abscesses in complicated acute diverticulitis

 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 

Answer: B

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.

#surgical-critical-care

#GI

References:

1. Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum 2020; 63:728. 

2. Gregersen R, Mortensen LQ, Burcharth J, et al. Treatment of patients with acute colonic diverticulitis complicated by abscess formation: A systematic review. Int J Surg 2016; 35:201. 

3. Francis NK, Sylla P, Abou-Khalil M, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc 2019; 33:2726. 

4. Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 2006; 186:680. 

5. Gaertner WB, Willis DJ, Madoff RD, et al. Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum 2013; 56:622.