Percutaneous drainage of colonic diverticular abscess: Is colon resection necessary?

BACKGROUND: Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended. OBJECTIVE: The aim of this study was to review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention. Design: This was an observational study. SETTINGS: This investigation was conducted at a tertiary care academic medical center and a single-hospital health system. Patients: Patients treated for symptomatic colonic diverticular abscess from 2002 through 2007 were included. MAIN OUTCOME MEASURES: The primary outcomes measured were complications, recurrence, and colectomy-free survival. Results: Two hundred eighteen patients underwent percutaneous drainage of colonic diverticular abscesses. Thirty-two patients (15%) did not undergo subsequent colonic resection. Abscess location was pelvic (n = 9) and paracolic (n = 23), the mean abscess size was 4.2 cm, and the median duration of percutaneous drainage was 20 days. The comorbidities of this group of patients included severe cardiac disease (n = 16), immunodeficiency (n = 7), and severe pulmonary disease (n = 6). Freedom from recurrence at 7.4 years was 0.58 (95% CI 0.42-0.73). All recurrences were managed nonoperatively. Recurrence was significantly associated with an abscess size larger than 5 cm. Colectomy-free survival at 7.4 years was 0.17 (95% CI 0.13-0.21). Limitation: This study was limited by its retrospective, nonexperimental design and short follow-up. Conclusion: In selected patients, observation after percutaneous drainage of colonic diverticular abscess appears to be a safe and low-risk management option.