Diverticular Abscess Research Articles

Outcomes after CT guided drainage of diverticular abscesses and predictive factors for fistulous communication to the colon

BackgroundThe purpose of the study is to analyze patient outcomes following CT guided drainage of colonic diverticular abscesses and identify the factors associated with development of fistulous communication to the drain. MethodsAll patients undergoing CT guided abscess drainage, from 2009 to 2017, were included in this single institutional study. Clinical and demographic variables associated with development of colonic fistula were investigated. ResultsOne–hundred-and-five patients (55% female), mean abscess size and BMI of 6.3 cm and 30.28 kg/m2, respectively, underwent CT guided abscess drainage. Patients with fistula had longer operative times (p = 0.03). On multivariable analysis, females (p = 0.02) and higher BMI (p = 0.01) were protective against, while increasing size (p = 0.01) was predictive of developing fistulous communication to the drain. ConclusionMore than half of patients developed colonic fistula after CT guided drainage. Male sex, lower BMI and increasing abscess size were predictive of developing colonic fistula.

S3381 Diverticular Abscess Growing Clostridium difficile; Is Oral Vancomycin Adequate Monotherapy?

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) estimates almost half a million illnesses in the United States each year due to Clostridium difficile infection (CDI).1 Colonic diverticulitis may share several clinical features with CDI with up to 200,000 inpatient admissions at a cost of more than $2 billion per year in the United States.2 Up to 5% of healthy adults and more in children may harbor Clostridium difficile among their normal intestinal flora without developing CDI. Moreover, 50% asymptomatic patients in long term care facilities are carriers of C. diff. In a disease process that involves intestinal perforation or micro-perforation such as diverticulitis, some of the intestinal flora become pathogenic organisms of intra-abdominal abscesses. CASE DESCRIPTION/METHODS: We report an uncommon case of diverticulitis of the sigmoid colon with complicating diverticular abscess in an 86-year-old Caucasian immune-compromised male with history of multiple myeloma, coronary artery disease, ischemic cardiomyopathy, hypertension, and atrial fibrillation (Figure 1). Abscess drainage cultures grew Clostridium difficile and Enterococcus faecium. Initial antimicrobial therapy with piperacillin-tazobactam had to be adjusted to metronidazole, and daptomycin. The patient recovered well with no further development or recurrence of CDI. DISCUSSION: For Clostridium difficile diverticular abscess, oral vancomycin monotherapy may not be adequate given its luminal activity and poor systemic absorption.3Figure 1.: CT scan of the abdomen without contrast revealing early abscess formation (yellow arrow) measuring 2.6 × 2.0 cm adjacent to the large bowel. No fistulous tract to the skin was identified.

S1807 Diverticular Abscess Causing Bowel Obstruction

INTRODUCTION: Emergency room visits for acute diverticulitis have increased 21% in the last few years. Although most of them are uncomplicated, an estimated 15% of all cases present with acute abdomen resulting in emergent surgery. The most common cause of complicated diverticulitis is bowel perforation which is usually diagnosed via computerized tomography (CT). A rare but more severe complication can include complete colonic obstruction secondary to diverticular abscess formation. CASE DESCRIPTION/METHODS: A 59 year-old female with a past medical history of recurrent diverticulitis presented with a three-day history of diffuse abdominal pain and distention associated with non-bloody emesis and non-bloody diarrhea. Her last diverticulitis flare was one year prior to presentation and resolved with antibiotics and supportive management. The patient denied prior colonoscopy and first-degree family members with colon cancer. On arrival, patient was afebrile and hemodynamically stable. Abdominal physical exam demonstrated a distended abdomen and diffuse tenderness along with decreased bowel sounds. Laboratory tests showed mild leukocytosis but were otherwise unremarkable. CT of the abdomen and pelvis with contrast demonstrated a 3 × 5 cm irregular mass at the junction of the descending colon and sigmoid colon suspicious for a malignant neoplasm along with colonic obstruction and sigmoid diverticulosis without fat stranding. Exploratory laparotomy found complete obstruction of the long segment of the thickened colon from which biopsies were obtained and she underwent left hemicolectomy with end-to-end anastomosis. Biopsy results showed diverticulitis with abscess, which was the etiology of the large bowel obstruction. The patient was placed on antibiotics and was discharged once she was able to have a bowel movement. DISCUSSION: Patients with known diverticulosis have a 10–25% chance of developing diverticulitis. Mortality from diverticular abscess is as high as 32% and can occur in remote areas via hematogenous spread of microorganisms through colonic mucosal defects. Severe bowel obstruction as with our patient, is rarer than partial obstruction which occurs due to wall edema and peripheral inflammation. Exploratory laparotomy is necessary and biopsy is crucial to definitively exclude colon cancer as CT imaging findings cannot solely include or exclude malignancy. It is important to evaluate for diverticular abscess in a patient with a history of diverticulitis in the setting of complete bowel obstruction.Figure 1.: 3 × 5cm Irregular mass seen at the junction of the Descending Colon and Sigmoid Colon.Figure 2.: Obstructing mass at the junction of the Sigmoid and Descending Colon.

