Efficacy of Non-Operative Management and Risk Factors for Failure in Acute Diverticulitis with Extraluminal Air: A Retrospective Analysis
Ekkarin Supatraku¹, Jiroot Paleekupt², Punnawat Chandrachamnong²
Affiliation : ¹ Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; ² Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background: Non-operative management (NOM) is increasingly considered for carefully selected cases of perforated diverticulitis with extraluminal air. However, the risk factors associated with failure in such cases remain unclear.
Objective: To evaluate the efficacy of NOM in acute diverticulitis with extraluminal air and to identify clinical and imaging risk factors associated with failure of NOM.
Materials and Methods: A retrospective review was conducted on 30 patients with extraluminal air on computed tomography (CT) imaging who met the inclusion criteria for NOM between January 2012 and December 2022. Baseline characteristics, clinical data, and imaging findings were analyzed. Univariable logistic regression was performed to identify predictors of failure, reported as odds ratios (OR) with 95% confidence intervals (CI).
Results: Of the 30 patients, 22 (73.3%) (95% CI 57.6 to 89.0) successfully underwent NOM, while eight (26.7%), required surgery due to clinical deterioration. Univariable logistic regression identified three significant risk factors for failure, temperature of 37.8 ℃ or greater (OR 3.50, 95% CI 1.03 to 11.87, p=0.044), complicated diverticulitis (OR 4.58, 95% CI 1.35 to 15.51, p=0.014), and distant intra-abdominal fluid (OR 16.67, 95% CI 2.17 to 128.18, p=0.007).
Conclusion: Approximately three-fourths of patients with extraluminal air can be successfully managed non-operatively. However, the presence of distant intra-abdominal fluid, complicated diverticulitis, and an initial temperature of 37.8℃ or greater were observed to be associated with increased risk of failure. These findings highlight the importance of careful risk stratification, close clinical monitoring, and the need for further studies to validate these results and optimize patient outcomes.
Received 21 March 2025 | Revised 29 July 2025 | Accepted 22 October 2025
DOI: 10.35755/jmedassocthai.2025.11.892-897-02932
Keywords : Right-side colonic diverticulitis; Extraluminal air; Non-operative management
