{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:01:37Z","timestamp":1780030897492,"version":"3.53.1"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The management of perforated diverticulitis (PD) has shifted over the last decade, moving from aggressive surgery toward non\u2010operative strategies for hemodynamically stable patients. However, the safety of non\u2010operative treatment in cases with extraluminal air, particularly Hinchey Ia\u2013II disease, remains debated. This systematic review evaluates the efficacy, safety, and long\u2010term outcomes of non\u2010operative management for PD and identifies radiologic predictors of treatment failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic review was conducted per PRISMA 2020 guidelines. PubMed\/MEDLINE, Europe PMC, Science Direct, EBSCO Open Dissertations,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.Gov<\/jats:ext-link>\n                      , and Cochrane Library were searched for cohort studies published between 2015 and 2025. Inclusion criteria were adults with CT\u2010confirmed PD (Hinchey I\u2013II) treated non\u2010operatively. The primary outcome was treatment success (survival without emergency surgery); secondary outcomes included recurrence, readmission, and mortality. Study quality was assessed using the Newcastle\u2010Ottawa Scale (NOS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve cohort studies comprising 25\u2009064 patients were included. Success rates ranged from 76% to 96% for contained perforations. Distant extraluminal air (DA) was a key predictor of failure, with success falling to 10%\u201337% compared to &gt;\u200985% for isolated pericolic air. Other risk factors included abscess diameter &gt;\u20094\u2009cm, free fluid, and age\u2009&gt;\u200975\u2009years. Mortality declined over time (from 18.6% to &lt;\u20095%), coinciding with increased colorectal subspecialist involvement. Recurrence rates remained notable (16.5%\u201337.5%), with most occurring after one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non\u2010operative management is a safe, effective first\u2010line option for stable patients with PD, especially those with isolated pericolic air. Patients with DA or large abscesses are at higher risk of failure and require close monitoring or early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70535","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T10:35:27Z","timestamp":1771324527000},"page":"1124-1133","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Conservative Management of Perforated Diverticulitis in Adults: An Updated Systematic Review of Outcomes"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2702-9240","authenticated-orcid":false,"given":"Abdaal","family":"Munir","sequence":"first","affiliation":[{"name":"Department of General Surgery Wirral University Teaching Hospital NHS Foundation Trust  Wirral UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-3797","authenticated-orcid":false,"given":"Jamal","family":"Montaser","sequence":"additional","affiliation":[{"name":"Psychiatry, California Institute of Behavioral Neurosciences &amp; Psychology  Fairfield USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srihas","family":"Tumu","sequence":"additional","affiliation":[{"name":"Psychiatry, California Institute of Behavioral Neurosciences &amp; Psychology  Fairfield USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6405-9492","authenticated-orcid":false,"given":"Venkata Yashashwini Maram","family":"Reddy","sequence":"additional","affiliation":[{"name":"Guntur Medical College  Guntur India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9645-6509","authenticated-orcid":false,"given":"Navod","family":"Jayasuriya","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, University of Ruhuna  Galle Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1138-4892","authenticated-orcid":false,"given":"Muaz","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Magee","sequence":"additional","affiliation":[{"name":"Department of General Surgery Wirral University Teaching Hospital NHS Foundation Trust  Wirral UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iana","family":"Malasevskaia","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Private Clinic 'Yana Alexandr'  Sana'a Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.10.017"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.033"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.12.015"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2018.0006"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-001-1143-y"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-021-02244-3"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.302"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.8688"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282025"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19388"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-024-02928-0"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02422.x"},{"key":"e_1_2_8_14_1","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page M. 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