Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 598 - файл
.pdf
33 Are Antibiotics Needed fortheManagement ofUncomplicated Diverticulitis?
https://t.me/medicina_free
ropeptides and low grade inammation. Neurogastroenterol Motil 2012 Apr;24(4):318-e163.
https://doi.org/10.1111/j.1365- 2982.2011.01863.x. Epub 2012 Jan 25. PMID: 22276853.
6. Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R, Picchio M, Giorgio
F, Ierardi E.Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity. Color Dis 2012 May;14(5):e258–e263. https://doi.org/10.1111/
j.1463- 1318.2012.02926.x. PMID: 22469482.
7. Jeganathan NA, Davenport ER, Yochum GS, Koltun WA. The microbiome of diverticulitis. Curr Opin Physiol. 2021;22:100452, ISSN 2468–8673. https://doi.org/10.1016/j.
cophys.2021.06.006.
8. Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC,
van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester
MA; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of
observational versus antibiotic treatment for a rst episode of CT-proven uncomplicated acute
diverticulitis. Br J Surg 2017 Jan;104(1):52–61. https://doi.org/10.1002/bjs.10309. Epub 2016
Sep 30. PMID: 27686365.
9. Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized
clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 2012
Apr;99(4):532–539. https://doi.org/10.1002/bjs.8688. Epub 2012 Jan 30. PMID: 22290281.
10. Bolkenstein HE, Draaisma WA, van de Wall B, Consten E, Broeders I. Treatment of acute
uncomplicated diverticulitis without antibiotics: risk factors for treatment failure. Int J
Colorectal Dis. 2018 Jul;33(7):863–869. https://doi.org/10.1007/s00384- 018- 3055- 1. Epub
2018 Apr 21. PMID: 29679152; PMCID: PMC6002463.
11. Emile SH, Elfeki H, Sakr A, Shalaby M.Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure. Tech Coloproctol 2018 Jul;22(7):499–509. https://doi.org/10.1007/
s10151- 018- 1817- y. Epub 2018 Jul 6. PMID: 29980885.
12. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF.Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 2014 Mar;57(3):284–294.
https://doi.org/10.1097/DCR.0000000000000075. PMID: 24509449.
13. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, Steele SR, Feingold DL;
Prepared on behalf of the clinical practice guidelines Committee of the American Society of
colon and Rectal surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum 2020
Jun;63(6):728–747. https://doi.org/10.1097/DCR.0000000000001679. PMID: 32384404.
14. Shabanzadeh DM, Wille-Jørgensen P.Antibiotics for uncomplicated diverticulitis. Cochrane
Database Syst Rev. 2012 Nov 14;11:CD009092. https://doi.org/10.1002/14651858.CD009092.
pub2. Update in: Cochrane Database Syst Rev. 2022 Jun 22;6:CD009092. PMID: 23152268.
15. Desai M, Fathallah J, Nutalapati V, Saligram S.Antibiotics versus no antibiotics for acute
uncomplicated diverticulitis: a systematic review and meta-analysis. Dis Colon Rectum 2019
Aug;62(8):1005–1012. https://doi.org/10.1097/DCR.0000000000001324. PMID: 30664553.
16. Mege D, Yeo H.Meta-analyses of current strategies to treat uncomplicated diverticulitis. Dis
Colon Rectum 2019 Mar;62(3):371–378. https://doi.org/10.1097/DCR.0000000000001295.
PMID: 30570549.
17. Au S, Aly EH.Treatment of uncomplicated acute diverticulitis without antibiotics: a systematic review and meta-analysis. Dis Colon Rectum 2019 Dec;62(12):1533–1547. https://doi.
org/10.1097/DCR.0000000000001330. PMID: 30663999.
18. van Dijk ST, Chabok A, Dijkgraaf MG, Boermeester MA, Smedh K.Observational versus
antibiotic treatment for uncomplicated diverticulitis: an individual-patient data meta-analysis.
Br J Surg. 2020 Jul;107(8):1062–1069. https://doi.org/10.1002/bjs.11465. Epub 2020 Feb 19.
PMID: 32073652; PMCID: PMC7318319.
