EP-306 Management of acute sigmoid diverticulitis in a district general hospital – a retrospective audit

Abstract

Abstract Aim Acute sigmoid diverticulitis is one of the most common emergency general surgery conditions. Guidelines from the European Society of Coloproctology published in 2020 outline best practice in management, including a move away from routine antibiotic therapy. This audit aims to assess compliance with these guidelines. Methods Electronic records of all patients admitted under the emergency general surgery team with acute sigmoid diverticulitis in 2021 were analysed to obtain information on management. These data were compared against the 2020 guidelines to assess compliance. Results 99 patients were admitted with acute sigmoid diverticulitis in 2021. 97% of patients underwent an abdominal CT scan and 100% received IV antibiotics. 65% of cases were classified as uncomplicated and 35% were classified as complicated (i.e. abscess formation or perforation). The mean length of stay for all patients was 5.7 days. The length of stay for patients with uncomplicated diverticulitis was 3.7 days compared to 9.3 days for complicated diverticulitis. 10% of patients underwent surgical intervention and no patients underwent radiological intervention. Only 57% of patients were referred for an outpatient lower GI endoscopy. Conclusion These results raise three main insights for further consideration. Firstly, it appears that the evidence against routine antibiotic therapy for acute diverticulitis is not yet being reflected in clinical practice. Secondly, patients admitted with uncomplicated diverticulitis have a relatively short length of stay, indicating a role for ambulatory management of this common condition. Lastly, referral rates for outpatient endoscopy must be improved to ensure that patients with an underlying malignant lesion can be identified.