S1820 Diverticulitis in the Time of COVID-19: Acute Diverticulitis Complicated by Colo-Colonic Fistula

INTRODUCTION: Colo-colonic fistula is a rare complication of diverticulitis. We present a case of acute diverticulitis with delayed presentation due to COVID 19, complicated by diverticular abscess and colo-colonic fistula in the setting of delayed treatment with oral antibiotics. CASE DESCRIPTION/METHODS: An 82 year old male presented with a 3 week history of diffuse abdominal pain, fever, nausea, anorexia and 12 lbs weight loss. He reported narrow stools without hematochezia. There were no other symptoms or prior episodes. Diverticulosis was present on his colonoscopy 5 years earlier. On examination his abdomen was mildly tender throughout without guarding or rebound. Stool was guaiac negative. Lab work revealed WBC of 19 K/uL, and a microcytic anemia with Hb 10.6 g/dL. Computed tomography (CT) revealed sigmoid diverticulitis with extraluminal air loculations and a 3 cm pericolonic abscess. Because of the Coronavirus pandemic, the patient requested outpatient therapy and was started on oral Ciprofloxacin and Metronidazole. He was followed weekly via telehealth with improvement in symptoms except for mild intermittent abdominal pain. Follow up CT revealed fistulization of the previously noted abscess to distal sigmoid colon, producing an inverted U-shaped fistulous tract from proximal to distal sigmoid. Labs revealed resolving leukocytosis and stable anemia. He completed 4 weeks of oral antibiotics and declined surgery. DISCUSSION: The Coronavirus pandemic has overt direct health consequences, as well as secondary and tertiary consequences. Our patient presented, after a 3 week interval without treatment, with localized sepsis and a 3 cm abscess. This would normally be treated with parenteral antibiotics and possibly percutaneous drainage or surgical intervention. Due to concerns regarding Coronavirus exposure in the hospital, he opted for treatment with oral antibiotics alone after a delayed presentation. Consequently, the abscess decompressed into a distal segment of sigmoid colon, producing a colo-colonic fistula. Colo-colonic fistulae are a rare complication of diverticulitis compared to colo-vesical, colo-vaginal, colo-enteric and colo-cutaneous types. Literature on colo-colonic fistulae is sparse in the past 50 years, perhaps because antibiotic therapy is often begun at the onset of symptoms. This case demonstrates an uncommon complication of a common condition which may not have occurred if not for the Coronavirus pandemic.Figure 1.: Sagittal CT showing U shaped fistula of sigmoid colon.

S1644 Mesh Migration Mimicking a Diverticular Abscess: A Rare Complication of Hernia Repair

INTRODUCTION: Inguinal herniorrhaphy with mesh is one of the most common surgical procedures done around the world. A rare complication of mesh repair is the migration of the mesh into adjacent abdominal structures, leading to fistulae and subsequently a diverse set of symptoms. We present a case of mesh erosion into the sigmoid colon presenting as an abdominal abscess. CASE DESCRIPTION/METHODS: A 62 year-old male with history of previous inguinal repairs (right and left elective hernia repairs were twenty and two years ago, respectively, without bowel resection or complications) presented with sharp and intermittent left lower quadrant abdominal pain near his left groin for three to four days. He did not appear in extremis; vital signs were within normal limits and a comprehensive metabolic panel and complete blood count were unremarkable. CT of the abdomen and pelvis suggested a left anterior pelvic abscess. A clinical diagnosis of a diverticular abscess was made, though no underlying diverticulosis was identified on imaging and the patient had not had a prior colonoscopy. The patient was administered intravenous piperacillin-tazobactam, transitioned to oral antibiotics, and discharged after an unremarkable hospital course, with plan for outpatient colonoscopy to rule out malignancy as an etiology for his diverticulitis. On outpatient colonoscopy, patient was noted to have mesh extruding into the sigmoid colon without adjacent mucosal inflammation. He had a repeat CTAP, which demonstrated a contained left pelvic wall/abdominal wall abscess communicating with the sigmoid colon. Colorectal surgery was consulted and the patient ultimately underwent an open sigmoidectomy and mesh explanation with repair of the left inguinal hernia with Viceryl mesh. DISCUSSION: Mesh migration into adjacent abdominal viscera is a rare complication that can present early to many years after the procedure. These can manifest in a variety of presentations, from mild abdominal pain to life threatening conditions, such as bowel obstruction, peritonitis, and as in our case, a colonic fistula which was presumed to be a diverticular abscess, with actual etiology only detected on colonoscopy done to rule out underlying malignancy. Early recognition is important to avoid superimposed infection, fibrosis, and further complications, as well as to lead to appropriate management, which is often surgical repair. This case highlights the importance of recognizing mesh erosion in patients with abdominal pain with history of hernia repair.Table 1.: Initial basic metabolic panel and complete blood count labs were unremarkable, as notedFigure 1.: The patient had a repeat CT Abdomen/Pelvic with contrast, which demonstrated a contained left pelvic-abdominal wall abscess communicating with the sigmoid colon (arrow).Figure 2.: On outpatient colonoscopy, patient was noted to have a foreign body, consistent with mesh extruding into the sigmoid colon without adjacent mucosal inflammation. No diverticulosis was seen.

S1672 A Case Description of Clostridium Glycolicum and Clostridium Paraputrificum Bacteremia From Complicated Diverticulitis

INTRODUCTION: Clostridium species are anaerobic gram-positive bacilli that can cause a broad range of invasive infections in humans, including bacteremia and intra-abdominal infections. Clostridium glycolicum and Clostridium paraputrificum in particular are infrequent isolates in bacteremia with incidence less than 1%. We describe a rare case of Clostridium paraputrificum and Clostridium glycolicum bacteremia resulting in septic shock secondary to a diverticular abscess. CASE DESCRIPTION/METHODS: A 66-year-old female was admitted with high fevers and seizure like activity. She had a history of Non-Hodgkin’s Lymphoma and breast cancer both of which were confirmed to be in remission. Prior to presentation, her husband had noticed the patient acting unusual and staring to the left with a fixed gaze. On arrival to the ER, she had a rectal temperature of 106.5F and needed vasopressor support. A computer tomography (CT) of the head showed no acute abnormalities and multiple lumbar punctures attempted were unsuccessful. She was empirically treated with levetiracetam/fosphenytoin for possible seizures and vancomycin/meropenem/metronidazole for sepsis. CT of the chest, abdomen and pelvis showed sigmoid diverticulitis with an adjacent small foci of gas which may have been a micro-perforation without fluid collections or pneumoperitoneum. Multiple blood cultures grew Clostridium glycolicum and Clostridium paraputrificum. Subsequent CT of abdomen and pelvis demonstrated a sigmoid diverticulitis with an adjacent abscess measuring 2.4 × 1.3 cm (Figure 1). She was treated with ceftriaxone and metronidazole for 3 weeks given her allergies to penicillin and ciprofloxacin. The patient is planned to have follow up imaging to check for resolution of the abscess. DISCUSSION: Presumably, the source of our patient's Clostridium bacteremia was the complicated diverticulitis given the imaging findings. Most species of Clostridium are considered to be harmless soil saprophytes but there are a few case reports of these strains causing bacteremia. Clostridium bacteremia in humans is usually caused by dissemination of gut colonizing strains due to disturbed host defenses locally or systemically. In our case, sigmoid diverticulitis could be considered a pre-disposing factor but given her past history she will need an outpatient work-up rule out malignancy. This case should heighten the awareness of these particular clostridium species as a clinically important organism and every effort should be made to investigate them further.Figure 1.: Transverse view of a computer tomography of the abdominal/pelvis showing an 2.4 × 1.3 cm abscess (blue arrow) on the anterior wall of the sigmoid colon with reactive thickening of the adjacent urinary bladder wall without evidence of a fistula.

