EP419 - Management of acute diverticulitis in ESAU according to WSES guidelines.And it’s predisposing factors in regard to the local Trust experience

Abstract

Abstract Introduction In 2015, WSES established a framework to approach management of acute left sided colonic diverticulitis. Lifetime incidence to develop acute inflammation on top of diverticulosis is 4%. Aim of the study: Investigate how adherent the local colorectal department to WSES guidelines and to look at possible factors contributing to acute flare ups. Patients and Methods Over 6 months, 63 patients presented to ESAU with clinical and laboratory signs, indicating intra-abdominal sepsis. CTAP was utilised to diagnose acute diverticulitis and its complications. Results The Vast majority were females (50) with 34 patients above 60 and only 3 were under 40 years old.22.5% had NEWS > 2 and 11% had a temperature spike >38.Quarter of the cases had a CRP >150. CT scan proved acute uncomplicated diverticulitis in 28 patients, but diagnosed Hinchey 1(8%),2(28%),3 & 4 (20%).2 cases had associated stricture, one of which proved to be malignant (1.5%).84% were managed with IV antibiotics (according to the local Trust),10% had emergency laparotomy and 6% were treated by IR-drainage. 28 patients were treated successfully and discharged with 48 hours, 10 cases had a prolonged recovery over 10 days.2 cases were deceased (3%). Interval colonoscopy (8-12 weeks) was not done in one-third of the cases. On other hand, 60% were smokers, and two thirds had significant comorbidities; cardiovascular (42%), pulmonary (20%), CKD3(20%), DM (15%), Bowel pathology (7%).27% had multiple comorbidities and 12% were known to have diverticulosis. Conclusion Although the firm is adherent to WSES guidelines, interval colonoscopy service should be improved. Age, Smoking, Cardiovascular, Diabetes and pulmonary diseases are predisposing factors for acute diverticulitis. Risk of inflammation and severity in multiple coexisting morbidities.