Our Summary

This research paper looks at how people with a specific type of severe intestinal inflammation, known as acute perforated diverticulitis, can be treated without surgery. This condition often leads to a hole in the intestines, which can cause an infection in the abdomen.

The researchers looked at previous studies on the topic, focusing on patients who were in a stable condition but had a localized infection in their abdomen. They found that, out of 479 patients, 407 (or 85%) were successfully treated without surgery. However, 70 patients (or about 15%) did not respond to non-surgical treatment and needed emergency surgery. A small number (0.4%) of patients died.

The researchers found that non-surgical treatment was more successful in patients with an infection near the inflamed area of the intestine, compared to those with an infection that had spread further. They also found that treatment was more likely to fail in patients with a large amount of free air (indicating a large hole in the intestines), an infection that had spread, and the presence of an abscess (a pocket of pus).

The researchers concluded that non-surgical treatment can be safe and successful for patients with this condition, as long as they do not have a generalized infection in their abdomen. However, they also stressed the importance of identifying patients who show signs of ongoing intestinal perforation, to ensure the success of non-surgical treatment.

FAQs

  1. What is the success rate of conservative management for patients with acute perforated diverticulitis without generalized peritonitis?
  2. What factors are associated with treatment failure in patients with acute perforated diverticulitis?
  3. What types of emergency surgery are performed for acute perforated diverticulitis?

Doctor’s Tip

A doctor may tell a patient undergoing diverticulitis surgery to follow post-operative care instructions carefully, including taking prescribed medications, eating a high-fiber diet, staying hydrated, and avoiding strenuous activities. They may also recommend regular follow-up appointments to monitor recovery progress and address any concerns.

Suitable For

Patients with acute perforated diverticulitis without generalized peritonitis are typically recommended conservative management rather than surgery. Non-operative treatment is successful in the majority of patients, with only a small proportion requiring surgical intervention. Factors associated with treatment failure include a high volume of free air, distant free air, and the presence of abscess. Early recognition of patients who may benefit from surgical management is important for optimizing outcomes in this specific group of patients.

Timeline

Before diverticulitis surgery:

  • Patient may experience symptoms such as abdominal pain, fever, nausea, vomiting, and changes in bowel habits.
  • Diagnosis is made through a physical examination, blood tests, imaging tests (such as CT scan or ultrasound), and possibly a colonoscopy.
  • Treatment may involve antibiotics, pain medication, and a clear liquid diet to rest the colon.

After diverticulitis surgery:

  • Patient may experience pain, fatigue, and limited mobility immediately following surgery.
  • Recovery time varies depending on the type of surgery performed (such as laparoscopic surgery or open surgery) and the individual patient’s overall health.
  • Follow-up appointments with the surgeon are necessary to monitor healing and address any complications.
  • After recovery, the patient may need to make dietary and lifestyle changes to prevent future episodes of diverticulitis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with diverticulitis surgery?
  2. How long is the recovery period after diverticulitis surgery?
  3. Will I need to make any lifestyle changes or follow a specific diet after surgery?
  4. What type of surgical procedure will be performed for my diverticulitis?
  5. Are there any alternative treatments or less invasive options available for my condition?
  6. How successful is diverticulitis surgery in treating the condition long-term?
  7. What is the likelihood of needing additional surgeries in the future after diverticulitis surgery?
  8. How experienced is the surgical team in performing diverticulitis surgeries?
  9. What can I expect in terms of pain management and post-operative care after surgery?
  10. Are there any specific tests or preparations I need to undergo before the surgery?

Reference

Authors: Chua TC, Jeyakumar A, Ip JCY, Yuide PJ, Burstow MJ. Journal: J Dig Dis. 2020 Feb;21(2):63-68. doi: 10.1111/1751-2980.12838. PMID: 31875348