Percutaneous drainage of colonic diverticular abscess: is colon resection necessary?

BACKGROUND

Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended.

OBJECTIVE

The aim of this study was to review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention.

DESIGN

This was an observational study.

SETTINGS

This investigation was conducted at a tertiary care academic medical center and a single-hospital health system.

PATIENTS

Patients treated for symptomatic colonic diverticular abscess from 2002 through 2007 were included.

MAIN OUTCOME MEASURES

The primary outcomes measured were complications, recurrence, and colectomy-free survival.

RESULTS

Two hundred eighteen patients underwent percutaneous drainage of colonic diverticular abscesses. Thirty-two patients (15%) did not undergo subsequent colonic resection. Abscess location was pelvic (n = 9) and paracolic (n = 23), the mean abscess size was 4.2 cm, and the median duration of percutaneous drainage was 20 days. The comorbidities of this group of patients included severe cardiac disease (n = 16), immunodeficiency (n = 7), and severe pulmonary disease (n = 6). Freedom from recurrence at 7.4 years was 0.58 (95% CI 0.42-0.73). All recurrences were managed nonoperatively. Recurrence was significantly associated with an abscess size larger than 5 cm. Colectomy-free survival at 7.4 years was 0.17 (95% CI 0.13-0.21).

LIMITATIONS

This study was limited by its retrospective, nonexperimental design and short follow-up.

CONCLUSION

In selected patients, observation after percutaneous drainage of colonic diverticular abscess appears to be a safe and low-risk management option.