Safety and efficiency of ambulatory treatment of acute diverticulitis

Introduction: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management. Objective: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients. Methods: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3 cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month. Results: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with Leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery. Conclusions: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs. (C) 2008 Elsevier Espana, S.L. All rights reserved.