Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation.

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study / Patricia, Tejedor; Carlos, Pastor; Gianluca, Pellino; Salomone, Di Saverio; Marguerite, Gorter-Stam; Patricia, Sylla; Nader, Francis; Tomas Morales-Bernaldo de Quiros, Javier; Hernández Sanz, Pablo; Pastor, Carlos; Alvarellos Pérez, Alicia; Granero Peiró, Lucía; Lucía Granero, Jorge; Simó, Vicente; Tejedor, Patricia; Miguel Jiménez, Luis; Luz Fernández, Maria; Vigorita, Vincenzo; Rodríguez Fernández, Laura; Paniagua García-Señoráns, Marta; Forero, Alejandro; Prieto, Isabel; Díaz San Andrés, Beatriz; Asensio Gómez, Luis; Prieto, Fernando; Turrado, Víctor; Morales Sevillano, Xavier; García Sánchez, Felipe; María Cano Pecharromán, Esther; Llamero Sanz, Tamara; Estaire Gómez, Mercedes; Olivenza Palomar, Pilar; Losada Ruiz, Manuel; Diéguez Fernández, Beatriz; Hernández García, Miguel; Alonso Poza, Alfredo; Jullien Petrelli, Ariel; Labalde Martínez, María; Rodríguez, Ana; Mendendez, Pablo; Navarro-Sánchez, Antonio; Soto-Darias, Iván; Sánchez-Guillén, Luis; Bosch-Ramírez, Marina; Castro Suárez, Marta; Tasende Presedo, Marta; César Lévano-Linares, Dennis; Salvans, Silvia; Pellino, Gianluca; Espín-Basany, Eloy; Mata, Rodrigo; Petrola, Carlos; Cagigas, Carmen; Caiña Ruiz, Rubén; Suárez, Natalia; Gómez Sánchez, Tatiana; María Sancho Maraver, Eva; Sánchez de la Orden, Carmen; Velasco López, Rosalía; Simó, Vicente; Pelloni, María; Rahy-Martin, Aida; Ocaña, Juan; Fernández Vega, Laura; García-Granero, Álvaro; Alonso Hernández, Natalia; Trujillo-Díaz, Jeancarlos; de San Pío Carvajal, Eduardo; Sagarra Cebolla, Elena; Gómez Carmona, Zahira; Gras Gómez, Cristina; Mestres Petit, Núria; de la Hermosa, Ruiz; Luisa de Fuenmayor Valera, María; Bollo Rodríguez, Jesús; Garbarino, Sabrina; Tutino, Roberta; Massani, Marco; Grossi, Ugo; Passuello, Nicola; Zanus, Giacomo; Gallo, Gaetano; de Paola, Gilda; Frontali, Alice; Pezzoli, Isabella; Cillara, Nicola; Deserra, Antonello; D’Agostino, Francesca; Nigri, Giuseppe; Zerunian, Marta; Laghi, Andrea; Abate, Emmanuele; Laface, Letizia; Roscio, Francesco; CLERICI BAGOZZI, Federico; Vito Marino, Marco; de Leonardis, Martina; Sartarelli, Lodovico; Montuori, Mauro; Pinotti, Enrico; Marco Palini, Gian; Marietta, Caterina; Schettino, Pietro; Romano, Giovanni; Biloslavo, Alan; Aizza, Giada; Tamini, Nicolò; Podda, Mauro; Esposito, Giuseppe; Grande, Michele; Campanelli, Michela; Siragusa, Leandro; Lapolla, Pierfrancesco; Mingoli, Andrea; Brachini, Gioia; De Nardi, Paola; Gonario Arru, Giaime; Chiarugi, Massimo; Tartaglia, Dario; Cicuttin, Enrico; Coccolini, Federico; Zago, Mauro; Burati, Morena; Gibelli, Ludovica; Runfola, Matteo; Esposito, Giuseppe; Palmeri, Matteo; Bianchini, Matteo; Annicchiarico, Alfredo; Giuffrida, Mario; Catena, Fausto; Perrone, Gennaro; Khan, Mansoor; Al Ain Atif, Qurrat; Davis, George; Hamid, ; Garvin, Joseph; H Paul, Sharjeel; Mustafa, Hamid; Byrne, James; Khan, Ata; Avellaneda, Nicolas; Carrie, Augusto; Espil, German; Samadov, Elgun; Ibrahimli, Arturan; Demirli Atici, Semra; Cázarez-Huazano, Sinue; Santes, Oscar; Salgado-Nesme, Noel; Luis Aguilar Frasco, Jorge; Garoufalia, Zoe; Nikiteas, Nikolaos; Aleš Košir, Jurij; Grosek, Jan. - In: INTERNATIONAL JOURNAL OF SURGERY. - ISSN 1743-9191. - 109:4(2023), pp. 689-697. [10.1097/JS9.0000000000000213]

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Gaetano Gallo;Giuseppe Nigri;Marta Zerunian;Andrea Laghi;Federico Clerici;Michele Grande;Pierfrancesco Lapolla;Andrea Mingoli;Gioia Brachini;Massimo Chiarugi;
2023

