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Journal Club PresentationPerforated Diverticulitis
Nor Haryanti Hashim
Surgical Intern28th September 2011
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Diverticulosis and Perforated Diverticulitis
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Diverticulosis and Perforated Diverticulitis
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Diverticulosis and Perforated Diverticulitis
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BACKGROUND
Aim of this study:
To measure perforated diverticulitis (PD) in alarge UK population
To identify factors affecting outcome perforateddiverticulitis
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METHODS
Computerised searches of hospital coding databases forPD were performed in 5 hospitals in East Anglia, UK
Data collected for 5 years (1995 2000)
Incidence was collected using population data
Factors associated with morbidity and mortality wereidentified using multivariable and univariable testing
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INCLUSION CRITERIA
Macroscopic colonic diverticular perforation at surgeryor autopsy
Evidence of extracolonic pus or feaces in the presence ofdiverticulum with no other intra abdominal pathology
Patient who did not undergo surgery if there is
radiological evidence of diverticular abscess
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MORTALITY
Risk factor
Pre existing
Medication
Comorbidities
In hospital
ASA score
Hinchey score
Type ofsurgery
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MORBIDITY
Morbidity
Cardiorespiratory Systemic sepsisWound & stoma
relatedThromboembolic
eventPersistent abdo
sepsis
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RESULTS
202 patiets with PD were identified
93.1 % underwent surgery
24.3 % died
Female > male
Incidence of PD increases with age
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MORTALITY (24 %)
Risk factor
Pre existing
Medication
NSAIDs
Comorbidities
Renal disease, age
In hospital
ASA score >2
Hinchey score
Severe perforation
Type of surgery
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MORBIDITY (48.5%)
Diverticulosis and Perforated Diverticulitis
Half of the patient has significant morbidity
Mainly Wound infection 13%
Cardiorespiratory 13%
Increasing age is a strong predictive factor
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CONCLUSION PD is uncommon but is a serious acute abdominal
condition
Highest incidence in women > 65 years old
Mortality rates are high especially in
NSAIDs users
Pre existing renal impairment
Is prevention better than cure ?
2/3 of patients have no previous diagnosis of DD
Effective surgical management and MDT are vital
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REFERENCES
1. Incidence of perforated diverticulitis and risk factors fordeath in a UK population, C. R. Morris et al, BritishJournal Surgery 2008
2. Management of diverticulitis, M. M. Szojda et al,Alimentary Pharmacology & Therapeutics Journal 2007
3. The current and evolving treatment of colonicdiverticular disease, A. Tursi et al, AlimentaryPharmacology & Therapeutics Journal 2009
4. OHCM
Diverticulosis and Perforated Diverticulitis