19. Mocanu V, Dang JT, Switzer N, Tavakoli I, Tian C, de Gara C, Birch DW, Karmali S.The role
of antibiotics in acute uncomplicated diverticulitis: a systematic review and meta-analysis. Am
J Surg 2018 Sep;216(3):604–609. https://doi.org/10.1016/j.amjsurg.2018.01.039. Epub 2018
Feb 2. PMID: 29454479.
377
378
https://t.me/medicina_free
20. van Dijk ST, Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets
BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf
MG, Boermeester MA; Dutch diverticular disease (3D) collaborative study group. Longterm effects of omitting antibiotics in uncomplicated acute diverticulitis. Am J Gastroenterol
2018 Jul;113(7):1045–1052. https://doi.org/10.1038/s41395- 018- 0030- y. Epub 2018 May 11.
PMID: 29700480.
21. Isacson D, Smedh K, Nikberg M, Chabok A.Long-term follow-up of the AVOD randomized trial
of antibiotic avoidance in uncomplicated diverticulitis. Br J Surg 2019 Oct;106(11):1542–1548.
https://doi.org/10.1002/bjs.11239. Epub 2019 Aug 6. PMID: 31386199.
22. Schug-Pass C, Geers P, Hügel O, Lippert H, Köckerling F.Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Colorectal Dis. 2010 Jun;25(6):751–759. https://doi.org/10.1007/
s00384- 010- 0899- 4. Epub 2010 Feb 6. Erratum in: Int J Colorectal Dis. 2010 Jun;25(6):785.
PMID: 20140619.
23. Biondo S, Golda T, Kreisler E, Espin E, Vallribera F, Oteiza F, Codina-Cazador A, Pujadas M,
Flor B.Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER trial). Ann Surg 2014 Jan;259(1):38–44.
doi: https://doi.org/10.1097/SLA.0b013e3182965a11. PMID: 23732265.
24. Estrada Ferrer O, Ruiz Edo N, Hidalgo Grau LA, Abadal Prades M, Del Bas Rubia M,
Garcia Torralbo EM, Heredia Budo A, Suñol Sala X.Selective non-antibiotic treatment in
sigmoid diverticulitis: is it time to change the traditional approach? Tech Coloproctol 2016
May;20(5):309–315. https://doi.org/10.1007/s10151- 016- 1464- 0. Epub 2016 Apr 6. PMID:
27053254.
25. Cheng YJ, Kanaya AM, Araneta MRG, et al. Prevalence of diabetes by race and ethnicity
in the United States, 2011-2016. JAMA. 2019;322(24):2389–98. https://doi.org/10.1001/
jama.2019.19365.
26. Critchley JA, Carey IM, Harris T, DeWilde S, Hosking FJ, Cook DG.Glycemic control and
risk of infections among people with Type 1 or Type 2 diabetes in a large primary care cohort
study. Diabetes Care. 2018 October 1;41(10):2127–35. https://doi.org/10.2337/dc18- 0287.
N. Kohrman and G. T. Ault
Do WeNeed toOperate onPatients After
https://t.me/medicina_free
Successful Percutaneous Drainage
34
ofaDiverticular Abscess?
TobiJ.Reidy andScottC.Dolejs
Introduction
Diverticulitis with abscess (modied Hinchey Ib and II) accounts for approximately
15% of all diverticular abdominal pain presentations in the United States [1]. The
acute management of these patients has become streamlined with the ability to clear
most infections through combined use of percutaneous drainage, antibiotics and
bowel rest. After the resolution of the acute infection, colectomy was recommended
in the past [2]. However, this paradigm has been challenged with the most recent
practice guidelines either not recommending routine colectomy or recommending
consideration of colectomy after successful nonoperative treatment of a diverticular
abscess [3, 4]. This chapter will provide the evidence basis for these recent changes
to help guide clinicians to make evidence-based decisions of this common problem.
