of diverticulitis with abscess formation has progressed from a surgical emergency to nonoperative management
with antibiotics and percutaneous drainage
followed by delayed resection
. Controversy has arisen regarding the necessity of elective surgery
, when nonoperative management
has successfully resolved the index attack.
The aim of this systematic review was to analyze the literature to determine the recurrence rate in those patients who were successfully managed nonoperatively and determine the role of elective surgical resection
An electronic literature search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Collected Reviews performed from 1986 to 2014. The search terms used were as follows: “diverticulitis,” “abscess,” “diverticular abscess
,” “percutaneous drainage
,” and “surgery
Studies included for review evaluated the management
of diverticular abscesses and the subsequent role of delayed elective resection
All of the studies were systematically reviewed and underwent a meta-analysis.
MAIN OUTCOME MEASURES:
End points were the need for surgery
and recurrent attacks without surgery
Twenty-two studies reporting a total of 1051 patients with acute diverticulitis with abscess formation (modified Hinchey grades IB and II) were included in the review. Percutaneous drainage
was successful in 49% patients (diameter, >3 cm) and antibiotic therapy in 14% patients. Urgent surgery
during the index hospitalization was performed in 30% of patients, elective resection
in 36%, and no surgery
in 35%. Recurrence rates were high, with 39% in patients awaiting elective resection
and 18% in the nonsurgery group, with an overall recurrence rate of 28%. Of the whole cohort, only 28% had no surgery
and no recurrence during follow-up.
Sample size, heterogeneity, selection and treatment bias, and limited follow-up of included studies were limitations to this study.
The evidence from the literature is weak but still suggests that complicated diverticulitis
with abscess formation is associated with a high probability of resective surgery
, whereas conservative management
may result in chronic or recurrent diverticular symptoms.