Elective surgery should be considered after successful conservative treatment of recurrent diverticular abscesses

Purpose: The purpose of this study was to evaluate the disease pattern and treatment of diverticular abscesses.Methods: Patients treated for diverticulitis (K57) in Västmanland, Sweden were identified for this retrospective population-based study between January 2010 and December 2014. Patients with diverticular abscesses were included. The clinical and radiological data were extracted, and the computed tomography scans were reevaluated.Results: Of the 75 patients (45 women) with a median age of 62 years (range: 23–88 years), abscesses were localized pericolic in 42 patients (59%) and in the pelvis in 33 patients (41%). The median abscess size was 4.8 cm (range: 1.1–11.0 cm). Six patients (8%) required urgent surgical intervention during the index admission. The median follow-up time was 58 months (range: 0–95 months). During follow-up, 40 patients (58%) had disease recurrence and 35 of these patients (88%) presented with complicated diverticulitis. The median time until re-admission was 2 months (range: 3 days–94 months). Patients with pelvic abscesses developed fistulas more frequently, 3 versus 11 patients (p = .003). Twenty-three percent of patients with pericolic abscesses required surgery compared with 40% of patients with pelvic abscesses (p = .09). No patients had a recurrence of abscesses after a colonic resection.Conclusion: The majority of patients with diverticular abscesses had recurrences with repeated admissions regardless of abscess location. An unexpectedly high proportion of patients required surgical intervention during the follow-up period. A liberal approach regarding elective surgery for patients with recurrent diverticulitis abscesses who tolerate surgery seems justified.

3225 A Rare Case of Ruptured Jejunal Diverticulitis

INTRODUCTION: Small intestinal diverticula are very rare, and the incidence ranges from 0.06 to 1.3%. Among these, duodenal diverticula are more frequent in 79% of patients followed by 18% in jejunum or ileum and 3% in all segments together. A jejunal diverticulum is usually asymptomatic, but only 10% develop complications. We report a unique case of a 70-year old female who presented with confusion, likely due to sepsis from perforated jejunal diverticulitis, that was successfully managed with initial resuscitation and definitive surgery. CASE DESCRIPTION/METHODS: A 76-year old female presented to the emergency room with confusion and epigastric pain for two days prior to presentation. Vital signs were stable. Physical examination was positive for mild epigastric tenderness. Laboratory results were normal except for leukocytosis of 15000, with left shift. Plain radiograph of the abdomen was negative for obstruction or perforation. Computed Tomography (CT) of the abdomen with oral and intravenous contrast showed the loop of thickened and edematous mid-jejunum and intraperitoneal free air consistent with perforated small bowel diverticulitis with abscess formation (Figure 1). She was initially resuscitated with intravenous fluids and was started on intravenous antibiotics. She underwent diagnostic laparoscopy with small bowel resection, primary anastomosis, drainage of the diverticular abscess. Pathology of resected jejunum was positive for diverticular disease with perforation. She did well postoperatively, tolerated diet, and discharged to home without any complications. DISCUSSION: Jejunal diverticula are usually multiple localized in proximal jejunum, develops as a result of herniation of mucosa, submucosa, serosa through muscular layer of bowel at the point of where vasa recta enter the muscular propria. Jejunal diverticulosis usually asymptomatic, only 10% develop complications. Perforation of jejunal diverticula is a severe complication that occurs in 2-6% of cases. A plain radiograph is the initial testing, but CT or Magnetic Resonance Imaging (MRI) is a gold standard for diagnosis. Acute uncomplicated jejunal diverticulitis is managed with intravenous fluids, bowel rest, and antibiotics. Acute Complicated diverticulitis needs surgical intervention such as laparotomy with segmental small bowel resection with primary anastomosis. Jejunal diverticulitis requires a high degree of clinical suspicion given the low incidence of the condition and increase in mortality after surgery up to 24%.

