Percutaneous drainage in a diverticular abscess: should we still do it? A literature review
Autores
Eva Borges, Ana Isabel Ferreira, Fabiana Silva, Sara Fernandes, Luís Miranda
Resumo Introdução
Intra-abdominal abscess formation is a complication that occurs in approximately 15-20% of patients with acute diverticulitis. The management of diverticulitis has evolved from an initial surgical approach to a non-operative strategy using broad-spectrum intravenous antibiotics, with or without percutaneous drainage (PD). Recent publications have cast doubt on the efficacy of percutaneous drainage for acute diverticulitis complicated by abscess (Hinchey Ib and II).
Resumo Métodos
A literature review.
Resumo Resultados
There are few studies comparing PD and antibiotics alone in the treatment of large abscesses, and they are all retrospective. One systematic review found a treatment failure rate of 19-21% regardless of the treatment chosen. Concerning PD, a failure rate of over 35% was observed, with a complication rate of 2.5% including enterocutaneous fistula and small bowel injury. Recent papers have suggested that percutaneous drainage with antibiotics does not appear to be superior to antibiotics alone and does not appear to reduce complication rates or recurrence and thus, should be carefully considered in refractory cases or in patients unfit for surgery.
Resumo Discussão
Treatment should not be based solely on abscess size. Antibiotherapy alone should be used as a first line therapy even for large diverticular abscesses. However, randomized controlled trials are essential for a formal recommendation.