Abstract
Background and objectives: We present initial results from a small cohort series for a hospital protocol related to the emergency hospitalization decision-making process for acute diverticulitis. We performed a retrospective analysis of 53 patients with acute diverticulitis admitted to the Department of Emergency and Trauma Surgery of the “Azienda Ospedaliero Universiaria-Ospedali Riuniti” in Ancona and to the Department of General and Emergency Surgery of the “Azienda Ospedaliera-Universitaria” in Perugia. Materials and Methods: All patients were evaluated according to hemodynamic status: stable or unstable. Secondly, it was distinguished whether patients were suffering from complicated or uncomplicated forms of diverticulitis. Finally, each patient was assigned to a risk class. In this way, we established a therapeutic/diagnostic process for each group of patients. Results: Non-operative treatment (NonOP) was performed in 16 patients, and it was successful in 69% of cases. This protocol primarily considers the patient’s clinical condition and the severity of the disease. It is based on a multidisciplinary approach, in order to implement the most suitable treatment for each patient. In stable patients with uncomplicated diverticulitis or complicated Hinchey grade 1 or 2 diverticulitis, the management is conservative. In all grade 3 and grade 4 forms, patients should undergo urgent surgery. Conclusions: This protocol, which is based on both anatomical damage and the severity of clinical conditions, aims to standardize the choice of the best diagnostic and therapeutic strategy for the patient in order to reduce mortality and morbidity related to this pathology.
Highlights
Diverticular disease is increasingly reported in Western industrialized countries and is primarily located in the left colon
In 2017, a hospital protocol to treat acute colonic diverticulitis was approved by the institutional review board as a hospital-wide protocol and by the board of directors and the chief medical officer at “Azienda Ospedaliero Universitaria-Ospedali Riuniti” in Ancona
On the basis of the new classification proposal from World Society of Emergency Surgery (WSES), the patients who came to our observation were divided according to Table 4 (Table 4; Figure 8)
Summary
Diverticular disease is increasingly reported in Western industrialized countries and is primarily located in the left colon. We present initial results from a small cohort series for a hospital protocol related to the emergency hospitalization decision-making process for acute diverticulitis. We performed a retrospective analysis of 53 patients with acute diverticulitis admitted to the Department of Emergency and Trauma Surgery of the “Azienda Ospedaliero Universiaria-Ospedali. Materials and Methods: All patients were evaluated according to hemodynamic status: stable or unstable It was distinguished whether patients were suffering from complicated or uncomplicated forms of diverticulitis. Results: Non-operative treatment (NonOP) was performed in 16 patients, and it was successful in 69% of cases This protocol primarily considers the patient’s clinical condition and the severity of the disease. It is based on a multidisciplinary approach, in order to implement the most suitable treatment for each patient. Conclusions: This protocol, which is based on both anatomical damage and the severity of clinical conditions, aims to standardize the choice of the best diagnostic and therapeutic strategy for the patient in order to reduce mortality and morbidity related to this pathology
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