Med Bull Sisli Etfal Hosp. 2022; 56(4): 503-508 | DOI: 10.14744/SEMB.2022.27095

Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient

Emre Teke¹, Huseyin Ciyiltepe², Nuriye Esen Bulut¹, Yasin Gunes¹, Mehmet Mahir Fersahoglu¹, Anil Ergin¹, Bora Karip³, Kemal Memisoglu^1
1Department of General Surgery, University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
²Department of Gastroenterology Surgery, Antalya Training and Research Hospital, Antalya, Türkiye
³Department of General Surgery, Istanbul Oncology Hospital, Istanbul, Türkiye

Objectives: Diverticular disease is a highly frequent condition and affects 50% of the population in the 9th decade in Western society. Acute diverticulitis is the most prevalent complication. The patients who are clinically stable and tolerate fluid should be hospitalized if fluid intake tolerance worsens, fever occurs, or pain increases. Bowel rest, intravenous fluid therapy, and empiric antibiotic therapy are the traditional treatments for patients admitted to the hospital. This retrospective study aimed to determine the parameters that will affect the outpatient or inpatient treatment of patients diagnosed with uncomplicated acute diverticulitis.
Methods: Patients who presented to the emergency department with abdominal pain between January 2018 and December 2020 and were diagnosed with uncomplicated diverticulitis (modified Hinchey 1a) on computed tomography (CT) taken after intravenous contrast material shoot up were included in the study. Patient records were recorded retrospectively in the Excel file. After being seen in the emergency department, a comparison was performed between the inpatient group (Group 1) and the outpatient follow-up group (Group 2).
Results: The study comprised 172 patients with acute uncomplicated diverticulitis (modified Hinchey 1a). While 110 (64.0%) patients were followed up and treated as inpatients (Group 1), 62 (36.0%) patients were followed up as outpatients (Group 2). There was no statistically significant difference between the two groups in terms of patients readmitted to the hospital in the first 30 days after discharge (both for outpatient follow-up in the emergency department and after treatment in the inpatient group).
Conclusion: In this retrospective study, in which we evaluated the hospitalization criteria in uncomplicated Modified Hinchey 1a patients, it was found that patients can be safely treated as an outpatient if they have poor physical examination findings. Although there was no difference between the two groups in terms of hospital readmission after discharge and it was thought that follow-up of patients with Modified Hinchey 1a diverticulitis with outpatient oral antibiotic therapy might be reliable, prospective studies with larger numbers of patients are needed.

Keywords: Diverticular disease, Diverticulitis, Hinchey 1a, Outpatient management, Uncomplicated diverticulitis

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Akut Komplike Olmayan Divertikülit Tedavisi: Yatarak veya Ayaktan

Emre Teke¹, Huseyin Ciyiltepe², Nuriye Esen Bulut¹, Yasin Gunes¹, Mehmet Mahir Fersahoglu¹, Anil Ergin¹, Bora Karip³, Kemal Memisoglu^1
1SBÜ Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Antalya Eðitim ve Araþtýrma Hastanesi, Gastroenteroloji Cerrahi Kliniði, Antalya
³Ýstanbul Onkoloji Hastanesi, Genel Cerrahi, Ýstanbul

Amaç: Divertiküler hastalýk oldukça sýk görülen bir durumdur. Batý toplumunda dokuzuncu dekatta nüfusun %50'sini etkiler. Akut divertikülit en sýk görülen komplikasyondur. Klinik olarak stabil olup sývýyý tolere eden hastalar, sývý alým toleransý kötüleþirse, ateþ yükselirse veya aðrý artarsa hastaneye yatýrýlmalýdýr. Baðýrsak istirahati, intravenöz sývý tedavisi ve ampirik antibiyotik tedavisi, hastaneye baþvuran hastalarda geleneksel tedavilerdir. Bu retrospektif çalýþma, komplike olmayan akut divertikülit tanýsý alan hastalarýn ayaktan veya yatarak tedavisini etkileyecek parametreleri belirlemeyi amaçlamaktadýr.
Yöntemler: Ocak 2018-Aralýk 2020 tarihleri arasýnda karýn aðrýsý ile acil servise baþvuran ve intravönöz contrast madde verilmesi sonrasý çekilen bilgisayarlý tomografide(BT) komplike olmayan divertikülit (modifiye Hinchey 1a) tanýsý alan hastalar çalýþmaya dahil edildi. Hasta kayýtlarý retrospektif olarak Excel dosyasýna kaydedildi. Acil serviste görüldükten sonra yatan hasta grubu (Grup 1) ile ayaktan takip grubu (Grup 2) arasýnda karþýlaþtýrma yapýldý.
Bulgular: Çalýþma akut komplike olmayan divertiküliti (modifiye Hinchey 1a) olan 172 hastayý içermektedir. 110 (%64,0) hasta yatarak takip ve tedavi edilirken (Grup 1) 62 (%36,0) hasta ayaktan (Grup 2) takip edildi. Taburculuk sonrasý ilk 30 gün içinde (hem ayaktan takip edilen hem de yatan hasta grubunda tedavi sonrasý) hastaneye tekrar baþvuran hastalar açýsýndan iki grup arasýnda istatistiksel olarak anlamlý fark yoktu.
Sonuç: Komplike olmayan Modifiye Hinchey 1a hastalarýnda yatýþ kriterlerini deðerlendirdiðimiz bu retrospektif çalýþmada hastalarýn þiddetli fizik muayene bulgularý olmamasý durumunda güvenle ayaktan tedavi olabileði bulundu. Taburculuk sonrasý yeniden hastaneye yatýþ açýsýndan iki grup arasýnda fark olmamasýna ve Modifiye Hinchey 1a divertiküliti olan hastalarýn ayaktan oral antibiyotik tedavisi ile takibinin güvenilir olabileceði düþünülse de, daha geniþ hasta sayýsý ile prospektif çalýþmalara ihtiyaç vardýr. (SETB-2022-02-030)

Anahtar Kelimeler: Hinchey 1a, divertikülit, komplike olmayan divertikülit, divertiküler hastalýk, ayaktan tedavi

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