title: Hinchey I and II diverticular abscesses: long-term outcome of conservative treatment.
abstract: BACKGROUND
  The management of diverticular disease and its complications are an increasing burden to the health system. The natural history of conservatively managed diverticular abscesses (Hinchey I and II) is poorly described and it remains open to debate whether subsequent sigmoid resection is indicated after conservative management. This observational study compares outcomes of patients treated with conservative management (antibiotics +/- percutaneous drainage) and surgery.
  
  
  METHODS
  All patients admitted at Christchurch Hospital with diverticulitis between 1 January 1998 and 31 December 2009 were recorded in a database. A retrospective analysis of patients with an abscess due to complicated diverticulitis was undertaken. Initial management, recurrence and subsequent surgery were recorded. The patients were followed until 1 January 2014.
  
  
  RESULTS
  Of 1044 patients with diverticulitis, 107 with diverticular abscess were included in this analysis. The median age was 66 ± 16 and 60 were male. All patients had sigmoid diverticulitis and were diagnosed with a computed tomography. The median abscess size was 4.2 ± 2.1 cm. During median follow-up of 110 months, the overall recurrence rate was 20% (21/107). Recurrence varied according to initial treatment; namely antibiotics (30%), percutaneous drainage plus antibiotics (27%) and surgery (5%) (P = 0.004). The median time to recurrence was 4 ± 11.7 months, and most recurrences were treated conservatively; four patients underwent delayed surgery.
  
  
  CONCLUSIONS
  Recurrence after diverticular abscess is higher after initial conservative treatment (antibiotics +/- percutaneous drainage) compared with surgery, however, patients with recurrent disease can be treated conservatively with similar good outcomes and few patients required further surgery.
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Pamela
authors.initials: P
authors.lastname: Buchwald
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Liane
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Wakeman
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Tim W
authors.initials: TW
authors.lastname: Eglinton
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Frizelle
mesh_terms: D018784:Abdominal Abscess / Q000150:complications* / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D012809:Colon, Sigmoid / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000072700:Conservative Treatment / Q000009:adverse effects / Q000379:methods; D000076385:Diverticular Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: Hinchey; antibiotics; diverticular abscess; diverticulitis; percutaneous drainage