Abstract

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation.
2023
surgery; complication; diverticular disease; diverticulitis; diverticulosis; nonoperative management
01 Pubblicazione su rivista::01a Articolo in rivista
Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study / Patricia, Tejedor; Carlos, Pastor; Gianluca, Pellino; Salomone, Di Saverio; Marguerite, Gorter-Stam; Patricia, Sylla; Nader, Francis; Tomas Morales-Bernaldo de Quiros, Javier; Hernández Sanz, Pablo; Pastor, Carlos; Alvarellos Pérez, Alicia; Granero Peiró, Lucía; Lucía Granero, Jorge; Simó, Vicente; Tejedor, Patricia; Miguel Jiménez, Luis; Luz Fernández, Maria; Vigorita, Vincenzo; Rodríguez Fernández, Laura; Paniagua García-Señoráns, Marta; Forero, Alejandro; Prieto, Isabel; Díaz San Andrés, Beatriz; Asensio Gómez, Luis; Prieto, Fernando; Turrado, Víctor; Morales Sevillano, Xavier; García Sánchez, Felipe; María Cano Pecharromán, Esther; Llamero Sanz, Tamara; Estaire Gómez, Mercedes; Olivenza Palomar, Pilar; Losada Ruiz, Manuel; Diéguez Fernández, Beatriz; Hernández García, Miguel; Alonso Poza, Alfredo; Jullien Petrelli, Ariel; Labalde Martínez, María; Rodríguez, Ana; Mendendez, Pablo; Navarro-Sánchez, Antonio; Soto-Darias, Iván; Sánchez-Guillén, Luis; Bosch-Ramírez, Marina; Castro Suárez, Marta; Tasende Presedo, Marta; César Lévano-Linares, Dennis; Salvans, Silvia; Pellino, Gianluca; Espín-Basany, Eloy; Mata, Rodrigo; Petrola, Carlos; Cagigas, Carmen; Caiña Ruiz, Rubén; Suárez, Natalia; Gómez Sánchez, Tatiana; María Sancho Maraver, Eva; Sánchez de la Orden, Carmen; Velasco López, Rosalía; Simó, Vicente; Pelloni, María; Rahy-Martin, Aida; Ocaña, Juan; Fernández Vega, Laura; García-Granero, Álvaro; Alonso Hernández, Natalia; Trujillo-Díaz, Jeancarlos; de San Pío Carvajal, Eduardo; Sagarra Cebolla, Elena; Gómez Carmona, Zahira; Gras Gómez, Cristina; Mestres Petit, Núria; de la Hermosa, Ruiz; Luisa de Fuenmayor Valera, María; Bollo Rodríguez, Jesús; Garbarino, Sabrina; Tutino, Roberta; Massani, Marco; Grossi, Ugo; Passuello, Nicola; Zanus, Giacomo; Gallo, Gaetano; de Paola, Gilda; Frontali, Alice; Pezzoli, Isabella; Cillara, Nicola; Deserra, Antonello; D’Agostino, Francesca; Nigri, Giuseppe; Zerunian, Marta; Laghi, Andrea; Abate, Emmanuele; Laface, Letizia; Roscio, Francesco; CLERICI BAGOZZI, Federico; Vito Marino, Marco; de Leonardis, Martina; Sartarelli, Lodovico; Montuori, Mauro; Pinotti, Enrico; Marco Palini, Gian; Marietta, Caterina; Schettino, Pietro; Romano, Giovanni; Biloslavo, Alan; Aizza, Giada; Tamini, Nicolò; Podda, Mauro; Esposito, Giuseppe; Grande, Michele; Campanelli, Michela; Siragusa, Leandro; Lapolla, Pierfrancesco; Mingoli, Andrea; Brachini, Gioia; De Nardi, Paola; Gonario Arru, Giaime; Chiarugi, Massimo; Tartaglia, Dario; Cicuttin, Enrico; Coccolini, Federico; Zago, Mauro; Burati, Morena; Gibelli, Ludovica; Runfola, Matteo; Esposito, Giuseppe; Palmeri, Matteo; Bianchini, Matteo; Annicchiarico, Alfredo; Giuffrida, Mario; Catena, Fausto; Perrone, Gennaro; Khan, Mansoor; Al Ain Atif, Qurrat; Davis, George; Hamid, ; Garvin, Joseph; H Paul, Sharjeel; Mustafa, Hamid; Byrne, James; Khan, Ata; Avellaneda, Nicolas; Carrie, Augusto; Espil, German; Samadov, Elgun; Ibrahimli, Arturan; Demirli Atici, Semra; Cázarez-Huazano, Sinue; Santes, Oscar; Salgado-Nesme, Noel; Luis Aguilar Frasco, Jorge; Garoufalia, Zoe; Nikiteas, Nikolaos; Aleš Košir, Jurij; Grosek, Jan. - In: INTERNATIONAL JOURNAL OF SURGERY. - ISSN 1743-9191. - 109:4(2023), pp. 689-697. [10.1097/JS9.0000000000000213]
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