EP28.22: A case of diverticular abscess of sigmoid colon in a pregnant woman: a case report

EP28.22: A case of diverticular abscess of sigmoid colon in a pregnant woman: a case report

Determinants of treatment and outcomes of diverticular abscesses

BackgroundDiverticular abscess diameter of 3–6 cm is generally accepted as a cutoff determining whether percutaneous drainage is recommended in addition to antibiotics, but this is not based on high-quality evidence. The aim of this study was to analyze the treatment choices and outcomes of patients with diverticular abscesses.MethodsThis was a retrospective cohort study conducted in an academic teaching hospital functioning as a secondary and tertiary referral center. Altogether, 241 patients with computer tomography-verified acute left-sided colonic diverticulitis with intra-abdominal abscess were collected from a database containing all patients treated for colonic diverticulitis in our institution during 2006–2013. The main measured outcomes were need of emergency surgery and 30-day mortality, and these were compared between antibiotics only and percutaneous drainage groups. Treatment choices, including surgery, were also analyzed for all patients.ResultsAbscesses under 40 mm were mostly treated with antibiotics alone with a high success rate (93 out of 107, 87%). In abscesses over 40 mm, the use of emergency surgery increased and the use of antibiotics alone decreased with increasing abscess size, but the proportion of successful drainage remained at 13–18% regardless of the abscess size. There were no differences in failure rate, 30-day mortality, the need of emergency surgery, permanent stoma, recurrence, or length of stay in patients treated with percutaneous drainage vs. antibiotics alone, even when groups were adjusted for potential confounders.ConclusionsPercutaneous drainage as a treatment for large abscess does not seem to be superior to the treatment with only antibiotics.

An acute abdomen packed full of surprises: a case report

“Acute abdomen” is a clinical diagnosis which defines the emergent nature of the condition, rather than the condition itself, and the true diagnosis is often only made after laparotomy or laparoscopy. On occasion, the final diagnosis is drastically different from what was clinically suspected. Diseases such as diverticulosis can have multiple possible pathological outcomes as a consequence of their inflammatory nature, such as stricture formation, adhesions, acute diverticulitis, diverticular abscess, perforation and even malignant transformation. Usually one of these complications will be the presenting factor with rarely another complication discovered during management, which may or may not have been symptomatic. Extremely rarely, will multiple pathological outcomes of a condition be present together. Here we report the case of a male patient who underwent laparotomy for a suspected hollow viscus perforation, with the resulting findings a bewildering surprise.

Diagnosis and Management of Acute Diverticulitis

Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed. This review contains 10 figures, 3 tables, and 67 references. keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis

Multicentre study of non-surgical management of diverticulitis with abscess formation.

This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5 cm in size were at higher risk of short-term treatment failure and emergency surgery respectively. Initial non-surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combination with antibiotics, with regard to short- and long-term outcomes. Most do not need drainage.

Septiceamia and pre term labour due to severe diverticular abscess in pregnancy.

Septiceamia and pre term labour due to severe diverticular abscess in pregnancy.

Percutaneous drainage of diverticular abscess

Percutaneous drainage of diverticular abscess

Long-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study.

