Failure of Conservative Treatment of Acute Diverticulitis with Extradigestive Air

BACKGROUND: Medical management for perforated diverticulitis without abscess or peritonitis (PDwAP) has a success rate of 40-70%. Identifying patients with a risk of medical treatment failure would improve outcomes. The aim of this study was to identify the risk factors for failure of medical treatment in patients admitted with PDwAP. METHODS: This multicenter retrospective observational study included all consecutive patients admitted for PDwAP and not surgically treated over a 7-year period. Peritonitis classified on the Hinchey scale was excluded. Potential clinical, biological and radiological risk factors for medical treatment failure were collected and compared between the group of patient with a failure of medical treatment (F) and the group in which treatment did not fail. Data were collected at referral. RESULTS: Ninety-one patients were included, and 29 had a failure of treatment (31.9%). The median heart rate was different between the two groups (p 5 mm (OR 5.193; p = 0.015) and peritoneal fluid location in the pouch of Douglas (OR 4.103; p = 0.036). CONCLUSION: The severity of sepsis (tachycardia and CRP ≥150 mg/mL) and of imaging signs (pneumoperitoneum ≥5 mm and peritoneal fluid in the pouch of Douglas) were risk factors for medical treatment failure of PDwAP requiring special supervision so as not to lose time in undertaking surgical management.