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Session: ePoster: Benign Abdominal 1 (Sun8)

EP217 - Complicated Diverticulitis Management: Comparing Outcomes of Standard Surgical Intervention to Aggressive Non-Operative Management as a Bridge to One Stage Resection

Sunday, May 11, 2025
8:43 AM – 8:48 AM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Marine Bolliet, MD (she/her/hers)

    General Surgery Resident
    Henry Ford Providence Hospital
    Southfield, MI, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • BM

    Brooke C. Mower, MD

    Resident Physician
    Ascension Providence Hospital
    Novi, Michigan, United States

    Disclosure information not submitted.

  • AL

    Athena Lekanides, MD

    Resident physician
    MSUCHM-Ascension Providence Hospital
    Southfield, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • AD

    Amir Damadi, MD, FASCRS

    Section Chair Colon and Rectal Surgery
    Providence Hospital Southfield Michigan/Michigan State University
    Southfield, Michigan, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • LR

    Lavanya Raghav, MS4

    Medical Student
    American University of the Caribbean
    Farmington Hills, Michigan, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Marine Bolliet, MD: This individual has no financial relationships with ineligible companies.
Amir Damadi, MD, FASCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Diverticular disease is the most common non-cancerous disease of the colon and the third most common gastrointestinal inpatient diagnosis, with over 300,000 admissions annually. Current management of diverticulitis is highly individualized, with factors including access to healthcare, comorbidities, and preferences of the patient and surgeon that all play a part in which management strategy is elected.

We aim to evaluate different management strategies to yield the best individualized patient care possible. Outcomes in patients who underwent aggressive conservative/non-surgical (AC) initial management were compared to patients who underwent same admission non-emergent surgical (SAS) management for complicated diverticulitis.

The goal of this study is to compare the rates of ostomy creations and subsequent reversals in patients who underwent AC management compared to SAS management.

Methods/Interventions: Patients from January 2015 to 2021 who underwent surgical intervention for complicated diverticulitis were analyzed and those who underwent AC or SAS management were identified. The AC management included patients who underwent multiple drainage procedures and/or were sent home on total parenteral nutrition (TPN) prior to their outpatient surgical intervention. Exclusion criteria were patients requiring emergent surgery, those with underlying gastrointestinal pathology, or immunocompromised patients.
The data were analyzed using Fisher’s exact test with the primary outcome being ostomy requirement. The secondary outcome was the rate of ostomy reversal within the AC and SAS groups.

Results/Outcomes: Patients with complicated diverticulitis demonstrated a statistically significant (p < 0.0001) decreased rate of ostomy formation in the AC management (11.43% ostomy rate; n=35) compared to the SAS management (88.89% ostomy rate; n=18). The ostomy reversal rate in the AC group was 75% (3 out of 4 ostomies), compared to 37.5% in the SAS group (6 out of 16 ostomies), which was not statistically significant (p=0.64).

Conclusion/Discussion: The rate of ostomy creation for complicated diverticulitis was found to be significantly decreased in the patient population with AC management compared to those who underwent SAS management. The ostomy reversal rates were found to be similar in the AC and SAS management groups, which suggests that initial conservative management does not preclude future ostomy reversal. Ostomy creation can lead to additional morbidity from dehydration, leaks, prolapse, retraction, skin maceration, and possible surgery for reversal. Our data suggests that in the appropriate population, escalating to aggressive conservative measures such as multiple drainage procedures and bowel rest with addition of TPN can be successfully utilized. These measures are used as initial bridging management strategies for complicated diverticulitis with the goal of one stage resection.