiac disease (n = 16), immunodeficiency (n = 7), and severe pulmonary disease (n = 6). Freedom from recurrence at 7.4 years was 0.58 (95% CI 0.42–0.73). All recurrences were managed nonoperatively. Recurrence was significantly associated with an abscess size larger than 5 cm. Colectomy-free survival at 7.4 years was 0.17 (95% CI 0.13–0.21).

LIMITATIONS: This study was limited by its retrospective, nonexperimental design and short follow-up.

CONCLUSION: In selected patients, observation after percutaneous drainage of colonic diverticular abscess appears to be a safe and low-risk management option.

© The ASCRS 2013


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