Hinchey I and II diverticular abscesses: long‐term outcome of conservative treatment

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Sigmoid diverticulosis is increasingly common in countries with a Western diet and increases with age, obesity and inactivity.1 It is uncertain how many individuals with diverticulosis will develop diverticulitis, however, given how endemic diverticulosis is, it is likely to be low despite some estimates putting it as high as 25%.1 A total of 10–25% of patients with diverticulitis will evolve into complicated disease defined by perforation, abscess formation, stenosis, fistulas or obstruction.
Perforated diverticulitis with pericolic or mesocolic abscess (Hinchey I and II) was traditionally managed with surgery, however, over recent decades, the treatment has changed to a more conservative approach.4 Improved abdominal imaging has allowed successful treatment using antibiotics with or without percutaneous drainage in many cases, thereby avoiding the morbidity and mortality of surgery as well as the and high chance of stoma associated with acute surgery. Despite this, a number of issues related to the conservative management of diverticular abscess require further clarification. Some guidelines suggest that percutaneous drainage should be used in addition to antibiotics for abscesses 5 cm or greater, although this threshold remains open to debate. In addition, studies have suggested a higher recurrence rate for pelvic abscesses treated with percutaneous drainage rather than surgery.5 Furthermore, if initial conservative management is successful, the need for elective sigmoid resection to prevent further recurrence is uncertain.
The aim of the present retrospective study is to compare recurrence rates and risk factors in patients with diverticular abscesses (Hinchey I and II) treated with antibiotics, percutaneous intervention or surgery.
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