title: Failure of Conservative Treatment of Acute Diverticulitis with Extradigestive Air.
abstract: Medical management for perforated diverticulitis without abscess or peritonitis (PDwAP) has a success rate of 40-70%. Identifying patients with a risk of medical treatment failure would improve outcomes. The aim of this study was to identify the risk factors for failure of medical treatment in patients admitted with PDwAP.
  
  
  
  This multicenter retrospective observational study included all consecutive patients admitted for PDwAP and not surgically treated over a 7-year period. Peritonitis classified on the Hinchey scale was excluded. Potential clinical, biological and radiological risk factors for medical treatment failure were collected and compared between the group of patient with a failure of medical treatment (F) and the group in which treatment did not fail. Data were collected at referral.
  
  
  
  Ninety-one patients were included, and 29 had a failure of treatment (31.9%). The median heart rate was different between the two groups (p < 0.001), at approximately 100/min in the F group. A blood level of C-reactive protein (CRP) ≥150 mg/mL was associated with a higher rate of failure (p = 0.021), but it was not confirmed in multivariate analysis. Pneumoperitoneum ≥5 mm and intraperitoneal liquid located in the pouch of Douglas were more likely to be present in the F group (respectively, p = 0.001 and p < 0.001). A multivariate analysis showed independent risk factors as being the highest pneumoperitoneum diameter >5 mm (OR 5.193; p = 0.015) and peritoneal fluid location in the pouch of Douglas (OR 4.103; p = 0.036).
  
  
  
  The severity of sepsis (tachycardia and CRP ≥150 mg/mL) and of imaging signs (pneumoperitoneum ≥5 mm and peritoneal fluid in the pouch of Douglas) were risk factors for medical treatment failure of PDwAP requiring special supervision so as not to lose time in undertaking surgical management.
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.|LUNAM, University of ANGERS, Angers, France.
authors.forename: P A
authors.initials: PA
authors.lastname: Colas
authors.affiliation: Department of Visceral Surgery, University Hospital of Nantes, 1 Rue Alexis Ricordeau, 44000, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Duchalais
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.|LUNAM, University of ANGERS, Angers, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Duplay
authors.affiliation: Department of Visceral Surgery, Hospital of Le Mans, Avenue Rubillard, 72000, Le Mans, France.
authors.forename: V
authors.initials: V
authors.lastname: Serra-Maudet
authors.affiliation: Department of Visceral Surgery, Hospital of Cholet, 1 Rue Marengo, 49325, Cholet Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Kanane
authors.affiliation: Department of Imaging and Diagnosis, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Ridereau-Zins
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.|LUNAM, University of ANGERS, Angers, France.|Laboratory HIFIH, UPRES EA 3859, UFR Sciences Médicales, Rue haute de reculée, 49045, Angers, France.
authors.forename: E
authors.initials: E
authors.lastname: Lermite
authors.affiliation: LUNAM, University of ANGERS, Angers, France.|Laboratory HIFIH, UPRES EA 3859, UFR Sciences Médicales, Rue haute de reculée, 49045, Angers, France.|Department of Imaging and Diagnosis, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Aubé
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.|LUNAM, University of ANGERS, Angers, France.|Laboratory HIFIH, UPRES EA 3859, UFR Sciences Médicales, Rue haute de reculée, 49045, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Hamy
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France. auvenara@yahoo.fr.|LUNAM, University of ANGERS, Angers, France. auvenara@yahoo.fr.|Laboratory HIFIH, UPRES EA 3859, UFR Sciences Médicales, Rue haute de reculée, 49045, Angers, France. auvenara@yahoo.fr.|UMR INSERM U1235-TENS, rue Gaston Veil, Nantes, France. auvenara@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Venara
mesh_terms: D000208:Acute Disease; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D000072700:Conservative Treatment; D004238:Diverticulitis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000628:therapy*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D002097:C-Reactive Protein