Year 2017 / Volume 109 / Number 5
Original
The use of the modified Neff classification in the management of acute diverticulitis

328-334

DOI: 10.17235/reed.2017.4738/2016

Laura Mora López, Roser Flores Clotet, Xavier Serra Aracil, Noemí Montes Ortega, Salvador Navarro Soto,

Abstract
Introduction: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. Objective: To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD. Material and methods: Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery. Results: The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage. Conclusions: The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD.
Share Button
New comment
Comments
No comments for this article
References
1. Biondo S, Lopez Borao J, Millan M,Kreisler E, Jaurrieta E.Current status of acutecolonic diverticulitis: a systematicreview.Colorectal Dis. 2011;14:e1-e11
2. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363:631-639
3. Ambrosetti P, Grossholz C, Becker C, Terrier F, Morel P. Computed tomography in acute left colonic diverticulitis. Br J Surg. 1997;84:532-534
4. Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, et al. The Management of Complicated Diverticulitis and the Role of Computed Tomography.Am J Gastroenterol 2005;100(4): 910-917
5. Liljegren G, Chabok A, Wickbom M, Smedh K, Nilsson K. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis. 2007;9:480-488
6. Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P. Acute left colonic diverticulitis - compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum. 2000;43:1363-1367
7. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon.Adv Surg. 1978;12:85-109
8. Wasvary H, Turfah F, Kadro O, Beauregard W. Same Hospitalization Resection for Acute Diverticulitis.Am Surg. 1999;65(7):632-635
9. Naraynsingh V, Maharaj R, Hassranah D, Hariharan S, Dan D, Zbar AP. Perforated left-sided diverticulitis with faecal peritonitis: is the Hinchey classification the best guide for surgical decision making? Tech. Coloproctol. 2011;15(2):199-203
10. Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG. Theefficacy of nonoperative management of acutecomplicated diverticulitis. Dis Colon Rectum. 2011;54:663-671
11. Mora L, Serra S, Serra-AracilX, Ballesteros E, Navarro S. Application of a modified Neff classification to patients with uncomplicateddiverticulitis. Colorectal Dis. 2013 Nov;15(11):1442-7
12. van de Wall BMJ, Draaisma WA, van der Kaaij RT, Consten EC, Wiezer MJ, Broeders IA. The value of inflammation markers and body temperature in acute diverticulitis.Colorectal Dis. 2013;15: 621-626
13. Lorimer JW, Doumit G. Comorbility is a major determinant of severity in acute diverticulitis. Am J Surg. 2007;193: 681-685
14. Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, Larson D. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005;242(4):576-583
15. Neff CC, van Sonnenberg E. CT of diverticulitis : diangosis and treatment. RadiolClin North Am 1989; 27: 743-52.
16. Ribas Y, Bombardó J, Aguilar F, Jovell E, Alcantara-Moral M, Campillo F, et al. Prospectiverandomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicatedacutediverticulitis.Int J Colorectal Dis. 2010 Nov; 25(11):1363-7
17. Vennix S, Morton DG, Hahnloser D. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis. 2014;16(11):866-878
18. Andeweg CS, Mulder IM, Felt-Bersma RJ. Guidelines of diagnostics and treatment of acute left-sided colonicdiverticulitis. Dig Surg. 2013;30(4-6):278-292
19. Chabok A, Pthman L, Hjern F, Haapaniemi S and Smedh K; AVOD Study Group.Randomizedclinical trial of antibiotics in acuteuncomplicated diverticulitis. Br J Surg. 2012;99(4):532–539
20. Unlü C, de Korte N, Daniels L, Consten EC, Cuesta MA, Gerhards MF, et al. Dutch Diverticular Disease (3D) Collaborative Study Group. A multicenterrandomizedclinical trial investigatingthe cost-effectiveness of treatmentstrategieswith or withoutantibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg. 2010;10:23
21. Wieghard N, Geltzeiler C, Tsikitis V. Trends in thesurgical management of diverticulitis. Ann
