Q: In complicated acute diverticulitis, abscesses are classified as small and large depending on size. The cutoff is? (select one)
A) more than 2 cm
B) more than 4 cm
Abscess formation is common in complicated acute diverticulitis. Depending on the size, the invasive vs non-invasive approach can be decided. Abscess size above 5 cm has a higher rate of complication. Given that a more aggressive approach is needed for sizes above 4 cm.
In smaller abscesses antibiotics is usually sufficient. Percutaneous drainage of diverticular abscesses should be strongly considered if the size is at or above 4 cm, though the American Society of Colon and Rectal Surgeons (ASCRS) recommends percutaneous drainage at or above 3 cm. Drainage catheter can be left till output is minimal. Catheter sinograms can be performed periodically as well as serial CT scans to evaluate the resolution.
In severe cases, open surgery may be needed.
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