title: Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients.
abstract: BACKGROUND
  The optimal treatment for diverticulitis with extraluminal air is controversial.
  
  
  OBJECTIVE
  The purpose of this research was to evaluate the safety and effectiveness of nonoperative treatment of acute diverticulitis with extraluminal air.
  
  
  METHODS
  This was a retrospective cohort.
  
  
  METHODS
  The study was conducted at an academic teaching hospital functioning as both a tertiary and secondary care referral center.
  
  
  METHODS
  All of the patients with CT-diagnosed acute perforated diverticulitis with extraluminal air from 2006 through 2010 were included in this study.
  
  
  METHODS
  Nonoperative treatment composed of intravenous antibiotics, bowel rest, and percutaneous drainage were the included interventions.
  
  
  METHODS
  The need for operative management and mortality were measured.
  
  
  RESULTS
  A total of 132 patients underwent nonoperative treatment, whereas 48 patients were primarily operated on. Patients treated nonoperatively were divided into 3 groups on the basis of identified factors that independently predicted risk for failure: 1) patients with pericolic air (n = 82) without abscess had a 99% success rate with 0% mortality. 2) Patients with distant intraperitoneal air (n = 29) had a 62% success ratewith 0% mortality. Abundant distant intraperitoneal air and fluid in the fossa Douglas were identified as risk factors for failure. Patients without these risk factors had an 86% success rate with nonoperative management. 3) Patients with distant retroperitoneal air (n = 14) had a 43% success rate with 7% mortality.
  
  
  CONCLUSIONS
  Comparison of nonoperative versus operative treatment cannot be made because of the study's retrospective nature.
  
  
  CONCLUSIONS
  Nonoperative treatment of acute diverticulitis with extraluminal air is safe and effective in patients with a small amount of distant intraperitoneal air or pericolic air without clinical signs of peritonitis.
authors.affiliation: Department of Abdominal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ville J
authors.initials: VJ
authors.lastname: Sallinen
authors.forename: Panu J
authors.initials: PJ
authors.lastname: Mentula
authors.forename: Ari K
authors.initials: AK
authors.lastname: Leppäniemi
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004239:Diverticulitis, Colonic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004322:Drainage; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002444:Cefuroxime