Journal Club Presentation

Perforated Diverticulitis

Nor Haryanti Hashim Surgical Intern 28th September 2011

Diverticulosis and Perforated Diverticulitis

Diverticulosis and Perforated Diverticulitis

Diverticulosis and Perforated Diverticulitis

BACKGROUND
Aim of this study:
To measure perforated diverticulitis (PD) in a large UK population To identify factors affecting outcome perforated diverticulitis

Diverticulosis and Perforated Diverticulitis

METHODS
Computerised searches of hospital coding databases for PD were performed in 5 hospitals in East Anglia, UK Data collected for 5 years (1995 2000)

Incidence was collected using population data

Factors associated with morbidity and mortality were identified using multivariable and univariable testing

Diverticulosis and Perforated Diverticulitis

INCLUSION CRITERIA
Macroscopic colonic diverticular perforation at surgery or autopsy Evidence of extracolonic pus or feaces in the presence of diverticulum with no other intra abdominal pathology Patient who did not undergo surgery if there is radiological evidence of diverticular abscess

Diverticulosis and Perforated Diverticulitis

MORTALITY
Medication

Pre existing
Comorbidities Risk factor

ASA score

In hospital

Hinchey score Type of surgery

Diverticulosis and Perforated Diverticulitis

MORBIDITY

Morbidity

Cardiorespiratory

Systemic sepsis

Wound & stoma related

Thromboembolic event

Persistent abdo sepsis

Diverticulosis and Perforated Diverticulitis

RESULTS
202 patiets with PD were identified 93.1 % underwent surgery 24.3 % died Female > male Incidence of PD increases with age

Diverticulosis and Perforated Diverticulitis

MORTALITY (24 %)
Medication NSAIDs

Pre existing
Comorbidities Renal disease, age
Risk factor ASA score >2

In hospital

Hinchey score Severe perforation Type of surgery

Diverticulosis and Perforated Diverticulitis

Diverticulosis and Perforated Diverticulitis

MORBIDITY (48.5%)
Half of the patient has significant morbidity

Mainly Wound infection 13% Cardiorespiratory 13% Increasing age is a strong predictive factor

Diverticulosis and Perforated Diverticulitis

Diverticulosis and Perforated Diverticulitis

CONCLUSION
PD is uncommon but is a serious acute abdominal condition Highest incidence in women > 65 years old Mortality rates are high especially in NSAIDs users Pre existing renal impairment Is prevention better than cure ? 2/3 of patients have no previous diagnosis of DD Effective surgical management and MDT are vital
Diverticulosis and Perforated Diverticulitis

REFERENCES
1. Incidence of perforated diverticulitis and risk factors for death in a UK population, C. R. Morris et al, British Journal Surgery 2008 2. Management of diverticulitis, M. M. Szojda et al, Alimentary Pharmacology & Therapeutics Journal 2007 3. The current and evolving treatment of colonic diverticular disease, A. Tursi et al, Alimentary Pharmacology & Therapeutics Journal 2009 4. OHCM
Diverticulosis and Perforated Diverticulitis