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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

Diseases of the Colon & Rectum: May 2013 - Volume 56 - Issue 5 - p 622–626
doi: 10.1097/DCR.0b013e31828545e3
Original Contribution: Benign Colorectal Disease

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.

1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota

2Division of Colon and Rectal Surgery, Department of Surgery, Park Nicollet Methodist Hospital, St. Louis Park, Minnesota

Financial Disclosures: None reported.

Podium presentation at the meeting of the American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Genevieve B. Melton, M.A., M.D., Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455. E-mail: gmelton@umn.edu

© The ASCRS 2013