Surgery for diverticulitis: a re-evaluation of the changing trends

Epidemiology, Management, and Outcomes of Acute Diverticulitis in King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia

BACKGROUND

Acute diverticulitis is considered one of the most common emergencies presenting with acute abdomen. There is a paucity of literature on the epidemiology and clinical picture of acute diverticulitis among the Middle Eastern population. Thus, this study aimed to describe the epidemiology, complications, and outcomes in addition to the management of acute diverticulitis in King Abdul-Aziz University Hospital (KAUH), Jeddah, Saudi Arabia.

METHODS

This retrospective study was conducted from 2009 to 2019, using data extracted from an electronic medical system. Data obtained included demographics, clinical presentation, and patient management. Quantitative variables were described as mean and standard deviation, whereas qualitative variables were described as numbers and percentages. The Mann-Whitney U test was used for non-parametric variables, and correlation analysis was done using Spearman's test.

RESULTS

Forty-five patients with a median age of 53 years had acute diverticulitis. Twenty-eight patients (62.2%) were Saudi Arabians, and 27 (60%) were male. The majority of patients (n=32, 71.1%) had only left-sided disease, and abdominal pain was the most frequently reported symptom (n=35, 77.8%). Computed tomography revealed that 21 (72.4 %) patients had Hinchey classification stage IA disease. The recurrence rate was 24.4% (N =11). Four patients required 30-day readmission (8.9%). The most commonly used inpatient antibiotic was metronidazole, and the most common surgical procedure was Hartmann's procedure. The 30-day mortality rate was 6.7% (n=3).

CONCLUSION

This study found that acute diverticulitis is more prevalent in men, has a high recurrence rate, and is predominantly seen in the left colon. Most patients have an uncomplicated form of the disease. Given the lack of previous studies in Saudi Arabia, future research should include population-based studies to identify the prevalence, complications, and outcomes of acute diverticulitis in the country.

[Acute abdomen : What the clinician wants to know from the radiologist]

CLINICAL ISSUE

Acute abdominal pain is a prevalent problem in the emergency department. The work-up has to include a broad spectrum of differential diagnoses, which should be narrowed down with respect to frequent diagnoses without overlooking rare but potentially even more severe pathologies.

STANDARD RADIOLOGICAL METHODS

The radiological method of choice for the initial work-up after sonography is computed tomography, which has demonstrated the highest sensitivity and specificity for most findings. Plain film radiographs of the abdomen rarely contribute to the final diagnosis. Magnetic resonance imaging is reserved for selected cases, which are described in this article.

ASSESSMENT

The clinical decision trees and recommendations, which need to be in the report depending on the diagnosis, are of relevance for every radiologist who deals with patients with acute abdominal presentations.

PRACTICAL RECOMMENDATIONS

Knowledge of the clinical diagnostic approach in patients with acute abdomen is an unavoidable prerequisite for optimal cooperation between clinicians and radiologists in acute situations.