title: Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted?
abstract: The primary aim of this study was to define predictors of computed tomography (CT)-guided percutaneous abscess drainage treatment failure in complicated diverticulitis. A 10-year retrospective analysis of inpatients seen in surgical consultation for diverticular abscess management subsequently referred for CT-guided percutaneous drainage (PD) was conducted. The clinical courses of patients undergoing a technically successful PD were categorized into three groups: 1) no colectomy; 2) elective colectomy; and 3) nonelective colectomy. Forty study patients were identified. Thirteen (33%) of the 40 patients required a nonelective colectomy, 20 patients (50%) underwent elective resection, and seven patients (18%) have been managed nonoperatively with no recurrent diverticulitis for a median of 46.8 months (range, 3.2 to 84.3 months). Forward logistic regression identified the presence of immunosuppression or renal insufficiency (creatinine 1.5 mg/dL or greater) as factors independently associated with failure of PD and need for nonelective colectomy. No clinical, laboratory, or radiologic variables were predictive of long-term nonoperative success. Although PD allows for the resolution of intra-abdominal sepsis for most cases of diverticulitis complicated by an abscess, a substantial proportion progress to nonelective colectomy, emphasizing the need for clinical vigilance in follow-up.
authors.affiliation: Division of Colon and Rectal Surgery of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Seth I
authors.initials: SI
authors.lastname: Felder
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Juliane
authors.initials: J
authors.lastname: Lynn
authors.forename: Zuri
authors.initials: Z
authors.lastname: Murrell
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome