Predictive factors for conservative treatment failure of right colonic diverticulitis

Youn Young Park; Soomin Nam; Jeong Hee Han; Jaeim Lee; Chinock Cheong

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저자정보: Youn Young Park (The Catholic University of Korea) Soomin Nam (National Health Insurance Service Ilsan Hospital) Jeong Hee Han (Hallym University College of Medicine) Jaeim Lee (The Catholic University of Korea) Chinock Cheong (Ajou University School of Medicine)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.100 No.6

발행연도: 2021.6

수록면: 347 - 355 (9page)

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Purpose: Conservative treatment is the first-line therapy for acute colonic diverticulitis without severe complications, but treatment failure may increase hospitalization duration, medical costs, and morbidities. Usage of the modified Hinchey classification is insufficient to predict the outcome of conservative management. We aimed to investigate the clinical efficacy of the modified Hinchey classification and to evaluate predictive factors such as inflammatory markers for the failure of conservative management.
Methods: Patients diagnosed with right colonic diverticulitis undergoing conservative treatment at 3 hospitals between 2017 and 2019 were included. Patients were categorized into conservative treatment success (n = 494) or failure (n = 46) groups. Clinical characteristics and blood inflammatory markers were assessed.
Results: The conservative treatment failure group presented with more elderly patients (>50 years, P = 0.002), more recurrent episodes (P < 0.001), a higher lymphocyte count (P = 0.021), higher C-reactive protein (CRP) levels (P = 0.044), and higher modified Glasgow prognostic scores (P = 0.021). Multivariate analysis revealed that age of >50 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.27–5.08; P = 0.008), recurrent episodes (OR, 4.78; 95% CI, 2.38–9.61; P < 0.001), and higher CRP levels (OR, 1.08; 95% CI, 1.03–1.12; P = 0.001) were predictive factors for conservative treatment failure, but not the modified Hinchey grade (P = 0.159).
Conclusion: Age of >50 years, recurrent episodes, and CRP levels are potential predictors for conservative management failure of patients with right-sided colonic diverticulitis. Further studies are warranted to identify candidates requiring early surgical intervention.

#Colonic diverticulitis #Conservative treatment #C-reactive protein #Inflammatory response #Recurrence

참고문헌 (29)

참고문헌 신청

Hall J / 2010 / New paradigms in the management of diverticular disease / Curr Probl Surg 47:680~735

백필선 / 2017 / Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis / Annals of Coloproctolgy 33(5):178~183

Seonhui Shin / 2018 / Impact of CT imaging on predicting the surgical management of acute diverticulitis / Annals of Surgical Treatment and Research 94(6):322~329

Bates DD / 2018 / Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters / Abdom Radiol (NY) 43:2060~2065

Matsushima K / 2010 / Management of right-sided diverticulitis: a retrospective review from a hospital in Japan / Surg Today 40:321~325

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