Journal Club New Version

8/3/2019 Journal Club New Version

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Journal Club PresentationPerforated Diverticulitis

Nor Haryanti Hashim

Surgical Intern28th September 2011


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Diverticulosis and Perforated Diverticulitis


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BACKGROUND

Aim of this study:

To measure perforated diverticulitis (PD) in alarge UK population

To identify factors affecting outcome perforateddiverticulitis



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METHODS

Computerised searches of hospital coding databases forPD 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 wereidentified using multivariable and univariable testing



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INCLUSION CRITERIA

Macroscopic colonic diverticular perforation at surgeryor autopsy

Evidence of extracolonic pus or feaces in the presence ofdiverticulum with no other intra abdominal pathology

Patient who did not undergo surgery if there is

radiological evidence of diverticular abscess



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MORTALITY

Risk factor

Pre existing

Medication

Comorbidities

In hospital

ASA score

Hinchey score

Type ofsurgery



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MORBIDITY

Morbidity

Cardiorespiratory Systemic sepsisWound & stoma

relatedThromboembolic

eventPersistent abdo

sepsis



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RESULTS

202 patiets with PD were identified

93.1 % underwent surgery

24.3 % died

Female > male

Incidence of PD increases with age



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MORTALITY (24 %)

Risk factor

Pre existing

Medication

NSAIDs

Comorbidities

Renal disease, age

In hospital

ASA score >2

Hinchey score

Severe perforation

Type of surgery



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MORBIDITY (48.5%)


Half of the patient has significant morbidity

Mainly Wound infection 13%

Cardiorespiratory 13%

Increasing age is a strong predictive factor


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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



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REFERENCES

1. Incidence of perforated diverticulitis and risk factors fordeath in a UK population, C. R. Morris et al, BritishJournal Surgery 2008

2. Management of diverticulitis, M. M. Szojda et al,Alimentary Pharmacology & Therapeutics Journal 2007

3. The current and evolving treatment of colonicdiverticular disease, A. Tursi et al, AlimentaryPharmacology & Therapeutics Journal 2009

4. OHCM


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