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Diseases of the Colon & Rectum

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name="wkhealth_article_publication_date" content="July 15, 2022" /><meta name="wkhealth_volume" content="66" /><meta name="wkhealth_ovid_accession_number" content="00003453-202303000-00016" /><meta name="wkhealth_issn" content="0012-3706" /><meta name="wkhealth_title" content="Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience" /><meta name="wkhealth_authors" content="He, Shengliang;Lu, Patricia;Etzioni, David;Young-Fadok, Tonia;Kelley, Scott R.;Merchea, Amit;Mishra, Nitin" /><meta name="wkhealth_doi" content="10.1097/DCR.0000000000002447" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/dcrjournal/abstract/2023/03000/management_of_acute_diverticulitis_in.16.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/dcrjournal/fulltext/2023/03000/management_of_acute_diverticulitis_in.16.aspx" /><meta name="wkhealth_toc_section" content="Original Contributions" /><meta name="wkhealth_toc_sub_section" content="Benign" /><meta name="wkhealth_eJpId" content="dcrjournal:2023:03000:00016" /><meta name="wkhealth_firstpage" content="434" /><meta name="wkhealth_date" content="March 2023" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/dcrjournal/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&amp;an=00003453-202303000-00016" /><meta name="Description" content="BACKGROUND: Acute diverticulitis in immunocompromised patients is associated with high morbidity " /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="Management of Acute Diverticulitis in Immunocompromised... : Diseases of the Colon &amp; Rectum" /><meta property="og:description" content="aimed to report the Mayo clinic experience of acute diverticulitis management in immunocompromised patients. DESIGN: This design is based on a retrospective cohort study. SETTING: This study was conducted with institutional data composed from 3 tertiary referral centers. PATIENTS: Immunocompromised patients presenting with acute diverticulitis at 3 Mayo clinic sites between 2016 and 2020 were included. MAIN OUTCOME MEASURES: The main outcome measures were the management algorithm and short-term outcomes. RESULTS: Immunocompromised patients presenting with acute uncomplicated diverticulitis (86) were all managed nonoperatively at presentation with a success rate of 93% (80/86). Two patients (2.3%, 2/86) required surgery during the same admission, and 4 patients (4.8%, 4/84) had 30-day readmission. Complicated diverticulitis patients with abscess (22) were all managed nonoperatively first with a success rate of 95.4% (21/22). One patient (4.6%, 1/22) required surgery during the same admission. All the patients who presented with obstruction (2), fistula (1), or free perforation (11) underwent surgery except one who chose hospice. Overall, the major complication rate was 50% (8/16) and mortality rate was 18.8% (3/16) among patients who underwent surgery during the same admission. For patients who presented with perforated diverticulitis, the mortality rate was 27.3% (3/11), compared with 0% (0/111) for patients who presented with nonperforated disease. LIMITATIONS: This cohort was limited by its retrospective nature and heterogeneity of the patient population. CONCLUSIONS: Nonoperative management was safe and feasible for immunocompromised patients with colonic diverticulitis without perforation at our center. Perforated colonic diverticulitis in immunocompromised patients was associated with high morbidity and mortality rate. See Video Abstract at http://links.lww.com/DCR/B988. MANEJO