Search Strategy
A comprehensive literature search of PubMed and MEDLINE from 2002 to 2022
was performed to identify English language publications related to diverticulitis
with abscess, percutaneous drainage procedures for diverticular abscess and surgical interventions in diverticulitis with abscess to answer the Patient, Intervention,
Comparator, Outcome (PICO) question as outlined in Table34.1. Key search words
included, “perforated diverticulitis”, “percutaneous drain”, “Hinchey Ib and II”, and
“diverticulitis with abscess”. Systematic reviews and full text articles were also
reviewed for additional studies that may meet inclusion criteria. Studies were
excluded if they only looked at short term outcomes (dened as surgery within
T. J. Reidy (*) · S. C. Dolejs
Indiana Colon and Rectal Specialists, Indianapolis, IN, USA
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
K. Umanskiy, N. Hyman (eds.), Difcult Decisions in Colorectal Surgery,
Difcult Decisions in Surgery: An Evidence-Based Approach,
https://doi.org/10.1007/978-3-031-42303-1_34
379
380
https://t.me/medicina_free
Table 34.1 Patient, Intervention, Comparator, Outcome (PICO) question
Patient
Patients with
diverticulitis who
underwent successful
drainage of a
diverticular abscess
Intervention Comparator
Colon
resection
Observation Complications/need for urgent
Outcome
surgery due to persistent or worsening
symptoms, development of new
complication such as stula formation
or peritonitis
T. J. Reidy and S. C. Dolejs
30 days of presentation or drainage) or did not include patients who underwent
percutaneous drainage. Only the most recent studies were included if similar studies
were released from the same group.
Results
Over the past 2 decades, there have been numerous retrospective series written
(Table34.2). There is a large degree of heterogeneity in the data. There are different
denitions of recurrence. Some studies specify radiographic recurrence, some are
based solely on readmission which may miss outpatient recurrence, and others
employed telephone follow-up. The reason for eventual colectomy is usually poorly
dened owing to the frequent retrospective design. Thus, it is often unclear if a surgery was planned and elective secondary to an initial episode, due to recurrent or
unresolving disease, or emergent. Finally, the number of patients who had percutaneous drains and did not pursue operative management is small in most studies
ranging from 7 to 81 patients except for a few larger database studies, which have
their own methodological challenges [5, 6]. The differing and at times unclear denitions of recurrence and rational for surgery result in substantial heterogeneity
between studies with recurrence rates varying from 0% to 74% and eventual need
for operation in patients in whom elective colectomy was not pursued between 0%
and 56% [7–10].
Overall, the rate of recurrence in patients undergoing a percutaneous drain had a
wide variability from 0% to 74% with most studies noting a recurrence rate between
15% and 35% (Table34.2). These recurrences were complicated between 0% and
100% of the time with most of the studies demonstrating complicated recurrences
about 40–60% of the time (Table34.2). Most of these recurrences were able to be
managed non-operatively. The rate of operation in patients who had percutaneous
drainage and then planned non-operative management ranged between 0% and 56%
with the bulk of the studies having an operative rate of 0–25% (Table34.2).
