EP207 - The Theoretical Management of Acute Diverticulitis in Space - A Literature Review

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Purpose/Background: Commercial space travel is exponentially increasing. Following a trend set forth by commercial aviation 100 years ago, commercial operations are poised to outpace governmental operations in the next 20 years. As commercial space flight participants and astronauts are currently not screened as rigorously as professional astronauts, the health risks will start to mirror background terrestrial health risks. It is inevitable that surgical emergencies will present themselves in these austere environments, potentially leading to loss of crew and mission failure. Predicting the types of surgical diseases, their severity, and their management outcomes becomes pivotal in mission medical system planning. Diverticulitis is one of the most common causes of gastrointestinal hospitalizations and emergency surgical care. As diverticulitis has a wide spectrum of presentation, knowing how to evaluate and treat patients in space diagnosed with potential diverticulitis will be crucial. This paper reviews the current literature on the incidence, evaluation, and management of diverticulitis in civilian populations and extends this review to include concerns related to colorectal and diverticular diseases in space flight.

Methods/Interventions: A literature review was conducted, briefly covering current management of diverticulitis and reviewing ASCRS guidelines. Further, additional review was conducted to review some of the risk factors unique to space flight such as gas expansion, immune system and microbiota changes, and delayed intestinal transit times. The final section details the theoretical diagnosis and management of acute uncomplicated and complicated diverticulitis in limited resource settings such as low earth orbit, lunar colonies, and deep space missions.

Results/Outcomes: Diagnosis and managing acute diverticulitis in a low resource setting such as low earth orbit or a lunar colony retains critical principles in the management of diverticulitis on earth with regular access to ample resources. History and a physical exam are critical portions that can be conducted in conjunction with a crew medical officer on the ground. Laboratory testing is still limited during space missions, but promising studies have been conducted with good reproducibility and validity. CT imaging that is classically used for diverticulitis diagnosis would be replaced with point of care ultrasound. Uncomplicated diverticulitis can be managed with or without antibiotics and bowel rest, similar to management on earth. Complicated diverticulitis would need potential ultrasound guided drain placement in abscesses. While further testing needs to be done, laparoscopic surgery is a possible approach to manage complicated diverticulitis in an emergency scenario.

Conclusion/Discussion: Acute diverticulitis is becoming a more and more commonly treated disease in Western countries. The odds of occult diverticulosis in astronaut candidates and civilians traveling to space in the future will only increase, and with this the risk of acute diverticulitis occurring in the microgravity environment of space. It is only a matter of time before surgical procedures in space will become necessary.There is a need for technological advancement if we are to accurately diagnose and treat diverticulitis, let alone other intra-abdominal pathology that will inevitably occur in space. This paper will be a springboard for future research looking at risk models using simulations to predict outcomes of acute diverticulitis on future space missions.