Management of Complicated Diverticulitis

Annotation for Point D

Grade II (phlegmon with abscess 94 cm) or those with smaller abscesses that are not responding to antibiotics should be treated by CT-guided percutaneous drainage (PCD).¹⁸ The preferred approach is transabdominal either anterior or lateral, attempting to avoid the inferior epigastric or deep circumflex iliac vessels. Other approaches include transgluteal, transperineal, transvaginal, or transanal. PCD patients are followed clinically, and the decision for surgery is based on progression of disease based on SIRS severity and ongoing organ dysfunction. Reported failure rates for PCD range from 15% to 30%, with a complication rate of 5% (including bleeding, perforation of a hollow viscus, or fistula formation). Patients who fail PDC should undergo the HP. Patients who respond well to PDC should be discharged home (see K. Home).