22. Peláez N, Pera M, Courtier R, Sánchez J, Gil MJ, Parés D, et al. Applicability, safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis.Cir Esp. 2006;80:369-372
23. Martín J, Serralta D, GarcíaA, Vaquero A, Rey C, Pérez MD, et al. Safety and efficiency of ambulatory treatment of acute diverticulitis.GastroenterolHepatol. 2009;32:83-87
24. Rodríguez-Cerrillo M, Poza-Montoro A, Fernandez-Diaz E, Romero AI. Patients with uncomplicated diverticulitis and comorbidity can be treated at home. Eur J Intern Med. 2010;21:553-554
25. Rodríguez-Cerrillo M, Poza-Montoro A, Fernandez-Diaz E, Matesanz-David M, Iñurrieta Romero A. Treatment of elderly patients with uncomplicated diverticulitis, even with comorbidity, at home. Eur J Intern Med. 2013;24:430-432
26. Etzioni DA, Chiu VY, Cannom RR, Burchette RJ, Haigh PI, Abbas MA. Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum. 2010;53:861-865
27. Ünlü C, Gunadi PM, Gerhards MF, Boermeester MA, Vrouenraets BC.Outpatient treatment for acute uncomplicated diverticulitis.Eur J GastroenterolHepatol. 2013;25:1038-1043
28. Sánchez-Velázquez P, Grande L, Pera M. Outpatient treatment of uncomplicated diverticulitis: a systematic review. Eur J GastroenterolHepatol. 2016;28:622-627
29. Jaung R, Robertson J, Vather R, Rowbotham D, Bisett IP. Changes in theapproach to acute diverticulitis ANZ J Surg. 2015;85:715-719
30. McDermott FD, Collins D, Heeney A, Winter DC. Minimallyinvasiveandsurgical management strategiestailored to theseverity of acute diverticulitis. Br J Surg. 2014;101:e90-99
31. Lorente L, Cots F, Alonso S, Pascual M, Salvans S, Courtier R, et al. Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs. Cir Esp. 2013;91:504:509
32. Sallinen VJ, Mentula PJ, Leppäniemi AK. Nonoperativemanagement of perforateddiverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon Rectum. 2014;57(7):875-81
33. Costi R, Cauchy F, Le Bian A, Honart JF, Creuze N, Smadja C. Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with nonoperative treatment. Surgical Endoscopy. 2012;26:2061-2071
34. Feingold D, Steele SR, Lee S, Kaiser A, Bousey R, Buie WD, et al. Practiceparameters for thetreatment of sigmoid diverticulitis. Dis. Colon Rectum. 2014;57:284-294
35. Luca Stocchi. Current indications and role of surgery in the management of sigmoid diverticulitis.World J Gastroenterol. 2010;16(7):804-817
36. Biondo S, Golda T, Kreisler E, Espin E, Vallribera F, Oteiza F, et al. Outpatient versus hospitalization management for uncomplicateddiverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial).Ann Surg. 2014;259(1):38-44
37. Alonso S, Pera M, Parés D, Pascual M, Gil MJ, Courtier R, et al. Outpatient treatment of patients with uncomplicatedacutediverticulitis.Colorectal Dis. 2010;12(10 Online):e278-e282
38. Ambrosetti P, Morel P. Acute left colonic diverticulitis: indications for operation and predictive parameters of early and late medical treatment failure: a prospective non-randomised study of 423 patients. Dig Surg. 1996;13:349-352
39. Hjern F, Josephson T, Altman D, Holmström B, Mellgren A, Pollack J, et al. Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory? Scand J Gastroenterol.2007;42:41-47
40. Isacson D, Andreasson K, Nikberg M, Smedh K, Chabok A. No antibiotics in acute uncomplicated diverticulitis: does it work? Scand J Gastroenterol. 2014;49:1441-1446
41. Shabanzadeh DM, Wille-Jorgensen P. Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev. 2012;11(92):CD009092
Related articles

Letter

Giant sigmoid diverticulum

DOI: 10.17235/reed.2023.9804/2023

Citation tools
Mora López L, Flores Clotet R, Serra Aracil X, Montes Ortega N, Navarro Soto S. The use of the modified Neff classification in the management of acute diverticulitis. 4738/2016


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1245 visits.
This article has been downloaded 541 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 19/11/2016

Accepted: 03/01/2017

Online First: 05/04/2017

Published: 03/05/2017

Article revision time: 39 days

Article Online First time: 137 days

Article editing time: 165 days


Share
This article has been rated by 3 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology