[Safety and efficiency of ambulatory treatment of acute diverticulitis].
BACKGROUND
The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management.


OBJECTIVE
To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients.


METHODS
We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month.


RESULTS
The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery.


CONCLUSIONS
In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs.
Martín Gil
Jorge
J
Servicio de Cirugía General y del Aparato digestivo II, Sección de Cirugía de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España. jorgemartingil1@hotmail.com
Serralta De Colsa
Daniel
D
García Marín
Andrés
A
Vaquero Rodríguez
Alberto
A
Rey Valcárcel
Cristina
C
Pérez Díaz
María Dolores
MD
Sanz Sánchez
Mercedes
M
Turégano Fuentes
Fernando
F
D015746:Abdominal Pain / Q000209:etiology; D000038:Abscess / Q000209:etiology; D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis; D003131:Combined Modality Therapy; D004238:Diverticulitis / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy* / Q000191:economics; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002939:Ciprofloxacin