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Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan.
Surg Endosc. 2006 Jul; 20(7):1129-33.SE

Abstract

BACKGROUND

Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis.

METHODS

The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed.

RESULTS

A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality.

CONCLUSION

Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The current results demonstrate that percutaneous abscess drainage is an effective initial therapeutic approach for patients with Hinchey II diverticulitis, and that emergency surgery should be avoided whenever possible.

Authors+Show Affiliations

Department of Surgery, University Hospital Geneva, Rue Micheli-du-Crest 24, 1211, Genève, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16755351

Citation

Durmishi, Y, et al. "Results From Percutaneous Drainage of Hinchey Stage II Diverticulitis Guided By Computed Tomography Scan." Surgical Endoscopy, vol. 20, no. 7, 2006, pp. 1129-33.
Durmishi Y, Gervaz P, Brandt D, et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surg Endosc. 2006;20(7):1129-33.
Durmishi, Y., Gervaz, P., Brandt, D., Bucher, P., Platon, A., Morel, P., & Poletti, P. A. (2006). Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surgical Endoscopy, 20(7), 1129-33.
Durmishi Y, et al. Results From Percutaneous Drainage of Hinchey Stage II Diverticulitis Guided By Computed Tomography Scan. Surg Endosc. 2006;20(7):1129-33. PubMed PMID: 16755351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. AU - Durmishi,Y, AU - Gervaz,P, AU - Brandt,D, AU - Bucher,P, AU - Platon,A, AU - Morel,P, AU - Poletti,P A, Y1 - 2006/06/03/ PY - 2005/08/19/received PY - 2006/02/15/accepted PY - 2006/6/7/pubmed PY - 2006/8/11/medline PY - 2006/6/7/entrez SP - 1129 EP - 33 JF - Surgical endoscopy JO - Surg Endosc VL - 20 IS - 7 N2 - BACKGROUND: Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis. METHODS: The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed. RESULTS: A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality. CONCLUSION: Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The current results demonstrate that percutaneous abscess drainage is an effective initial therapeutic approach for patients with Hinchey II diverticulitis, and that emergency surgery should be avoided whenever possible. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/16755351/Results_from_percutaneous_drainage_of_Hinchey_stage_II_diverticulitis_guided_by_computed_tomography_scan_ DB - PRIME DP - Unbound Medicine ER -