Abstract：
BACKGROUND: Acute diverticulitis with extraluminal air constitutes a heterogeneous condition whose management is controversial. The aims of this study are to report the failure rate of conservative treatment for diverticulitis with extraluminal air and to report risk factors of conservative treatment failure.
METHODS: A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission.
RESULTS: Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002).
CONCLUSIONS: Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.
METHODS: A retrospective study was performed from an institutional review board-approved database of patients admitted with acute diverticulitis with extraluminal air from 2015 to 2021 at a tertiary referral center. All patients managed for acute diverticulitis with covered perforation (without intraabdominal abscess) were included. The primary endpoint was failure of medical treatment, defined as a need for unplanned surgery or percutaneous drainage within 30 days after admission.
RESULTS: Ninety-three patients (61% male, mean age 57 ± 17 years) were retrospectively included. Ten patients had failure of conservative treatment (11%). These patients were significantly older than 50 years (n = 9/10, 90% versus n = 47/83, 57%, p = 0.007), associated with cardiovascular disease (n = 6/10, 60% versus n = 10/83, 12%, p = 0.002), American Society of Anesthesiologists (ASA) score of 3-4 (n = 4/7, 57% versus 6/33, 18%, p = 0.05), under anticoagulant and antiplatelet (n = 6/10, 60% versus n = 11/83, 13%, p = 0.04) and steroid or immunosuppressive therapy (n = 3/10, 30% versus 5/83, 6%, p = 0.04), and with distant pneumoperitoneum location (n = 7/10, 70% versus n = 14/83, 17%, p = 0.001) compared with those with successful conservative treatment. On multivariate analysis, only distant pneumoperitoneum was an independent risk factor of failure (odds ratio (OR) 6.5, 95% confidence interval (CI) [2-21], p = 0.002).
CONCLUSIONS: Conservative treatment with antibiotics for acute diverticulitis with extraluminal air is safe with a success rate of 89%. Patients with distant pneumoperitoneum should be carefully monitored.
摘要：
背景：具有腔外空气的急性憩室炎构成了一种异质性疾病，其治疗存在争议。这项研究的目的是报告腔外空气保守治疗憩室炎的失败率，并报告保守治疗失败的危险因素。
方法：从2015年至2021年在三级转诊中心接受急性憩室炎并腔外空气的机构审查委员会批准的数据库中进行了一项回顾性研究。包括所有治疗急性憩室炎并有覆盖性穿孔（无腹腔脓肿）的患者。主要终点是药物治疗失败，定义为入院后30天内需要进行计划外手术或经皮引流。
结果：93例患者（61%为男性，平均年龄57±17岁）被回顾性纳入。10例患者保守治疗失败(11%)。这些患者年龄明显大于50岁（n=9/10，90％与n=47/83，57％，p=0.007),与心血管疾病相关(n=6/10，60%与n=10/83，12%，p=0.002),美国麻醉医师协会（ASA）得分为3-4分（n=4/7，57％对6/33，18％，p=0.05)，抗凝和抗血小板（n=6/10，60％与n=11/83，13％，p=0.04）和类固醇或免疫抑制治疗（n=3/10，30％对5/83，6％，p=0.04),并伴有远处的气腹位置（n=7/10，70％对n=14/83，17％，p=0.001）与成功保守治疗的患者相比。在多变量分析中，仅远处气腹是失败的独立危险因素（优势比（OR）6.5，95％置信区间（CI）[2-21]，p=0.002)。
结论：用抗生素保守治疗急性憩室炎并腔外空气是安全的，成功率为89%。远端气腹患者应仔细监测。
方法：从2015年至2021年在三级转诊中心接受急性憩室炎并腔外空气的机构审查委员会批准的数据库中进行了一项回顾性研究。包括所有治疗急性憩室炎并有覆盖性穿孔（无腹腔脓肿）的患者。主要终点是药物治疗失败，定义为入院后30天内需要进行计划外手术或经皮引流。
结果：93例患者（61%为男性，平均年龄57±17岁）被回顾性纳入。10例患者保守治疗失败(11%)。这些患者年龄明显大于50岁（n=9/10，90％与n=47/83，57％，p=0.007),与心血管疾病相关(n=6/10，60%与n=10/83，12%，p=0.002),美国麻醉医师协会（ASA）得分为3-4分（n=4/7，57％对6/33，18％，p=0.05)，抗凝和抗血小板（n=6/10，60％与n=11/83，13％，p=0.04）和类固醇或免疫抑制治疗（n=3/10，30％对5/83，6％，p=0.04),并伴有远处的气腹位置（n=7/10，70％对n=14/83，17％，p=0.001）与成功保守治疗的患者相比。在多变量分析中，仅远处气腹是失败的独立危险因素（优势比（OR）6.5，95％置信区间（CI）[2-21]，p=0.002)。
结论：用抗生素保守治疗急性憩室炎并腔外空气是安全的，成功率为89%。远端气腹患者应仔细监测。
