ABSTRACT
Aim: To confirm safety of treatment of acute uncomplicated diverticulitis (AUD) without antibiotics, developing a standarized protocol for selected patients. Method(s): Prospective observational multicentre study carried out between january 1st 2021 and april 15th 2022. Inclusion criteria: Age between 18 and 80, AUD diagnosed by computarized tomography (CT), adequate family support and cognitive capacity, good symptom control, adequate oral intake, signed informed consent. Exclusion criteria: diabetes mellitus, cardiologic event in the last 3 months, chronic liver disease, advanced chronic renal failure, active neoplasic pathology, HIV active infection, corticoidsteroid or immunosuppresant therapy, transplant, splenectomy, inflamatory bowel disease, previous episode of diverticulitis during last 3 months and antibiotic treatment during last 2weeks. Maximum 1 of the following: T >38degreeC-<36degreeC, L >12,000/ml-<4000/ ml, heart rate>90 bpm, CPR >15 mg/dL. Patients were proposed to take part of the study and those who accepted were treated as outpatient with ibuprofen 600mg/8 h, paracetamol 1 g/8 h and omeprazol 40 mg/24h during 7days. Follow-up was carried out by telephone during first 24 h, and attending the emergency department at 48 h and at 7days. Result(s): 157 patients were diagnosed of acute diverticulits, 132 were Hinchey Ia, with 37 (28.1%) patients that fullfilled criteria for the study. 67.6% of patients were male, with median age of 57.6+/-9.7years. Among 37 patients included in the study, 36 were contacted by telephone 24 h. after first visit to emergency department. Only one of them had fever 48 h after diagnosis all patients were clinically reevaluated and only two of them needed a change of strategy, one because of fever, so we started antibiotic therapy and the other because COVID-19 infection. None of the patients needed urgent surgical intervention nor hospitalisation during the study and follow up. Conclusion(s): Our results confirm that treatment of AUD without antibiotics in selected patients is safe.
ABSTRACT
Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.