Only one study directly compared patients who underwent elective colectomy
versus observation following successful percutaneous drainage [11]. In this study,
the rate of stoma was higher in patients who underwent elective colectomy (13% in
elective colectomy versus 9% in patients with planned non-operative management,
p<0.05) [11]. Elective colectomy in this study was also associated with increased
inpatient days and increased cost [11]. This was a population-based study based on
statewide data from NewYork and thus granular detail about what drove these
34 Do We Need to Operate on Patients After Successful Percutaneous Drainage…
https://t.me/medicina_free
Follow-up, months
60
38
381
(continued)
Operative rate amongst
patients initially
planned for non-op
Percent of
recurrences that
Number of
patients with
a
management, %
were complicated, %
1137 27% 14% 22%
drain Recurrence rate, %
34 18% Unknown 18%
Unknown 0% 32
b
9 7%
treated
non- operatively
19% 110
0% 107
recurrences were
44 13% Unknown, all
required for
recurrences
33 30% 10% 12% 62
c
490 24% 66% 16%
d
81 23% 21% 26%
cohort database
Study design
Aquina [11] Observational
Table 34.2 Outcomes of non-operative management after successful percutaneous drainage of a diverticular abscess
Article
Brandt [19] Retrospective,
telephone
case-control
follow-up
Bridoux [9] Retrospective with
Retrospective,
Broderick-Villa
cohort
[20]
Felder [8] Retrospective 7 0% 0% 0% 47
Elagili [16] Retrospective 18 39% 43% 17% 90
Buchwald [21] Retrospective 22 27% No end colostomy
Devaraj [7] Retrospective 65 74% 71% 56% 14
Gaertner [10] Retrospective 32 42% 44% 0% 89
telephone
Garnkle [14] Retrospective with
follow-up
database
Gregersen [13] Retrospective
telephone
Jalouta [6] Retrospective with
follow-up
382
https://t.me/medicina_free
T. J. Reidy and S. C. Dolejs
Follow-up, months
72
e
Operative rate amongst
patients initially
planned for non-op
management, %
35
28
g
d
j
10% 76
41%
Percent of
recurrences that
were complicated, %
Number of
patients with
drain Recurrence rate, %
Study design
Unknown 7% 47
f
409 15%
Retrospective
h
h
database
21%
j
Unknown 0% 67
44%
i
j
30 32% 100% 2% 24
control trial
31
Lambricht [15] Retrospective 115 25% Unknown Unknown
Kaiser [5] Retrospective 16 42% Unknown 42%
Table 34.2 (continued)
Article
Li
Macias [22] Retrospective 10 30% 67% 19%
Nelson [23] Retrospective 11 46%
Singh [24] Retrospective 16 11% Unknown 50%
Trenti [12] Retrospective 9 15%
Van de Waal [25] Retrospective 7 33%
You [26] Randomized
This was recurrence rate in 105 patients with complicated disease. Did not have this stratied by patients with drain
Unclear how many of these operations were planned elective operation. Had an 11% rate of non- elective surgery
a
b
specied
Rate reects operative rate in all patients with complicated disease, not just those drained. Some of these operations were elective, but this rate was not
c
Unclear why operative rate is higher than rate of recurrence if all patients were initially intended to be managed non-operatively
d
e
rence as the recurrence rate in those with a drain was only 25%
This reects a cohort of 70 patients with complicated disease and not just those with a drain
68% of patients with drain underwent surgery, but it is unclear how many of these were planned elective operations versus need for surgery secondary to recur-
Rate reects a cohort of 99 patients with complicated disease and not just those with a drain
This is the rate of readmission and may not reect the true rate of recurrence
f
Rate reects a cohort of 560 patients with complicated disease and not just those with a drain
g
Rate reects cohort of 59 patients with complicated disease and not just those with a drain
h
i
j
34 Do We Need to Operate on Patients After Successful Percutaneous Drainage…
https://t.me/medicina_free
differences was not available and it is possible that recurrences were missed that
would have biased the study towards non-operative management.
383
Recommendations
After successful percutaneous drainage and resolution of complicated diverticulitis,
the decision to pursue elective surgical resection versus observation only should be
individualized and made in a shared decision-making framework that weighs the
patient comorbidities, surgical risks, and risk of recurrence.
Strong recommendation based on low-quality evidence.
The current literature points to around a 15–35% risk of recurrence after successful percutaneous drainage in complicated diverticulitis, of which about half will be
complicated. The majority of these recurrences can be managed non-operatively.
Certain patient populations, such as those on chronic steroids, may additionally
have a higher rate of recurrence and greater impact of recurrence and are likely better steered to denitive resection [12, 13]. Prior episodes of diverticulitis preceding
the need for a drain are also associated with higher risks of recurrence [14]. Pursuing
elective surgical resection in patients with diverticulitis and abscess after successful
percutaneous drainage may have a paradoxically higher rate of ostomy than a trial
of non-operative management, and thus, the primary aim of elective resection
should not be to prevent a stoma [11]. With this data in mind, care of these patients
should be individualized considering patient perspectives and preferences.
