treatmen of acute colonic diverticulite as described in a 2015 article of Gastroenterologia and hepatologia journal. in english

1. Treatment of acute colonicTreatment of acute colonic
diverticulitisdiverticulitis
Gargallo Puyuelo C, Sopeña F, Arbeloa A.
Colonic diverticular disease. Treatment and prevention.
Gastroenterol Hepatol. 2015
Vargas Flores Edgar PGY3

2. • Require inpatient treatment
• Fever or peritonitis
• Oral fluids intolerance
• >85 years
• Immunosupresion
• Comorbidities
Hinchey 0 or IaHinchey 0 or Ia
Gargallo Puyuelo C et al. Colonic diverticular disease. Treatment and
prevention. Gastroenterol Hepatol. 2015

3. • AB therapy does not prevent complications or
recurrences
• Ciprofloxacin/metronidazol (most widely used
therapy (ampicilina/sulbactam as an alternative)
• There are no advantages of IV vs oral AB therapy
• Clinical improvement should be seen in the first
3 to 4 days
Hinchey 0 or IaHinchey 0 or Ia
Gargallo Puyuelo C et al. Colonic diverticular disease. Treatment and
prevention. Gastroenterol Hepatol. 2015

4. • 15% of patiens will develop an abscess
• In hospital treatment required
• There is no clinical evidence of an optimal
therapy
• AB effective in up to 70% of abscess <4cm
• Percutaneous drainage effective in up to 80%
Hinchey Ib or IIHinchey Ib or II
Gargallo Puyuelo C et al. Colonic diverticular disease. Treatment and
prevention. Gastroenterol Hepatol. 2015

5. Gargallo Puyuelo C et al. Colonic diverticular disease. Treatment and
prevention. Gastroenterol Hepatol. 2015
• Mortality 14%
• Early surgery recommended
• Hemodynamicaly unstable: Hartmann’s
procedure
• Hemodynamicaly stable: primary anastomosis
with or without proximal fecal diversion.
Hinchey III or IVHinchey III or IV

6. Gargallo Puyuelo C, Sopeña F, Arbeloa A. Colonic diverticular disease.
Treatment and prevention. Gastroenterol Hepatol. 2015

7. Gargallo Puyuelo C, Sopeña F, Arbeloa A. Colonic diverticular disease.
Treatment and prevention. Gastroenterol Hepatol. 2015