Management of Acute Complicated Diverticulitis: An Assessment of Current Practices

NCT07601958 | Completed

• 1 other identifier: SRB2025380
• Study Type: observational
• Target: 208
• Locations: 1 country
• Sites: 1

Brief Summary

Acute complicated diverticulitis (ACD) is a frequent surgical emergency that can be life-threatening. It encompasses various clinical entities, including colonic perforations, abscesses (Hinchey II), fistulas, and purulent or fecal peritonitis (Hinchey III/IV). Historically, the Hartmann procedure (HP) was established as the standard of care for diffuse peritonitis, particularly in frail patients. However, this intervention is associated with high rates of permanent stomas, long-term complications, and impaired quality of life. Over the past decade, several randomized controlled trials (RCTs) have compared HP with sigmoid resection and primary anastomosis (PA), sometimes combined with a diverting ileostomy. Results from these studies, notably the LADIES and DIVERTI trials, indicate that in hemodynamically stable and immunocompetent patients, PA is associated with superior functional outcomes, fewer late complications, and higher stoma reversal rates. Other minimally invasive approaches, such as laparoscopic peritoneal lavage for Hinchey III, have also been explored, showing promise in reducing stomas and reinterventions. However, their efficacy relies on stringent patient selection, and their use is not recommended by current guidelines (e.g., HAS 2017) due to higher reintervention rates. Recent epidemiological data suggest a trend toward reducing emergency surgical interventions in favor of more conservative strategies in selected cases, such as initial medical management followed by elective surgery. In this context of diversifying therapeutic options, choosing the optimal treatment requires a delicate balance between efficacy, morbidity, mortality, quality of life, and long-term preservation of intestinal function. Despite these advances, several questions remain, particularly regarding patient selection criteria and the real-world long-term impact of these interventions. A potentially underestimated factor is the role of the operator, as a significant portion of emergency cases (nights and weekends) are handled by surgeons in training. Primary Objective: To provide a comprehensive overview of current management strategies for acute complicated diverticulitis by identifying preferred therapeutic modalities (conservative management, emergency surgery, delayed surgery) at the HUB (Hôpital Universitaire de Bruxelles). Secondary Objectives: To evaluate the adherence of these therapeutic approaches to international guidelines. To identify clinical and context-specific predictive factors influencing the choice of therapeutic strategy.

Conditions

Acute Complicated Diverticulitis; Colonic Diverticulitis

Outcome Measures

Primary Outcomes (1)

• Distribution of management strategies for acute complicated diverticulitis.

  Percentage of patients treated by each of the following strategies: exclusive medical treatment, radiological drainage, immediate emergency surgery, rescue surgery following medical failure, or elective surgery.

  From hospital admission up to 10 years (end of study period).

Secondary Outcomes (7)

• Surgical Procedure Type (Hartmann Procedure vs. Primary Anastomosis) based on Hinchey Classification and Clinical Status.

  Through study completion, an average of 14 days (duration of index hospitalization).

• Success rate of conservative treatment for complicated diverticulitis.

  During index hospitalization (average of 12.4 days).

• Post-operative morbidity and mortality.

  30 days post-surgery.

• Stoma reversal rate.

  Up to 10 years.

• Evolution of the Rate of Laparoscopic Approach.

  Perioperative (during initial surgery).

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients older than 18 years who were treated for acute complicated diverticulitis between January 1, 2015 and December 31, 2024 at Erasme Hospital and Institut Jules Bordet.

You may qualify if:

• Patients presenting with a first episode or recurrence of acute complicated diverticulitis.
• CT scan confirmation of a Hinchey stage ≥ Ib (including stages Ib, II, III, and IV) at admission.
• Initial management performed within the HUB (Hôpital Universitaire de Bruxelles) network.
• Hospital admission between January 1, 2015, and December 31, 2024.

You may not qualify if:

• Uncomplicated acute diverticulitis, defined by a CT scan Hinchey stage of 0 or Ia.
• Patients in whom the diagnosis of acute diverticulitis was ultimately ruled out during medical chart review.
• Patients whose initial management occurred at another hospital facility (outside the HUB network).
• Incomplete medical records preventing the reliable extraction of clinical or follow-up data.

Sponsors & Collaborators

• Jules Bordet Institute: lead

Study Sites (1)

Institut Jules Bordet

Anderlecht, Brussels Capital, 1070, Belgium

Location

MeSH Terms

Conditions

Diverticulitis, Colonic

Condition Hierarchy (Ancestors)

Diverticulitis; Diverticular Diseases; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Diverticulosis, Colonic; Colonic Diseases; Intestinal Diseases

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: May 11, 2026
• First Posted: May 22, 2026
• Study Start: December 1, 2025
• Primary Completion: March 30, 2026
• Study Completion: March 30, 2026
• Last Updated: May 22, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

BE (1)