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Clinical suspicion of Diverticulitis

DIABOLO trial www.diabolo-trial.nl. Clinical suspicion of Diverticulitis. In case of diverticulitis negative US in clinically suspected patients an i.v. contrast enhanced CT scan is mandatory for confirmation of diverticulitis or exclusion of other pathology.

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Clinical suspicion of Diverticulitis

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  1. DIABOLO trial www.diabolo-trial.nl Clinicalsuspicion of Diverticulitis In case of diverticulitis negative US in clinically suspected patients an i.v. contrast enhanced CT scan is mandatory for confirmation of diverticulitis or exclusion of other pathology. Acute Ultrasound or CT scan Always CT scan within 24 hours Hinchey 1a or 1b? Inclusion DIABOLO Trial www.diabolo-trial.nl for randomisation Conservative strategy with antibiotics Liberal strategy without antibiotics

  2. DIABOLO trial www.diabolo-trial.nl • Conservative strategy with antibiotics • - Hospital admission; • Total of 10-day antibiotics; • 48 hours amoxi-clav. 3 dd 1200 mg iv, • If tolerated change to oral 3 dd 625mg; • - Adequate pain relief; • - Oral intake as tolerated; • Daily monitoring.  In case of allergy: ciprofloxacine + metronidazole • Liberal strategy without antibiotics • - Admission only if discharge criteria are not met; • - Adequate pain relief; • - Oral intake as tolerated; • Daily (self)-monitoring. Discharge criteria: - Normal diet (defined by tolerating vast food and more than 1L of fluid orally); - Temperature < 38.0 °C; - VAS score < 4 (with paracetamol only). Full-recovery criteria: - Out-patient (see discharge criteria); - Resuming pre-illness working activities; - No use of daily pain medication or or back to pre-illness pain medication use • Exclusion criteria: • 1. Previous radiological (US and/or CT) proven episode of diverticulitis; • 2. Colonic cancer; • 3. Inflammatory bowel disease (ulcerative colitis, Crohn's disease); • 4. Hinchey stages 2, 3 and 4, which require surgical or percutaneous treatment; • Disease with expected survival of less than 6 months; • Contraindication for the use of the study medication (e.g. patients with advanced renal failure or allergy to antibiotics used in this study); • 7. Pregnancy, breastfeeding; • 8. ASA (American Society of Anesthesiologists) classification > III; • 9. Immuno-compromised patient; • 10. Clinical suspicion of bacteraemia (i.e. sepsis); • 11. The inability of reading/understanding and filling in the questionnaires; • 12. Antibiotic use in the 4 weeks prior to presentation.

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