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Symptomatic Treatment for Uncomplicated Acute Diverticulitis: A Prospective Cohort Study

Mali, Juha P. Cand.Med.; Mentula, Panu J. M.D., Ph.D.; Leppäniemi, Ari K. M.D., Ph.D.; Sallinen, Ville J. M.D., Ph.D.

Diseases of the Colon & Rectum: June 2016 - Volume 59 - Issue 6 - p 529–534
doi: 10.1097/DCR.0000000000000579
Original Contributions: Benign

BACKGROUND: Even though evidence for nonantibiotic treatment of uncomplicated diverticulitis exists, it has not gained widespread adoption.

OBJECTIVE: The aim of this prospective single-arm study was to analyze the safety and efficacy of symptomatic (nonantibiotic) treatment for uncomplicated diverticulitis during a 30-day follow-up period.

DESIGN: This study is a single-arm prospective trial (ClinicalTrials.gov ID NCT02219698).

SETTINGS: This study was performed at an academic teaching hospital functioning as both a tertiary and secondary care referral center.

PATIENTS: Patients, who had CT-verified uncomplicated acute colonic diverticulitis (including diverticulitis with pericolic air), were evaluated for the study. Patients with ongoing antibiotic therapy, immunosuppression, suspicion of peritonitis, organ dysfunction, pregnancy, or other infections requiring antibiotics were excluded.

INTERVENTIONS: Symptomatic in- or outpatient treatment consisted of mild analgesics (nonsteroidal anti-inflammatory drug or paracetamol).

MAIN OUTCOME MEASURES: The incidence of complicated diverticulitis was the primary outcome.

RESULTS: Overall, 161 patients were included in the study, and 153 (95%) completed the 30-day follow-up. Four (3%) of these patients were misdiagnosed (abscess in the initial CT scan). A total of 14 (9%) patients had pericolic air. Altogether, 140 (87%) patients were treated as outpatients, and 4 (3%) of them were admitted to the hospital during the follow-up. None of the patients developed complicated diverticulitis or required surgery, but, 2 days (median) after inclusion, antibiotics were given to 14 (9%, 6 orally, 8 intravenously) patients.

LIMITATIONS: This study is limited by the lack of a comparison group and by the relatively short follow-up.

CONCLUSIONS: Symptomatic treatment of uncomplicated diverticulitis without antibiotics is safe and effective.

1 Department of Abdominal Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland

2 Department of Transplantation and Liver Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland

Funding/Support: Vatsatautien tutkimussäätiö-foundation, Mary and Georg Ehrnrooth’s Foundation, Governmental competitive funds (EVO), The Finnish Medical Foundation.

Financial Disclosure: None reported.

Presented at the meeting of National Surgical Week (Operatiiviset päivät), Helsinki, Finland, November 25 to 27, 2015.

Correspondence: Ville Sallinen, M.D., Ph.D., Department of Abdominal Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 HUS, Finland. E-mail: ville.sallinen@helsinki.fi

© 2016 The American Society of Colon and Rectal Surgeons