IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments
Authors: Sartelli Massimo , Binda Gian Andrea , Brandara Francesco , Borasi Andrea , Feroci Francesco , Vadalà Salvatore , Labricciosa Francesco M. , Birindelli Arianna , Luridiana Gianluigi , Coccolini Federico , Di Saverio Salomone , Catena Fausto , Ansaloni Luca , Campanile Fabio Cesare , Agresta Ferdinando , Piazza Diego ,   IPOD study Collaborative Working Group, Anania Gabriele , Caproli Emanuele , Gasparrini Marcello , Bordoni Pierpaolo , Lucchi Andrea , Scabini Stefano , Picardi Biagio , Sarro Giuliano , Piccinini Alice , Bedin Natalino , Bussotti Alessandro , De Angelis Renato , Baiocchi Gian Luca , Andreotti Antonella , Cillara Nicola , Petronio Barbara , Grimaldi Sergio , Biancafarina Alessia , Somenzi Dario , Costanzi Andrea , Marvaso Alberto , Canfora Alfonso , Vasquez Giorgio , Chiodo Carlo , Nano Mario , Cavicchi Angelo , Ruffato Alberto , Baccari Paolo , Polastri Roberto , Marsanic Patrizia , Portale Giuseppe , Gordini Luca , Abongwa Hariscine K , Pili Michela , Turati Luca , Nusca Vittoria , Guercioni Gianluca , Delogu Leonardo Andrea , Robustelli Umberto , Piras Danilo , Serventi Fernando , Prando Daniela , Brunelli Antonio , Zani Bruno , Pintaldi Salvatore , Verzelli Augusto , Mulas Silvia , Confalonieri Gianmaria , Spagni Giuditta , Crucitti Antonio , Sagnotta Andrea , Fiume Stefania , Balestra Francesco , Gatti Matteo , Eugeni Emilio , Carraro Amedeo , Genna Michele , Taglietti Lucio , Azzinnaro Antonio , Ferfoglia Stefano , Miranda Giuseppe , Tirone Giuseppe , Luparello Pietro , Berti Stefano , Tutino Roberta , De Manzoni Garberini Andrea , Roscio Francesco , Maglione Valeria , Podda Mauro , Ioia Giovanna , Cantore Fabrizio , Mazzalai Franco , Cortesi Francesco , Arcuri Giacomo , Bellanova Giovanni , Beltramo Massimo , Chessa Antonella , Coppola Massimiliano , Gozzo Davide , Harbi Asaf , Minciotti Edoardo , Pata Francesco , Pinna Giovanni , Testini Mario , Vanella Serafino 
Published: November 2016

Background

In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon’s personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments.

Methods

IPOD study is a prospective observational study performed during a 6‐month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter.

Results

Eleven hundred and twenty‐five patients with a median age of 62 years [interquartile range (IQR), 51–74] were enrolled in the IPOD study. One thousand and fifty‐four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5–10). Eight hundred and twenty‐eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann’s resection. However, the Hartmann’s resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate.

Conclusions

The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon’s personal preference.