DE LA DIVERTICULITIS AGUDA EN PACIENTES INMUNOCOMPROMETIDOS: EXPERIENCIA DE LA CLINICA MAYO ANTECEDENTES: La diverticulitis aguda en pacientes inmunocomprometidos se asocia con una alta tasa de morbilidad y mortalidad con el tratamiento médico o quirúrgico. Por lo tanto, el enfoque de manejo es controvertido, especialmente para pacientes que presentan enfermedad no perforada. OBJETIVO: El propósito fue informar la experiencia de la clínica Mayo en el manejo de la diverticulitis aguda en pacientes inmunocomprometidos. DISEÑO: Este es un estudio de cohorte retrospectivo ENTORNO CLÍNICO: Este estudio se realizó con datos institucionales compuestos de tres centros de referencia terciarios. PACIENTES: Se incluyeron pacientes inmunocomprometidos que presentaron diverticulitis aguda en tres sitios de la clínica Mayo entre 2016 y 2020. RESULTADO PRINCIPAL: Algoritmo de gestión y resultados a corto plazo. RESULTADOS: Los pacientes inmunocomprometidos que presentaban diverticulitis aguda no complicada (86) fueron tratados de forma no quirúrgica en la presentación inicial con una tasa de éxito del 93 % (80/86). Dos pacientes (2,3%, 2/86) requirieron cirugía durante el mismo ingreso y cuatro pacientes (4,8%, 4/84) tuvieron reingreso a los 30 días. Todos los pacientes con diverticulitis complicada con absceso (22) fueron tratados primero de forma no quirúrgica con una tasa de éxito del 95,4 % (21/22). Un paciente (4,6%, 1/22) requirió cirugía durante el mismo ingreso. Todos los pacientes que presentaron obstrucción (2), fístula (1) o perforación libre (11) fueron intervenidos excepto uno que optó por hospicio. La tasa global de complicaciones mayores fue del 50 % (8/16) y la tasa de mortalidad fue del 18,8 % (3/16) entre los pacientes que se sometieron a cirugía durante el mismo ingreso. Para los pacientes que presentaban diverticulitis perforada, la tasa de mortalidad fue del 27,3 % (3/11), en comparación con el 0 % (0/111) de los pacientes que presentaban enfermedad no perforada. LIMITACIONES: Esta cohorte estuvo limitada por su naturaleza retrospectiva y la heterogeneidad de la población de pacientes. CoNCLUSIÓNES: El manejo no quirúrgico fue seguro y factible para pacientes inmunocomprometidos con diverticulitis colónica sin perforación en nuestro centro. La diverticulitis colónica perforada en pacientes inmunocomprometidos se asoció con una alta tasa de morbilidad y mortalidad. Consulte Video Resumen en http://links.lww.com/DCR/B988. 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XItZ2FfMjg5M2I2M2UtNWNiMS00MTZkLTk3MmMtMmIyM2RlNjI4ZDA4IiBkYXRhLXNpemVtYXA9IltbWzAsIDBdLCBbWzMwMCwgMjUwXV1dXSIgZGF0YS1hZHBhdGg9Ii8xNTcyNjcwMjc2MS9EZXNrdG9wL2RjcmpvdXJuYWwvQXJ0aWNsZS9SaWdodCIgZGF0YS1hdXRvbG9hZD0ibm8iIGRhdGEtb3V0b2ZwYWdlPSJubyIgZGF0YS1zdGlja3k9Im5vIiBkYXRhLXNsb3R0YXJnZXRpbmc9JycgZGF0YS1kaXNwbGF5c2x1Zz0ieWVzIiBkYXRhLXN0aWNreS1kdXJhdGlvbj0iMCIgZGF0YS1uYW1lPSJSaWdodCI+PC9kaXY+HwBnZAUmZ18zMjc1MjhlY19jNTUxXzQ4ZDdfOWM4NV9hNzMyOTE3ZWU0YWIPZBYEZg8WBB8DZB8sBVp7InNlcnZpY2VVcmwiOm51bGwsImRpc3BsYXlNb2RlIjpudWxsLCJoYXNoIjoiMSIsIml0ZW1zUGVyUGFnZSI6NDAsInJlbmRlck9uU2VydmVyIjpmYWxzZX1kAgEPZBYCZg9kFgJmDxQrAAIPFgQfJmcfJwIFZGRkBSZnXzZmY2RiYzBhX2Y4M2RfNDZhNF9hMjk0XzExNzhkMzQwN2I3YQ9kFgJmD2QWAgICDxYEHwMFLWVqLWFkdmVydGlzZW1lbnQgZWotYWR2ZXJ0aXNlbWVudC1iYW5uZXJjb21ibx8AZxYCAgEPFgQfAgXmAzxkaXYgaWQ9ImdhXzU5MTI0ZDA0LWViYTItNDk3NC1iZWFkLTQxMDIzNDNmNWM1YiIgY2xhc3M9ImFkLXNsb3QtY29udGFpbmVyIGFkLXNsb3QtY29udGFpbmVyLWdhXzU5MTI0ZDA0LWViYTItNDk3NC1iZWFkLTQxMDIzNDNmNWM1YiIgZGF0YS1zaXplbWFwPSJbW1sxMDUwLCAyMDBdLCBbWzMwMCwgNjAwXSwgWzMwMCwgMjUwXSwgWzE2MCwgNjAwXV1dLCBbWzczMCwgNjAwXSwgW1szMDAsIDYwMF0sIFszMDAsIDI1MF1dXSwgWyBbIDAsIDAgXSwgWyBbMzAwLCAyNTBdIF0gXSBdIiBkYXRhLWFkcGF0aD0iLzE1NzI2NzAyNzYxL0Rlc2t0b3AvZGNyam91cm5hbC9BcnRpY2xlL1JpZ2h0MSIgZGF0YS1hdXRvbG9hZD0ibm8iIGRhdGEtb3V0b2ZwYWdlPSJubyIgZGF0YS1zdGlja3k9Im5vIiBkYXRhLXNsb3R0YXJnZXRpbmc9JycgZGF0YS1kaXNwbGF5c2x1Zz0ieWVzIiBkYXRhLXN0aWNreS1kdXJhdGlvbj0iMCIgZGF0YS1uYW1lPSJSaWdodDEiPjwvZGl2Ph8AZ2QCCQ8WAh8AaBYCAgUPZBYCAgMPFgIfAGgWAmYPZBYEAgIPZBYGAgEPFgIfAGhkAgMPFgIfAGhkAgUPFgIfAGhkAgMPDxYCHglBY2Nlc3NLZXkFAS9kZAILD2QWAgIBDw8WAh8AaGRkAhMPZBYCAgEPZBYCZg9kFgICAg8WBB8DBSplai1hZHZlcnRpc2VtZW50IGVqLWFkdmVydGlzZW1lbnQtdG9wY29tYm8fAGcWAgIBDxYEHwIFmAM8ZGl2IGlkPSJnYV8xZWUzNmNjNi1kZWQwLTQ0NjctYjk1NS1hZmQ3NTA1YjRkM2EiIGNsYXNzPSJhZC1zbG90LWNvbnRhaW5lciBhZC1zbG90LWNvbnRhaW5lci1nYV8xZWUzNmNjNi1kZWQwLTQ0NjctYjk1NS1hZmQ3NTA1YjRkM2EiIGRhdGEtc2l6ZW1hcD0iW1tbNzMwLCA1MDBdLCBbWzcyOCwgOTBdXV0sIFtbMCwgMF0sIFtbMzAwLCA1MF1dXV0iIGRhdGEtYWRwYXRoPSIvMTU3MjY3MDI3NjEvRGVza3RvcC9kY3Jqb3VybmFsL0FydGljbGUvVG9wIiBkYXRhLWF1dG9sb2FkPSJ5ZXMiIGRhdGEtb3V0b2ZwYWdlPSJubyIgZGF0YS1zdGlja3k9InllcyIgZGF0YS1zbG90dGFyZ2V0aW5nPScnIGRhdGEtZGlzcGxheXNsdWc9InllcyIgZGF0YS1zdGlja3ktZHVyYXRpb249IjUiIGRhdGEtbmFtZT0iVG9wIj48L2Rpdj4fAGdkAhUPZBYCZg9kFhBmD2QWBGYPZBYKAgEPFgIfAGgWBAIDD2QWEAIBDxYCHwBoFgICAQ8PFgIfKwWiAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9kY3Jqb3VybmFsL3NlY3VyZS9wYWdlcy9teWFjY291bnQuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweGRkAgMPFgIfAGgWAgIBDw8WAh8rBcMBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvc2VjdXJlL3BhZ2VzL215YWNjb3VudC5hc3B4P0NvbnRleHRVcmw9JTJmZGNyam91cm5hbCUyZmFic3RyYWN0JTJmMjAyMyUyZjAzMDAwJTJmbWFuYWdlbWVudF9vZl9hY3V0ZV9kaXZlcnRpY3VsaXRpc19pbi4xNi5hc3B4JmVkaXRXZWJQYXJ0PWVkaXRDaGFuZ2VQYXNzd29yZFdQZGQCBQ8WAh8AaBYCAgEPDxYCHysFpAFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9zZWN1cmUvcGFnZXMvbXlmYXZvcml0ZXMuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweGRkAgcPZBYCAgEPDxYCHysFvQFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9zZWN1cmUvcGFnZXMvbXlmYXZvcml0ZXMuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweCZjb2xsZWN0aW9uPVNhdmVkU2VhcmNoZXNkZAILD2QWAgIBDw8WAh8rBZoBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweGRkAg0PZBYCAgEPFgIfAQUZaHR0cDovL2hlYWx0aGpvYnNwbHVzLmNvbWQCDw8WAh8AZxYCAgEPDxYGHysFtwFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9wYWdlcy9sb2dpbi5hc3B4P0NvbnRleHRVcmw9JTJmZGNyam91cm5hbCUyZmFic3RyYWN0JTJmMjAyMyUyZjAzMDAwJTJmbWFuYWdlbWVudF9vZl9hY3V0ZV9kaXZlcnRpY3VsaXRpc19pbi4xNi5hc3B4JlJlcXVlc3RGb3I9QWN0aXZhdGVTdWJzY3JpcHRpb24eB0VuYWJsZWRnHwBnZGQCEw8WAh8AaBYCAgEPDxYCHysFlwFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9fbGF5b3V0cy8xNS9vYWtzLmpvdXJuYWxzL2xvZ291dC5hc3B4P0NvbnRleHRVcmw9aHR0cHMlM2ElMmYlMmZqb3VybmFscy5sd3cuY29tJTJmZGNyam91cm5hbCUyZnBhZ2VzJTJmZGVmYXVsdC5hc3B4ZGQCBQ8WAh8AaBYCAgEPFCsAAmRkZAIDDxYCHwBnZAIED2QWAgIBDw8WCB8kBSB1c2VyLW1lbnVfX2xpbmsganMtcmVnaXN0ZXItbGluax8rBZoBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweB8lAgIfAGcWAh8sBVR7ImV2ZW50TmFtZSI6IlJlZ2lzdGVyIiwiZXZlbnREZXRhaWwiOnsic291cmNlIjoiTWFzdGhlYWQgRHJvcGRvd24ifSwiaXNOdWxsIjpmYWxzZX1kAggPZBYCAgEPDxYEHwIFFFN1YnNjcmliZSB0byBqb3VybmFsHysFvgFodHRwczovL3Nob3AubHd3LmNvbS9EaXNlYXNlcy1vZi10aGUtQ29sb24tLS1SZWN0dW0tT25saW5lL3AvMTUzMC0wMzU4P3V0bV9zb3VyY2U9ZWpwLWxpbmstb3V0JnV0bV9tZWRpdW09cGFydG5lcl9zaXRlJnV0bV9jYW1wYWlnbj1oZWFsdGhfaGxycF9wcl9tZWRqbmxfY2xpbmljYWwtbnVjbGVhci1tZWRpY2luZV9saW5rLWNsaWNrZGQCCw9kFgICBg9kFgICAQ9kFgICBQ8PFgQfKwVHaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvX2xheW91dHMvb2Frcy5qb3VybmFscy9wcml2YWN5LmFzcHgfAgUOUHJpdmFjeSBQb2xpY3lkZAIBD2QWBmYPEA8WBh4NRGF0YVRleHRGaWVsZAUEVGV4dB4ORGF0YVZhbHVlRmllbGQFBFRleHQfJmdkEBUGA0FsbAhBcnRpY2xlcwZJbWFnZXMGVmlkZW9zCFBvZGNhc3RzBUJsb2dzFQYDQWxsCEFydGljbGVzBkltYWdlcwZWaWRlb3MIUG9kY2FzdHMFQmxvZ3MUKwMGZ2dnZ2dnZGQCBQ8PFgIfKwU9aHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvYWR2YW5jZWRzZWFyY2guYXNweGRkAgYPDxYCHy5oZGQCAQ8PFgIfAGhkZAICDw8WAh8rBZoBaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweGRkAgMPDxYEHysFogFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9zZWN1cmUvcGFnZXMvbXlhY2NvdW50LmFzcHg/Q29udGV4dFVybD0lMmZkY3Jqb3VybmFsJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDMwMDAlMmZtYW5hZ2VtZW50X29mX2FjdXRlX2RpdmVydGljdWxpdGlzX2luLjE2LmFzcHgfAGhkZAIEDw8WAh8AaBYCHyIFImJvcmRlci1yaWdodDoxcHggc29saWQgIWltcG9ydGFudDtkAgYPDxYCHysFlwFodHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9fbGF5b3V0cy8xNS9vYWtzLmpvdXJuYWxzL2xvZ291dC5hc3B4P0NvbnRleHRVcmw9aHR0cHMlM2ElMmYlMmZqb3VybmFscy5sd3cuY29tJTJmZGNyam91cm5hbCUyZnBhZ2VzJTJmZGVmYXVsdC5hc3B4FgIfIgUiYm9yZGVyLXJpZ2h0OjFweCBzb2xpZCAhaW1wb3J0YW50O2QCBw8WAh8sBbkBeyJicm93c2luZ0hpc3RvcnkiOnsiaXNFbmFibGVkIjp0cnVlLCJzZXJ2aWNlVXJsIjoiaHR0cHM6Ly9hcGltLWhscnAtZWpwLXByb2QuYXp1cmUtYXBpLm5ldC9lZSIsInBkZkRvd25sb2FkVXJsIjoiL19sYXlvdXRzLzE1L29ha3Muam91cm5hbHMvZG93bmxvYWRwZGYuYXNweD90cmNrbmdfc3JjX3BnPUhpc3RvcnlUYWIifX1kAgoPZBYGZg8QDxYGHy8FBFRleHQfMAUEVGV4dB8mZ2QQFQYDQWxsCEFydGljbGVzBkltYWdlcwZWaWRlb3MIUG9kY2FzdHMFQmxvZ3MVBgNBbGwIQXJ0aWNsZXMGSW1hZ2VzBlZpZGVvcwhQb2RjYXN0cwVCbG9ncxQrAwZnZ2dnZ2dkZAIFDw8WAh8rBT1odHRwczovL2pvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9wYWdlcy9hZHZhbmNlZHNlYXJjaC5hc3B4ZGQCBg8PFgIfLmhkZAIhD2QWAmYPZBYcAgEPZBYCZg9kFgJmD2QWCAIBDxYCHykFV2h0dHBzOi8vaW1hZ2VzLmpvdXJuYWxzLmx3dy5jb20vZGNyam91cm5hbC9YTGFyZ2VUaHVtYi4wMDAwMzQ1My0yMDI0MTIwMDAtMDAwMDAuQ1YuanBlZ2QCAw8WAh8qBRNOZXZlciBNaXNzIGFuIElzc3VlZAIFDxYCHyoFQUdldCBuZXcgam91cm5hbCBUYWJsZXMgb2YgQ29udGVudHMgc2VudCByaWdodCB0byB5b3VyIGVtYWlsIGluYm94ZAIJDxYGHg9kYXRhLWFsZXJ0LXR5cGUFBEV0b2MeE2RhdGEtc3Vic2NyaWJlZC1tc2cFT1lvdSBhcmUgbm93IHN1YnNjcmliZWQgdG8gcmVjZWl2ZSBlVE9DIGFsZXJ0cyB3aGVuZXZlciBuZXcgaXNzdWVzIGFyZSBwdWJsaXNoZWQfKgUUR2V0IE5ldyBJc3N1ZSBBbGVydHNkAgMPZBYGAgEPFCsAAg8WBB8mZx8nAgVkZBYKZg9kFgJmDxUDMS9kY3Jqb3VybmFsL3BhZ2VzL3ZpZXdhbGxtb3N0cG9wdWxhcmFydGljbGVzLmFzcHgADE1vc3QgUG9wdWxhcmQCAQ9kFgJmDxUDQi9kY3Jqb3VybmFsL19sYXlvdXRzLzEwMzMvb2Frcy5qb3VybmFscy9pbmZvcm1hdGlvbmZvcmF1dGhvcnMuYXNweAALRm9yIEF1dGhvcnNkAgIPZBYCZg8VAyYvZGNyam91cm5hbC9wYWdlcy9hYm91dHRoZWpvdXJuYWwuYXNweAARQWJvdXQgdGhlIEpvdXJuYWxkAgMPZBYCZg8VAyAvZGNyam91cm5hbC9wYWdlcy9pc3N1ZWxpc3QuYXNweAALUGFzdCBJc3N1ZXNkAgQPZBYCZg8VAyEvZGNyam91cm5hbC9wYWdlcy9jdXJyZW50dG9jLmFzcHgADUN1cnJlbnQgSXNzdWVkAgMPZBYCZg8PFgIfKwWaAWh0dHBzOi8vam91cm5hbHMubHd3LmNvbS9kY3Jqb3VybmFsL3BhZ2VzL3JlZ2lzdGVyLmFzcHg/Q29udGV4dFVybD0lMmZkY3Jqb3VybmFsJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDMwMDAlMmZtYW5hZ2VtZW50X29mX2FjdXRlX2RpdmVydGljdWxpdGlzX2luLjE2LmFzcHhkZAIJDxYCHwBoFgICAQ8UKwACZGRkAgUPZBYMAgEPZBYCAgEPFCsAAg8WBB8mZx8nAgJkZBYEZg9kFgJmDxUEAEUvZGNyam91cm5hbC9fbGF5b3V0cy8xNS8xMDMzL29ha3Muam91cm5hbHMvaW5mb3JtYXRpb25mb3JhdXRob3JzLmFzcHgAEVN1Ym1pdCBhbiBhcnRpY2xlZAIBD2QWAmYPFQQAJWh0dHBzOi8vd2thdXRob3JzZXJ2aWNlcy5lZGl0YWdlLmNvbS8GX2JsYW5rFkhvdyB0byBwdWJsaXNoIHdpdGggdXNkAgUPFgIfJwIEFghmD2QWAmYPFQQaZWpwLWZvb3Rlci0tc2hvdy1vbi1tb2JpbGWZAWh0dHBzOi8vbHd3LmNvbS9zZWN1cmUvcGFnZXMvYWN0aXZhdGVzdWJzY3JpcHRpb24uYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweAAiQWN0aXZhdGUgeW91ciBqb3VybmFsIHN1YnNjcmlwdGlvbmQCAQ9kFgJmDxUEGmVqcC1mb290ZXItLWhpZGUtb24tbW9iaWxlmQFodHRwczovL2x3dy5jb20vc2VjdXJlL3BhZ2VzL2FjdGl2YXRlc3Vic2NyaXB0aW9uLmFzcHg/Q29udGV4dFVybD0lMmZkY3Jqb3VybmFsJTJmYWJzdHJhY3QlMmYyMDIzJTJmMDMwMDAlMmZtYW5hZ2VtZW50X29mX2FjdXRlX2RpdmVydGljdWxpdGlzX2luLjE2LmFzcHgAHUFjdGl2YXRlIEpvdXJuYWwgU3Vic2NyaXB0aW9uZAICD2QWAmYPFQQaZWpwLWZvb3Rlci0taGlkZS1vbi1tb2JpbGU4aHR0cHM6Ly93a2hscnAubXkuc2l0ZS5jb20vTGlwcGluY290dE9ubGluZUhlbHBDZW50ZXIvcy8AFkJyb3dzZSB0aGUgaGVscCBjZW50ZXJkAgMPZBYCZg8VBBplanAtZm9vdGVyLS1zaG93LW9uLW1vYmlsZVlodHRwczovL3draGVhbHRoLmZvcmNlLmNvbS9sd3dvbmxpbmUvcy90b3BpYy8wVE8wVjAwMDAwMVlnTFpXQTAvbHd3LW9ubGluZT90YWJzZXQtZGRiZmU9MgAESGVscGQCBw8WBh8BBSBodHRwczovL3d3dy50ZmFmb3Jtcy5jb20vNDk2NjU3MB4GdGFyZ2V0BQZfYmxhbmsfKgUYU3VibWl0IGEgU2VydmljZSBSZXF1ZXN0ZAINDxYCHwBoZAIPDxQrAAIPFgQfJmcfJ2ZkZGQCEQ8WAh8AZ2QCBw8WAh8sBd8SeyJsb2dpbkNvbmZpZ3VyYXRpb24iOnsic2VydmljZVVybCI6Imh0dHBzOi8vc2VydmljZXMuam91cm5hbHMubHd3LmNvbS9JbnRlZ3JhdGlvblNlcnZpY2VzL0FjY291bnRTZXJ2aWNlLnN2Yy9Mb2dpbiIsInJlZ2lzdGVyVXJsIjoiaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvcmVnaXN0ZXIuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwMjMlMmYwMzAwMCUyZm1hbmFnZW1lbnRfb2ZfYWN1dGVfZGl2ZXJ0aWN1bGl0aXNfaW4uMTYuYXNweCIsImZvcmdvdFBhc3N3b3JkVXJsIjoiaHR0cHM6Ly9qb3VybmFscy5sd3cuY29tL2RjcmpvdXJuYWwvcGFnZXMvZm9yZ290cGFzc3dvcmQuYXNweD9Db250ZXh0VXJsPSUyZmRjcmpvdXJuYWwlMmZhYnN0cmFjdCUyZjIwM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'Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience', '07152022', 'Shengliang He, Patricia Lu, David Etzioni, et al', '66', '3', '\u00A9 The ASCRS 2022', '00003453-202303000-00016', '', false, ''); } </script> <div id="ArticleContainer"> <article id="ej-abstract-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">Original Contributions: Benign</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">Management of Acute Diverticulitis in Immunocompromised Patients—The Mayo Clinic Experience</h1></header><section id="ejp-article-authors"><p id="P7">He, Shengliang M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup>; Lu, Patricia M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup>; Etzioni, David M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup>; Young-Fadok, Tonia M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup>; Kelley, Scott R. M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2</sup>; Merchea, Amit M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">3</sup>; Mishra, Nitin M.D.<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup></p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">1</sup> Division of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">2</sup> Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">3</sup> Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida</p> <p id=""><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Funding/Support:</strong> None reported.</p> <p id=""><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Financial Disclosure:</strong> None reported.</p> <p id="">Presented at the American Society of Colon and Rectal Surgeons Annual Scientific Meeting, San Diego, CA, April 24 to 28, 2021.</p> <p id="c1"><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Correspondence:</strong> Nitin Mishra, M.D., Division of Colon and Rectal Surgery, Mayo Clinic, PX SP 03 GenSrg, 5777 E Mayo Blvd, Phoenix, AZ 85054. E-mail: <span><a href="/cdn-cgi/l/email-protection#412c20282d352e7b2c28322933206f2f2835282f012c20382e6f242534" onclick="javascript:window.open('mailto:mailto:mishra.nitin@mayo.edu');return false"><span class="__cf_email__" data-cfemail="6a07031902180b4404031e03042a070b1305440f0e1f">[email&#160;protected]</span></a></span></p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Diseases of the Colon &amp; Rectum </span><span id="ej-journal-date-volume-issue-pg"><a href="/dcrjournal/toc/2023/03000">66(3):p 434-442, March 2023.