Diverticulitis recurrence after percutaneous abscess drainage.

Abstract

Recurrent diverticulitis has been reported in 30-50% of patients who recover from an episode of diverticular-associated abscess. Our aim was to review the outcomes of patients who underwent non-operative management after percutaneous drainage (PD) of colonic diverticular abscess. All patients with a diverticular-associated abscess were identified between 2001 and 2012. Individual charts were queried for peri-procedural data and follow-up. The most recent follow-up data were acquired via the electronic medical record or telephone call. A total of 165 patients underwent PD of diverticular-associated abscesses. Abscess locations were pelvic (n=122), abdominal (n=36), and both (n=7), while median abscess size was 6.1±2.2cm. One hundred eighteen patients clinically improved following non-operative management, and 81 of these patients did not undergo subsequent colonic resection within 4months of PD. Of these, 8 died within 12months. Among the remaining 73 patients, there were no significant differences in demographics or abscess variables compared to those who underwent elective surgery within 4months. Only 7 of 73 patients had documented episodes of recurrences, while 22 patients later had elective surgery (1.1±1.2years from the index case). Five-year colectomy-free survival was 55% (95%CI 42-66%), while the recurrence-free survival at 5years was 77% (95%CI 65-86%). All recurrences were managed non-operatively initially and one patient went on to have elective resection. A sizable number of patients successfully recover from complicated diverticulitis following PD. Subsequent non-operative management carries an acceptable risk for recurrent episodes and may be considered as a reasonable management option.