The study aimed to investigate long-term mortality, recurrence, and death related to recurrence for patients admitted with acute diverticulitis with abscess formation (Hinchey stage Ib-II). The cohort was identified by linking administrative registers for all Danish citizens in years 2000-2012. Patients were identified from ICD-10 discharge codes and stratified according to treatment (antibiotics, percutaneous abscess drainage, or surgery). From 6,641,672 persons, 3148 patients were identified with acute diverticulitis with abscess formation. Survival was comparable between treatment groups with a 1-year survival of 81-83% and a 5-year survival of 66-67% (p = 0.66). Glucocorticoid usage prior to admission increased risk of mortality with hazard ratio 1.64 (95%CI 1.39-1.93), 1.77 (1.20-2.63), and 1.92 (1.07-3.44) for the antibiotics, drainage, and operative treatment group, respectively. Drainage treatment increased risk of recurrence with sub-distribution hazard (SDH) of 1.52 (1.19-1.95) and operative treatment decreased risk with a SDH of 0.55 (0.32-0.93), both compared with antibiotic treatment (p = 0.0001). Recurrence occurred in 23.6% (18.5-30.1%) of patients in the drainage group, 15.5% (13.9-17.3%) in the antibiotics group, and 9.1% (5.1-16.1%) in the operative group. Recurrence-related mortality was 2.0% (0.9-4.4%) for the drainage group, 1.1% (0.7-1.8%) for the antibiotics group, and 0.6% (0.1-4.3%) for the operative group (p = 0.24). Most recurrences and recurrence-related mortality occurred within the first year after primary admission. This study with complete national data revealed a high mortality and recurrence rate after diverticular abscesses. Survival was comparable between treatment groups, but patients treated with drainage had significantly higher risk of recurrence.

Mucinous Adenocarcinoma Arising within a Colonic Diverticulum Mimicking a Diverticular Abscess: A Case Report

Mucinous Adenocarcinoma Arising within a Colonic Diverticulum Mimicking a Diverticular Abscess: A Case Report

Diverticulitis recurrence after percutaneous abscess drainage.

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.

Diverticulitis Diagnosed in the Emergency Room: Is It Safe to Discharge Home?

Inpatient treatment of patients with colon diverticulitis represents a significant financial and clinical burden to the health care system and patients. The aim of this study was to compare patients with diverticulitis in the emergency department (ED), who were discharged to home vs admitted to the hospital. We reviewed all patients evaluated in the ED of a metropolitan health system, with the primary diagnosis of diverticulitis (ICD-9 562.11), from 2010 through 2012. Only patients diagnosed with CT and those with follow-up were included. We identified 240 patients; 132 (55%) were women and mean age was 59.1 years (SD 16.1 years). Imaging findings included extraluminal air (21%), pericolic or pelvic abscess (12%), free fluid (16%), and pneumoperitoneum (6%). One hundred forty-four (60%) were admitted to the hospital and 96 (40%) were discharged to home on oral antibiotics. Patients admitted to the hospital were more likely to be older than 65 years (p= 0.0007), have a Charlson comorbidity score ≥ 2 (p= 0.0025), to be on steroids or immunosuppression (p= 0.0019), and have extraluminal air (p < 0.0001) or diverticular abscess (p < 0.0001) on imaging. Median follow-up for all patients was 36.5 months (interquartile range 25.2 to 43 months). Among patients discharged from the ED, 12.5% returned to the ED or were readmitted within 30 days, with only 1 patient (1%) requiring emergency surgery, but not until 20 months later. Patients admitted to the hospital had similar rates of readmission (15%; p= 0.65). Patients diagnosed with uncomplicated diverticulitis in the emergency room can be safely discharged home on oral antibiotics, as long as CT findings are included in the decision-making process. Patients with complicated diverticulitis on CT scan should be admitted to the hospital with surgical consultation.

PERCUTANEOUS DRAINAGE : AN EFFECTIVE AND LESS AGRESSIVE APPROACH FOR COMPLICATED DIVERTICULAR ABSCESS

Retroperitoneal abscess is a serious complication of diverticular disease. Its management involves several options, ranging from conservative management to surgery. Elective colectomy is most often thought to be mandatory after a percutaneous drainage given the high rate of recidive. However, in patients with high risk for surgery, percutaneous drainage is often the main therapeutic alternative. We report a case of a 80-year-old woman, who was diagnosed to have a retroperitoneal abscess complicating a sigmoid diverticulitis. Ultrasound-guided percutaneous drainage allowed to drain 1500cc of pus and gas. The cytobacteriological examination was positive for: Streptococcus spp and Alkalescens dispar. The therapeutic outcomes were uneventful and despite we did not realize a colectomy because the patient was at high risk for surgery, there was no recidive after a 2-year-follow-up period. Percutaneous drainage can be a therapeutic alternative in patients with high risk for surgery in diverticular abscess of big size.