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Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly

Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated dive...

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Autores principales: Perrone, Gennaro, Giuffrida, Mario, Bonati, Elena, Petracca, Gabriele Luciano, Tarasconi, Antonio, Baiocchi, Gianluca, Catena, Fausto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8778743/
https://www.ncbi.nlm.nih.gov/pubmed/35056340
http://dx.doi.org/10.3390/medicina58010029
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author Perrone, Gennaro
Giuffrida, Mario
Bonati, Elena
Petracca, Gabriele Luciano
Tarasconi, Antonio
Baiocchi, Gianluca
Catena, Fausto
author_facet Perrone, Gennaro
Giuffrida, Mario
Bonati, Elena
Petracca, Gabriele Luciano
Tarasconi, Antonio
Baiocchi, Gianluca
Catena, Fausto
author_sort Perrone, Gennaro
collection PubMed
description Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65–74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 ± 6.8 years (range 65–92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88%). Average white cells count was 10.04 ± 5.05 × 109/L in the early elderly group and 11.24 ± 7.89 in the late elderly group. CRP was elevated in 29 (78.3%) cases in early elderly and in 23 late elderly patients (67.6%). A CT scan of the abdomen was performed in every case (100%). Almost all patients were treated with bowel rest and antibiotics (95.7%). Average length of stay was 7.74 ± 7.1 days (range 1–48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 ± 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6%). New episodes of acute diverticulitis were reported in 20 patients (28.1%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities.
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spelling pubmed-87787432022-01-22 Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly Perrone, Gennaro Giuffrida, Mario Bonati, Elena Petracca, Gabriele Luciano Tarasconi, Antonio Baiocchi, Gianluca Catena, Fausto Medicina (Kaunas) Article Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65–74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 ± 6.8 years (range 65–92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88%). Average white cells count was 10.04 ± 5.05 × 109/L in the early elderly group and 11.24 ± 7.89 in the late elderly group. CRP was elevated in 29 (78.3%) cases in early elderly and in 23 late elderly patients (67.6%). A CT scan of the abdomen was performed in every case (100%). Almost all patients were treated with bowel rest and antibiotics (95.7%). Average length of stay was 7.74 ± 7.1 days (range 1–48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 ± 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6%). New episodes of acute diverticulitis were reported in 20 patients (28.1%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities. MDPI 2021-12-24 /pmc/articles/PMC8778743/ /pubmed/35056340 http://dx.doi.org/10.3390/medicina58010029 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Perrone, Gennaro
Giuffrida, Mario
Bonati, Elena
Petracca, Gabriele Luciano
Tarasconi, Antonio
Baiocchi, Gianluca
Catena, Fausto
Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title_full Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title_fullStr Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title_full_unstemmed Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title_short Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly
title_sort conservative management of complicated colonic diverticulitis in early and late elderly
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8778743/
https://www.ncbi.nlm.nih.gov/pubmed/35056340
http://dx.doi.org/10.3390/medicina58010029
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