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BACKGROUND: There is limited data assessing the effectiveness of antibiotic treatment as sole initial therapy (ABX) instead of percutaneous drainage (PCD) in patients with large abscess complicating diverticulitis. The aim of our study was to evaluate outcomes for patients initially treated with PCD vs. those for patients initially treated with ABX.
METHODS: All patients with a diagnosis of abscess ≥3 cm in diameter associated with sigmoid diverticulitis admitted to our institution from 1994-2012 were identified from an institutional, IRB-approved diverticular database. All patients ultimately underwent surgery. One hundred fourteen patients were initially treated with PCD and 32 patients were initially treated with ABX. Patients treated with PCD alone or requiring emergent surgery at admission were excluded.
RESULTS: Patient characteristics are summarized in the table and were similar except for larger abscess diameter in the PCD group. Reasons for ABX included technical inability for PCD based on CT images (n=15) and surgeon preference (n=17). All ABX patients requiring urgent surgery had continued symptoms. No PCD was attempted in this group. Reasons for urgent surgery in the PCD group besides continued symptoms (n=16) were technical failure of attempted PCD (n=4) and PCD-related small bowel injury (n=1). The two groups had similar incidence of elective surgery, comparable postoperative outcomes and stoma creation rates.
CONCLUSION: Selected patients with peridiverticular abscess can be initially treated with antibiotics without adverse consequences on the timing of their operations, requirements for stoma creation and postoperative morbidity.

Variables	PCD (n=114)	ABX (n=32)	P value
Age (years)	57±13	57±12	0.9
Abscess diameter (cm)	7.1 ± 2.6	5.9 ± 4.0	0.001
Intrabdominal / pelvic location	49/65	15/17	0.37
Urgent surgery for failure of initial treatment	21 (18%)	8 (25%)	0.21
Elective surgery	93 (82%)	24 (75%)	0.2
Mortality	3 (2.6%)	0	1
Morbidity	42/114(37%)	11/32(34%)	0.77
Postoperative abdomino-pelvic abscess	6(5%)	2(6%)	1
Anastomotic leak	3/94(3%)	2/26(7%)	0.5
Overall stoma rate	51 (45%)	11 (34%)	0.3
Permanent stoma rate	16 (14%)	4 (13%)	0.7
Length of hospital stay (days)	8.2 ± 6.2	9.5 ± 11.1	0.6