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.1097/DCR.0000000000002447</div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-buy" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Buy()" onmouseout="javascript:Tooltip_MouseOut()"><a href="#ContentAccessOptions"><span class="ejp-indicator">Buy</span></a></li> <li class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_CustomIndicator('Denotes Associated Video Abstract', 'This article contains video content.')" onmouseout="javascript:Tooltip_MouseOut()"><a href="https://links.lww.com/DCR/B988" Target="_blank"><img src="//journals.lww.com/dcrjournal/PublishingImages/blue%20icon1%20(3).jpg" Alt="Denotes Associated Video Abstract" Border="0"></a></li> <li class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_CustomIndicator('Denotes X (Twitter) Account Access', 'Tweet this article! Simply being social is a great way to get others to notice your important work. Social media mentions have been proven to at least double how much your article gets noticed.')" onmouseout="javascript:Tooltip_MouseOut()"><a href="https://twitter.com/intent/tweet?url=https%3A%2F%2Fbit.ly%2F3K27LTG&amp;via=DCRjournal&amp;text=%23DCRJournal%20out%20with%20a%20new%20publication&amp;hashtags=ColorectalResearch" Target="_blank"><img src="https://journals.lww.com/dcrjournal/PublishingImages/Twitter%20icon%20for%20tweeting%20smaller.jpg" Alt="Denotes X (Twitter) Account Access" Border="0"></a></li> <li class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_CustomIndicator('Denotes Visual Abstract', 'Click here to view Visusal Abstract.')" onmouseout="javascript:Tooltip_MouseOut()"><a href="https://journals.lww.com/dcrjournal/PublishingImages/March%202023%20Visual%20Abstracts/ImmunocompromisedDiverticulitis_March23_IR.jpg" Target="_blank"><img src="https://journals.lww.com/dcrjournal/PublishingImages/VISUAL%20ABSTRACT%20new%20icon2.jpg" Alt="Denotes Visual Abstract" Border="0"></a></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.1097/DCR.0000000000002447" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2022-07-15" data-articlePublicationDateString="July 15, 2022" data-receivedDate="" data-revisionReceivedDate="" data-acceptedDate="" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="35853178"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3>BACKGROUND:&nbsp;</h3> <p>Acute diverticulitis in immunocompromised patients is associated with high morbidity and mortality rates with either medical or surgical treatment. Thus, management approach is controversial, especially for patients presenting with nonperforated disease.</p> <h3>OBJECTIVE:&nbsp;</h3> <p>This study aimed to report the Mayo clinic experience of acute diverticulitis management in immunocompromised patients.</p> <h3>DESIGN:&nbsp;</h3> <p>This design is based on a retrospective cohort study.</p> <h3>SETTING:&nbsp;</h3> <p>This study was conducted with institutional data composed from 3 tertiary referral centers.</p> <h3>PATIENTS:&nbsp;</h3> <p>Immunocompromised patients presenting with acute diverticulitis at 3 Mayo clinic sites between 2016 and 2020 were included.</p> <h3>MAIN OUTCOME MEASURES:&nbsp;</h3> <p>The main outcome measures were the management algorithm and short-term outcomes.</p> <h3>RESULTS:&nbsp;</h3> <p>Immunocompromised patients presenting with acute uncomplicated diverticulitis (86) were all managed nonoperatively at presentation with a success rate of 93% (80/86). Two patients (2.3%, 2/86) required surgery during the same admission, and 4 patients (4.8%, 4/84) had 30-day readmission. Complicated diverticulitis patients with abscess (22) were all managed nonoperatively first with a success rate of 95.4% (21/22). One patient (4.6%, 1/22) required surgery during the same admission. All the patients who presented with obstruction (2), fistula (1), or free perforation (11) underwent surgery except one who chose hospice. Overall, the major complication rate was 50% (8/16) and mortality rate was 18.8% (3/16) among patients who underwent surgery during the same admission. For patients who presented with perforated diverticulitis, the mortality rate was 27.3% (3/11), compared with 0% (0/111) for patients who presented with nonperforated disease.</p> <h3>LIMITATIONS:&nbsp;</h3> <p>This cohort was limited by its retrospective nature and heterogeneity of the patient population.</p> <h3>CONCLUSIONS:&nbsp;</h3> <p>Nonoperative management was safe and feasible for immunocompromised patients with colonic diverticulitis without perforation at our center. Perforated colonic diverticulitis in immunocompromised patients was associated with high morbidity and mortality rate. See <strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Video Abstract</strong> at <span><a href="https://links.lww.com/DCR/B988" onclick="javascript:window.open('https://links.lww.com/DCR/B988');return false">https://links.lww.com/DCR/B988</a></span>.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">MANEJO DE LA DIVERTICULITIS AGUDA EN PACIENTES INMUNOCOMPROMETIDOS: EXPERIENCIA DE LA CLINICA MAYO</strong></p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ANTECEDENTES:</strong></p> <p>La diverticulitis aguda en pacientes inmunocomprometidos se asocia con una alta tasa de morbilidad y mortalidad con el tratamiento médico o quirúrgico. Por lo tanto, el enfoque de manejo es controvertido, especialmente para pacientes que presentan enfermedad no perforada.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">OBJETIVO:</strong></p> <p>El propósito fue informar la experiencia de la clínica Mayo en el manejo de la diverticulitis aguda en pacientes inmunocomprometidos.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">DISEÑO:</strong></p> <p>Este es un estudio de cohorte retrospectivo</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ENTORNO CLÍNICO:</strong></p> <p>Este estudio se realizó con datos institucionales compuestos de tres centros de referencia terciarios.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">PACIENTES:</strong></p> <p>Se incluyeron pacientes inmunocomprometidos que presentaron diverticulitis aguda en tres sitios de la clínica Mayo entre 2016 y 2020.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">RESULTADO PRINCIPAL:</strong></p> <p>Algoritmo de gestión y resultados a corto plazo.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">RESULTADOS:</strong></p> <p>Los pacientes inmunocomprometidos que presentaban diverticulitis aguda no complicada (86) fueron tratados de forma no quirúrgica en la presentación inicial con una tasa de éxito del 93 % (80/86). Dos pacientes (2,3%, 2/86) requirieron cirugía durante el mismo ingreso y cuatro pacientes (4,8%, 4/84) tuvieron reingreso a los 30 días. Todos los pacientes con diverticulitis complicada con absceso (22) fueron tratados primero de forma no quirúrgica con una tasa de éxito del 95,4 % (21/22). Un paciente (4,6%, 1/22) requirió cirugía durante el mismo ingreso. Todos los pacientes que presentaron obstrucción (2), fístula (1) o perforación libre (11) fueron intervenidos excepto uno que optó por hospicio. La tasa global de complicaciones mayores fue del 50 % (8/16) y la tasa de mortalidad fue del 18,8 % (3/16) entre los pacientes que se sometieron a cirugía durante el mismo ingreso. Para los pacientes que presentaban diverticulitis perforada, la tasa de mortalidad fue del 27,3 % (3/11), en comparación con el 0 % (0/111) de los pacientes que presentaban enfermedad no perforada.