Personal View
Patients presenting with complicated diverticulitis with a localized abscess need to
be assessed and cared for individually. Initial management of these patients should
include control of sepsis with percutaneous drainage and antibiotics. These patients
should undergo colonoscopy after symptom resolution to rule out malignancy as a
source of their disease. Following this, patients with ongoing complication of their
diverticulitis such as stricture, stula, or ongoing impairment to their quality of life
should be managed operatively. The decision to pursue elective resection if the initial episode has completely resolved should be individualized.
Of particular interest to me are patients with quality-of-life decline after percutaneous drainage of diverticular abscess. These patients have become the most
nuanced group to manage in my practice. Their clinical symptoms are subtle and
often impossible to quantify on imaging or examination. Despite clearing their disease radiographically, they complain of chronic abdominal pain, pelvic pain, and
often have food fear. They repetitively visit the emergency room, primary care physicians, and surgeons with concern of repeat infection even when radiographically
and chemically there is no sign of recurrence. They do not respond to probiotics,
antispasmodics or dietary changes and they live with anxiety of possibly requiring
an ostomy at some point in their lives. In these situations, the surgeon must parse out
384
https://t.me/medicina_free
T. J. Reidy and S. C. Dolejs
patients who are likely to have remarkable symptom reduction from resection such
as in those with post-diverticular hyperalgesia due to phlegmonous diverticulitis
versus those where benet from resection is controversial such as those with psychosomatic effects resulting from the index disease state and underlying irritable
bowel syndrome complicating the initial are [17, 18].
When quality of life is negatively impacted and resection is deemed appropriate,
extensive counseling is required to assure all patients understand that there is not a
guarantee symptoms will resolve if there is substantial overlap with a functional
bowel disorder. I nd that most patients do have remarkable improvement overall
when expectations are dened.
In patients without diverticular complications (stula or stricture) or quality of
life impairment, my practice is to individualize recommendations for surgery versus
observation based on the patient in front of me. A young and healthy patient with no
surgical history and two prior episodes of diverticulitis before the complicated
attack is likely best treated with denitive resection after successful percutaneous
drainage. In this patient, the risk of recurrence and complicated recurrence is high
while the expected postoperative morbidity is low. In contrast, the data highlighted
in this chapter could be used to steer a very obese elderly patient with multiple
comorbidities and multiple prior abdominal operations away from surgery. In this
patient, the risks of surgery likely outweigh the potential benets.
Until we have prospective trials with well-dened inclusion criteria and end
points which include quality of life measurements to study the evolving role of elective surgery in patients who have undergone successful percutaneous drainage of
diverticular abscesses, the role of surgery in these patients need to be
individualized.
Recommendations
After successful percutaneous drainage and resolution of complicated diverticulitis,
the decision to pursue elective surgical resection versus observation only should be
individualized and made in a shared decision-making framework that weighs the
patient comorbidities, surgical risks, and risk of recurrence.
Strong recommendation based on low-quality evidence.
Disclaimers Dr.’s Reidy and Dolejs have no conicts of interest to disclose.
Funding There is no funding for this book chapter.
References
1. Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis.
Gastroenterology. 2019;156(5):1282–98.e1281.
2. Feingold D, Steele SR, Lee S, etal. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284–94.
34 Do We Need to Operate on Patients After Successful Percutaneous Drainage…
https://t.me/medicina_free
3. Francis NK, Sylla P, Abou-Khalil M, etal. EAES and SAGES 2018 consensus conference on
acute diverticulitis management: evidence-based recommendations for clinical practice. Surg
Endosc. 2019;33:2726–41.
4. Hall J, Hardiman K, Lee S, etal. The American Society of Colon and Rectal Surgeons clinical
practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum.
2020;63(6):728–47.
5. Kaiser AM, Jiang JK, Lake JP, etal. The management of complicated diverticulitis and the role
of computed tomography. Am J Gastroenterol. 2005;100(4):910–7.
6. Jalouta T, Jrebi N, Luchtefeld M, Ogilvie JW Jr. Diverticulitis recurrence after percutaneous
abscess drainage. Int J Color Dis. 2017;32(10):1367–73.
7. Devaraj B, Liu W, Tatum J, Cologne K, Kaiser AM. Medically treated diverticular abscess
associated with high risk of recurrence and disease complications. Dis Colon Rectum.
2016;59(3):208–15.
8. Felder SI, Barmparas G, Lynn J, Murrell Z, Margulies DR, Fleshner P.Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be
predicted? Am Surg. 2013;79(10):1013–6.
9. Bridoux V, Antor M, Schwarz L, etal. Elective operation after acute complicated diverticulitis:
is it still mandatory? World J Gastroenterol WJG. 2014;20(25):8166–72.
10. Gaertner WB, Willis DJ, Madoff RD, et al. Percutaneous drainage of colonic diverticular
abscess: is colon resection necessary? Dis Colon Rectum. 2013;56(5):622–6.
11. Aquina CT, Becerra AZ, Xu Z, etal. Population-based study of outcomes following an initial
acute diverticular abscess. Br J Surg. 2019;106(4):467–76.
12. Trenti L, Kreisler E, Galvez A, Golda T, Frago R, Biondo S. Long-term evolution of acute
colonic diverticulitis after successful medical treatment. World J Surg. 2015;39(1):266–74.
13. Gregersen R, Andresen K, Burcharth J, Pommergaard HC, Rosenberg J.Long-term mortality
and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study. Int J Color Dis. 2018;33(4):431–40.
14. Garnkle R, Kugler A, Pelsser V, etal. Diverticular abscess managed with long-term denitive
nonoperative intent is safe. Dis Colon Rectum. 2016;59(7):648–55.
15. Lambrichts DPV, Bolkenstein HE, van der Does D, etal. Multicentre study of non-surgical
management of diverticulitis with abscess formation. Br J Surg. 2019;106(4):458–66.
16. Elagili F, Stocchi L, Ozuner G, Dietz DW, Kiran RP.Outcomes of percutaneous drainage
without surgery for patients with diverticular abscess. Dis Colon Rectum. 2014;57(3):331–6.
17. Lamb MN, Kaiser AM.Elective resection versus observation after nonoperative management
of complicated diverticulitis with abscess: a systematic review and meta-analysis. Dis Colon
Rectum. 2014;57(12):1430–40.
18. Cohen E, Fuller G, Bolus R, et al. Increased risk for irritable bowel syndrome after acute
diverticulitis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc.
2013;11(12):1614–9.
19. Brandt D, Gervaz P, Durmishi Y, Platon A, Morel P, Poletti PA.Percutaneous CT scan-guided
drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon
Rectum. 2006;49(10):1533–8.
20. Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI.Hospitalization for acute
diverticulitis does not mandate routine elective colectomy. Arch Surg (Chicago, Ill : 1960).
2005;140(6):576–81; discussion 581–573.
21. Buchwald P, Dixon L, Wakeman CJ, Eglinton TW, Frizelle FA.Hinchey I and II diverticular
abscesses: long-term outcome of conservative treatment. ANZ J Surg. 2017;87(12):1011–4.
22. Macias LH, Haukoos JS, Dixon MR, etal. Diverticulitis: truly minimally invasive management. Am Surg. 2004;70(10):932–5.
23. Nelson RS, Ewing BM, Wengert TJ, Thorson AG.Clinical outcomes of complicated diverticulitis managed nonoperatively. Am J Surg. 2008;196(6):969–72; discussion 973–964.
24. Singh B, May K, Coltart I, Moore NR, Cunningham C.The long-term results of percutaneous
drainage of diverticular abscess. Ann R Coll Surg Engl. 2008;90(4):297–301.
385
386
https://t.me/medicina_free
25. van de Wall BJ, Draaisma WA, Consten EC, van der Kaaij RT, Wiezer MJ, Broeders IA.Does
the presence of abscesses in diverticular disease prelude surgery? J Gastrointest Surg Off J Soc
Surg Aliment Tract. 2013;17(3):540–7.
26. You K, Bendl R, Taut C, Sullivan R, Gachabayov M, Bergamaschi R.Randomized clinical
trial of elective resection versus observation in diverticulitis with extraluminal air or abscess
initially managed conservatively. Br J Surg. 2018;105(8):971–9.
T. J. Reidy and S. C. Dolejs
Соседние файлы в папке @xirurgi_2025