title: A national evaluation of the management practices of acute diverticulitis.
abstract: BACKGROUND
  Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases.
  
  
  METHODS
  A national survey of all consultant surgeons evaluating their practices was performed. Reasons for changes in management, use of radiological imaging, role of non-antibiotic treatment approaches and indications for elective surgical management were evaluated.
  
  
  RESULTS
  Response rate for this survey was 67.7% (n = 67/99). An overwhelming 92.5% stated that computed tomography imaging was routinely used to investigate acute presentations. Interestingly, 22.4% stated they would consider a non-antibiotic treatment approach in uncomplicated diverticulitis. Main reasons for adopting this approach was low inflammatory markers with short duration of symptoms. Co-amoxiclav was the most common antibiotic used for acute diverticulitis, with considerable variability in duration of treatment. Additionally, there was considerable heterogeneity regarding how many recurrences were necessary before surgical management was required.
  
  
  CONCLUSIONS
  This review highlights substantial variation in the management of diverticulitis across Ireland. Shifts to non-antibiotic treatment approaches for uncomplicated cases are observed, but less so than in Northern Europe. National guidelines are required to establish uniform treatment protocols including indications for surgical resection.
authors.affiliation: School of Medicine, Royal College of Surgeons, Dublin, Ireland.
authors.forename: D Z
authors.initials: DZ
authors.lastname: Khan
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland. Electronic address: kellym11@tcd.ie.
authors.forename: M E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: O'Reilly
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland.
authors.forename: W
authors.initials: W
authors.lastname: Khan
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Waldron
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland; Discipline of Surgery, National University of Ireland, Galway, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Barry
authors.affiliation: Dept. of Surgery, Mayo General Hospital, Saolta University Hospital Group, Ireland.
authors.forename: I Z
authors.initials: IZ
authors.lastname: Khan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000072700:Conservative Treatment / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004238:Diverticulitis / Q000175:diagnosis / Q000628:therapy*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobials; Conservative treatment; Diverticulitis; Surgical management