</p> <p><strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">LIMITACIONES:</strong></p> <p>Esta cohorte estuvo limitada por su naturaleza retrospectiva y la heterogeneidad de la población de pacientes.</p> <h3>CoNCLUSIÓNES:&nbsp;</h3> <p>El manejo no quirúrgico fue seguro y factible para pacientes inmunocomprometidos con diverticulitis colónica sin perforación en nuestro centro. La diverticulitis colónica perforada en pacientes inmunocomprometidos se asoció con una alta tasa de morbilidad y mortalidad. Consulte <strong xmlns:mrws="http://webservices.ovid.com/mrws/1.0">Video Resumen</strong> en <span><a href="https://links.lww.com/DCR/B988" onclick="javascript:window.open('https://links.lww.com/DCR/B988');return false">https://links.lww.com/DCR/B988</a></span>. <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">(Traducción— Dr. Ingrid Melo</em>)</p> </div> </div> </div></section><section class="ej-article-copyright">© The ASCRS 2022</section></article> </div> </div> <section id="ContentAccessOptions" class="article-not-authorized-msg"> <div class="ejp-access-options-wrapper"> <div class="ejp-access-options ejp-access-options--desktop"> <div id="ctl00_ctl29_g_721823aa_3937_4f86_9832_796272fad90e_ctl00_FullTextAccessOptionsContainer" class="ejp-access-options__subscriber-access"> <h3 class="ejp-access-options__subscriber-access-title">Full Text Access for Subscribers:</h3> <div class="ejp-access-options__subscriber-access-society-list"> <div 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}); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","PopupControlID":"ctl00_ctl29_g_721823aa_3937_4f86_9832_796272fad90e_ctl00_emailToColleague_pnlEmailToColleague","dynamicServicePath":"/dcrjournal/pages/articleviewer.aspx","id":"emailToColleaguePopupExtender_1581385939"}, null, null, $get("ctl00_ctl29_g_721823aa_3937_4f86_9832_796272fad90e_ctl00_emailToColleague_hypEmailToColleague")); }); //]]> </script> </form> <span id="DeltaPlaceHolderUtilityContent"> </span> <script type="text/javascript">// <![CDATA[ var g_Workspace = "s4-workspace"; // ]]> </script> <div id="ctl00_ctl64_divAdConfig" data-adconfig="{&quot;adTitle&quot;:&quot;Advertisement&quot;,&quot;slotClass&quot;:&quot;ad-slot-container&quot;,&quot;topBanner&quot;:{&quot;sticky&quot;:&quot;true&quot;,&quot;stickyDuration&quot;:&quot;5000&quot;},&quot;lazyLoadingEnabled&quot;:false,&quot;npiHash&quot;:&quot;&quot;,&quot;pageTargeting&quot;:{&quot;ArticleId&quot;:&quot;00003453-202303000-00016&quot;}}" data-videoadconfig="{&quot;serverURL&quot;:&quot;https://pubads.g.doubleclick.net/gampad/ads&quot;,&quot;sizes&quot;:&quot;320x180|640x360&quot;,&quot;overlayUnitPath&quot;:&quot;/15726702761/Desktop/dcrjournal/Video/overlay&quot;,&quot;prerollUnitPath&quot;:&quot;/15726702761/Desktop/dcrjournal/Video/pre-roll&quot;,&quot;postrollUnitPath&quot;:&quot;/15726702761/Desktop/dcrjournal/Video/post-roll&quot;}" class="js-ad-config"> </div> <div id="ctl00_ctl64_divScripts"><script type="text/plain" async="async" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js" class="optanon-category-C0004"></script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/ads.js?v=05.24.00.023" defer="true"> </script> </div> <!-- Control to add scripts depending on settings from Configuration DB like --> <script type="text/javascript"> (function($) { if (false) { $(".top-microbar-container").addClass('top-microbar-container-moved').insertAfter(".advertisement-content_top"); 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