Joliat GR, et al. – Authors here assessed the 1–month failure rate of outpatient treatment (OT) for uncomplicated diverticulitis (uD)/mild complicated diverticulitis (mcD) compared to inpatient treatment (IT), and identified predictive factors for treatment failure. They realized the feasibility and safety of outpatient treatment for uncomplicated/mild complicated diverticulitis. Prognostic factors of failure necessitating closer follow–up included admission/CT time, Ambrosetti score of 4, and free air around the colon.

Methods

• Authors retrospectively analyzed all consecutive patients (2006–2012) diagnosed with uD/mcD by CT scan.
• They defined acute uD as absence of the following: abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery.
• Complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm was observed as acute mcD.
• Antibiotherapy was offered to all patients.
• They defined treatment failure as (re)hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization.
• They contacted all patients using a standardized questionnaire.

Results

• 540 uD/mcD were assessed; IT was offered to 369 patients (68%) and OT to 171 patients (32%).
• In this study, the IT group indicated higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP.
• To the questionnaire, response rates of 56% (IT) vs. 62% (OT) were observed (p = 0.18).
• Findings revealed failure rates of 32% in IT vs. 10% in OT group, p < 0.01.
• Among the uD/mcD patients, risk factors for failure included admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon.