From the Guidelines
Sigmoid abscesses should be managed with antibiotic therapy alone for 7 days in patients with small diverticular abscesses, while percutaneous drainage combined with antibiotic therapy for 4 days is recommended for large diverticular abscesses. The management of sigmoid abscesses, also known as diverticular abscesses, requires a tailored approach based on the size of the abscess and the patient's clinical condition. According to the most recent guidelines, patients with small diverticular abscesses can be treated with antibiotics alone for 7 days 1. On the other hand, patients with large diverticular abscesses should undergo percutaneous drainage combined with antibiotic therapy for 4 days 1.
Key Considerations
- The size of the abscess is a crucial factor in determining the management approach, with smaller abscesses potentially resolving with antibiotics alone and larger abscesses requiring percutaneous drainage.
- The patient's clinical condition, including the presence of sepsis or peritonitis, should also be taken into account when deciding on the management approach.
- Percutaneous drainage is the preferred first-line intervention for accessible abscesses larger than 3-4cm, while surgical intervention may be necessary for complex, multiloculated, or inaccessible abscesses.
Management Approach
- Initial treatment involves broad-spectrum antibiotics, such as piperacillin-tazobactam or a combination of ciprofloxacin and metronidazole, for 7-14 days.
- Percutaneous drainage guided by CT or ultrasound is the preferred first-line intervention for accessible abscesses larger than 3-4cm.
- Surgical intervention, including laparoscopic or open drainage, may be necessary for complex, multiloculated, or inaccessible abscesses.
- In severe cases with peritonitis or sepsis, emergency surgery with possible sigmoid resection and temporary colostomy might be required.
Monitoring and Follow-up
- Patients should be monitored for signs of improvement, including decreasing pain, fever resolution, and normalizing white blood cell count.
- After the acute episode resolves, colonoscopy should be performed to rule out underlying malignancy or inflammatory bowel disease.
- Elective sigmoid resection may be considered after 6-8 weeks in patients with recurrent diverticulitis or complications, as recommended by previous guidelines 1. However, the most recent guidelines prioritize percutaneous drainage and antibiotic therapy for large diverticular abscesses 1.
From the Research
Management of Sigmoid Abscess
The management of a sigmoid abscess, also known as a diverticular abscess, typically involves a combination of percutaneous drainage and antibiotic therapy.
- Percutaneous drainage is a minimally invasive procedure that involves inserting a catheter into the abscess to drain the pus and fluid 2, 3, 4.
- Antibiotic therapy is used to treat the underlying infection and prevent further complications 2, 3, 4.
- In some cases, endoscopic drainage may be used as an alternative to percutaneous drainage 5.
- Surgery, such as colectomy, may be necessary in cases where percutaneous drainage is not successful or if there are complications such as perforation or peritonitis 3, 4.
Treatment Outcomes
The treatment outcomes for sigmoid abscesses are generally good, with percutaneous drainage and antibiotic therapy providing satisfactory results in most cases 2, 3, 4.
- A study of 12 patients with perisigmoid diverticular abscesses found that percutaneous drainage combined with antibiotic therapy provided efficient treatment in 10 out of 12 cases 3.
- Another study found that percutaneous drainage can successfully treat the acute septic component and allow planning of the surgical procedure later in better conditions, avoiding the need for temporary colostomy in selected patients 4.
Diagnostic Tools
Diagnostic tools such as computed tomography (CT) scans, ultrasound, and colonoscopy are used to diagnose and manage sigmoid abscesses 2, 5, 3, 6.
- CT scans can help identify the location and size of the abscess, as well as any complications such as perforation or peritonitis 2, 3.
- Ultrasound can be used to guide percutaneous drainage and monitor the response to treatment 3, 4.
- Colonoscopy can be used to diagnose underlying sigmoid diverticulitis and rule out other conditions such as cancer 6.