Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess

Background There are limited data assessing the effectiveness of antibiotics as sole initial therapy in patients with large diverticular abscess. The aim of our study was to compare outcomes of selected patients treated with initial antibiotics alone versus percutaneous drainage. Methods All pa...

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Main Authors:	Elagili, Faisal, Stocchi, Luca, Ozuner, Gokhan, Kiran, Pokala Ravi
Format:	Article
Language:	English
Published:	Springer Milan 2015
Subjects:	RD Surgery
Online Access:	http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/1/elagili2014.pdf

id	iium-69637
recordtype	eprints
spelling	iium-696372019-04-11T02:00:28Z http://irep.iium.edu.my/69637/ Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess Elagili, Faisal Stocchi, Luca Ozuner, Gokhan Kiran, Pokala Ravi RD Surgery Background There are limited data assessing the effectiveness of antibiotics as sole initial therapy in patients with large diverticular abscess. The aim of our study was to compare outcomes of selected patients treated with initial antibiotics alone versus percutaneous drainage. Methods All patients with diverticular abscess ≥3 cm in diameter treated in our institution in 1994–2012 with percutaneous drainage or antibiotics alone followed by surgery were identified from an institutional diverticular disease database. Groups were compared based on patient and disease characteristics, treatment failures and postoperative outcomes. Results Thirty-two patients were treated with antibiotics alone because of either technically impossible percutaneous drainage (n = 15) or surgeon preference (n = 17) while 114 underwent percutaneous drainage. Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage (p = 0.21). Reasons for urgent surgery after percutaneous drainage were persistent symptoms (n = 16), technical failure of percutaneous drainage (n = 4) and small bowel injury (n = 1). Patients treated with antibiotics had a significantly smaller abscess diameter (5.9 vs. 7.1 cm, p = 0.001) and shorter interval from initial treatment to sigmoidectomy (mean 50 vs. 80 days, p = 0.02). The Charlson comorbidity index, initial treatment failure rates, postoperative mortality, overall morbidity, length of hospital stay during treatments, and overall and permanent stoma rates were comparable in the two groups. Postoperative complications following antibiotics alone were significantly less severe than after percutaneous drainage based on the Clavien–Dindo classification (p = 0.04). Conclusions Selected patients with diverticular abscess can be initially treated with antibiotics without adverse consequences on their outcomes. Springer Milan 2015-02 Article PeerReviewed application/pdf en http://irep.iium.edu.my/69637/1/elagili2014.pdf Elagili, Faisal and Stocchi, Luca and Ozuner, Gokhan and Kiran, Pokala Ravi (2015) Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess. Techniques in Coloproctology, 19 (2). pp. 1-7. ISSN 1123-6337 E-ISSN 1128-045X (In Press) https://link.springer.com/article/10.1007/s10151-014-1250-9 10.1007/s10151-014-1250-9
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD Surgery
spellingShingle	RD Surgery Elagili, Faisal Stocchi, Luca Ozuner, Gokhan Kiran, Pokala Ravi Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
description	Background There are limited data assessing the effectiveness of antibiotics as sole initial therapy in patients with large diverticular abscess. The aim of our study was to compare outcomes of selected patients treated with initial antibiotics alone versus percutaneous drainage. Methods All patients with diverticular abscess ≥3 cm in diameter treated in our institution in 1994–2012 with percutaneous drainage or antibiotics alone followed by surgery were identified from an institutional diverticular disease database. Groups were compared based on patient and disease characteristics, treatment failures and postoperative outcomes. Results Thirty-two patients were treated with antibiotics alone because of either technically impossible percutaneous drainage (n = 15) or surgeon preference (n = 17) while 114 underwent percutaneous drainage. Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage (p = 0.21). Reasons for urgent surgery after percutaneous drainage were persistent symptoms (n = 16), technical failure of percutaneous drainage (n = 4) and small bowel injury (n = 1). Patients treated with antibiotics had a significantly smaller abscess diameter (5.9 vs. 7.1 cm, p = 0.001) and shorter interval from initial treatment to sigmoidectomy (mean 50 vs. 80 days, p = 0.02). The Charlson comorbidity index, initial treatment failure rates, postoperative mortality, overall morbidity, length of hospital stay during treatments, and overall and permanent stoma rates were comparable in the two groups. Postoperative complications following antibiotics alone were significantly less severe than after percutaneous drainage based on the Clavien–Dindo classification (p = 0.04). Conclusions Selected patients with diverticular abscess can be initially treated with antibiotics without adverse consequences on their outcomes.
format	Article
author	Elagili, Faisal Stocchi, Luca Ozuner, Gokhan Kiran, Pokala Ravi
author_facet	Elagili, Faisal Stocchi, Luca Ozuner, Gokhan Kiran, Pokala Ravi
author_sort	Elagili, Faisal
title	Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
title_short	Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
title_full	Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
title_fullStr	Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
title_full_unstemmed	Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
title_sort	antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
publisher	Springer Milan
publishDate	2015
url	http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/ http://irep.iium.edu.my/69637/1/elagili2014.pdf
first_indexed	2023-09-18T21:38:50Z
last_indexed	2023-09-18T21:38:50Z
_version_	1777413003412504576

Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess

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