Department of Surgery, Torbay Hospital, Newton Rd, Torquay, TQ2 7AA, UK.
European University Cyprus School of Medicine, 6 Diogenis Str 2404 Engomi, P.O. Box: 22006, 1516, Nicosia, Cyprus.
Int J Surg. 2021 Jan;85:1-9. doi: 10.1016/j.ijsu.2020.11.019. Epub 2020 Nov 25.
Colonic diverticulitis is one of the most common gastrointestinal pathologies and its prevalence increases with the aging of the population in Western countries. Approximately 15% of patients with Hinchey Ia acute diverticulitis present with concomitant isolated pericolic air bubbles that denote intestinal perforation and thus prompting a more "aggressive" treatment attitude, including emergency surgery, despite the absence of evidence-based indications. This study is trying to delineate whether this approach is justified or whether a conservative treatment would suffice for this group of patients.
PubMed and Cochrane CENTRAL databases were systematically searched in order to identify all studies that reported the need for emergency surgery and for percutaneous drainage in patients presenting with Hinchey Ia colonic diverticulitis with extraluminal pericolic gas on CT imaging who were initially treated conservatively. The last database search was performed on November 29, 2019 and no language or study type restriction criteria were applied. The Newcastle-Ottawa scale was used to assess the risk of bias of selected studies.
Nine observational cohort studies with 411 patients reported the need for emergency surgery, with a pooled rate of 5.1%. Among these studies, four studies comprising 165 patients reported the need for percutaneous drainage separately with a pooled rate of 1.2%.
Non-operative management of Hinchey Ia acute diverticulitis with isolated pericolic air is feasible and safe with a success rate of 94.9%. Abscess formation requiring percutaneous drainage is present in only 1.2% of patients, thus rendering the conservative initial treatment of these patients justified. Nevertheless, low quality of included studies indicates further research to validate the outcomes of this review.
结肠憩室炎是最常见的胃肠道疾病之一，在西方国家，随着人口老龄化，其发病率也在增加。约 15%的 Hinchey Ia 级急性憩室炎患者伴有孤立性结肠旁气泡，提示肠穿孔，因此需要更积极的治疗态度，包括紧急手术，尽管缺乏基于证据的指征。本研究旨在探讨这种方法是否合理，或者对于这组患者，保守治疗是否足够。
系统检索了 PubMed 和 Cochrane CENTRAL 数据库，以确定所有报道 CT 影像学显示结肠旁有游离气体的 Hinchey Ia 级结肠憩室炎患者，初始保守治疗后需要紧急手术和经皮引流的研究。最后一次数据库检索时间为 2019 年 11 月 29 日，未应用语言或研究类型限制标准。采用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。
9 项观察性队列研究共纳入 411 例患者，报告需要紧急手术，总体发生率为 5.1%。其中 4 项研究共纳入 165 例患者单独报告需要经皮引流，总体发生率为 1.2%。
对于伴有孤立性结肠旁气泡的 Hinchey Ia 级急性憩室炎，非手术治疗是可行且安全的，成功率为 94.9%。需要经皮引流的脓肿形成仅占 1.2%，因此对这些患者进行初始保守治疗是合理的。然而，纳入研究的质量较低，表明需要进一步研究来验证本综述的结果。
