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Outcomes of Percutaneous Drainage Without Surgery for Patients With Diverticular Abscess

Elagili, Faisal M.D.; Stocchi, Luca M.D.; Ozuner, Gokhan M.D.; Dietz, David W. M.D.; Kiran, Ravi P. M.D.

Diseases of the Colon & Rectum: March 2014 - Volume 57 - Issue 3 - p 331–336
doi: 10.1097/DCR.0b013e3182a84dd2
Original Contributions: Benign Colorectal Disease

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.

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Luca Stocchi, M.D., Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Ave, A30, Cleveland, OH 44195. E-mail:stocchl@ccf.org

© 2014 The American Society of Colon and Rectal Surgeons