A focus of therapeutic strategies in acute diverticulitis with distant free air: a systematic review

Acute diverticulitis (AD) is a significant socioeconomic burden on healthcare systems, primarily due to elevated rates of hospital admissions and considerable healthcare expenditures. The aim of this systematic review is to update and sum- marise existing knowledge regarding the viability of conservative management in 2B stage cases (distant free extralu- minal air) that remains a crucial condition for surgeons to decide for operative or non-operative management. Patients ages ranging between 52.2 and 60.5 years. Male patients varied from 47 to 73.4%. BMI ranged from 25.7 to 27.1 kg/m2 , and ASA scores between I and III. Antibiotic regimens varied across studies, including mono-antibiotic or bi-antibiotic therapy (average duration from 7 to 21 days). Percutaneous drainage was used in 3.5 to 27.6%. NOM failure ranged from 2.6 to 31.9%, with corresponding emergency surgery rates between 2.17 and 69%. Mortality was low overall. Follow-up durations ranged from 1 to 71 months.

Acute diverticulitis (AD) is a significant socioeconomic burden on healthcare systems, primarily due to elevated rates of hospital admissions and considerable healthcare expenditures. The aim of this systematic review is to update and summarise existing knowledge regarding the viability of conservative management in 2B stage cases (distant free extraluminal air) that remains a crucial condition for surgeons to decide for operative or non-operative management. Patients ages ranging between 52.2 and 60.5 years. Male patients varied from 47 to 73.4%. BMI ranged from 25.7 to 27.1 kg/m2, and ASA scores between I and III. Antibiotic regimens varied across studies, including mono-antibiotic or bi-antibiotic therapy (average duration from 7 to 21 days). Percutaneous drainage was used in 3.5 to 27.6%. NOM failure ranged from 2.6 to 31.9%, with corresponding emergency surgery rates between 2.17 and 69%. Mortality was low overall. Follow-up durations ranged from 1 to 71 months. Thirty-day readmission (7.7%) and recurrence (up to 27.8%) were inconsistently reported. The management of AD with distant extraluminal free air remains a complex and challenging topic, however, despite several limits due to the low level of evidence, our review reported that NOM may be feasible in carefully selected, hemodynamically stable individuals, knowing that failure rates can be variable. The ongoing COLD 2B study (ClinicalTrials.Gov ID Number NCT 06388538), a multi-center prospective trial, promoted by research Emergency Surgery committee of the Italian Society of Endoscopic Surgery and New Technologies (SICE), was designed to provide high-quality evidence on this complex condition.