AB045. SOH24AB_271. The role of antibiotics in diverticular bleeding

Background: Diverticular disease is a leading cause of lower gastrointestinal bleeding. The management of diverticular bleeding varies between surgeons. Evidence has shown that omission of antibiotics for the first presentation of uncomplicated acute diverticulitis is sometimes safe. We sought to identify trends that may suggest the same is true in patients presenting with diverticular bleeding.

Methods: This was a retrospective cohort study. The Hospital Inpatient Enquiry coding system was used to identify patients presenting to our hospital with diverticular bleeding without colonic perforation requiring hospitalisation between the period. Data were then collected regarding demographics, initial blood results, inclusion or omission of antibiotic therapy, need for inpatient endoscopy, length of stay, need for surgery and readmission within 30 days with re-bleeding.

Results: A total of 34 patients were identified, roughly 3/4 of whom were female. The average age was 75 years old [standard deviation (SD) +/−13] and the median duration of bleeding before presentation was 24 hours. The mean haemoglobin was 11.5 grams/decilitre (SD +/−2) and mean white cell count was 10.4 (SD +/−4). Median C reactive protein was 8.2 (range 1–209) mg/dL. Eighteen/34 patients were prescribed antibiotics and had a mean length of stay of 4.8 days. Those in whom antibiotics were omitted had a mean length of stay of 3.7 days. There were 19 inpatient endoscopies undertaken, none of which resulted in any endoscopic intervention. Only 1 patient was readmitted within 30 days with rebleeding.

Conclusions: This study suggests omission of antibiotics in patients presenting with diverticular bleeding may be safe in select circumstances.

Keywords: Diverticular bleeding; diverticular disease; emergency surgery; general surgery; lower gastrointestinal bleeding