Is early enteral nutrition dangerous in acute non surgical complicated diverticu- litis ? About 25 patients fed with oral fiber free energetic liquid diet

Background and study aims : Complicated Acute Colonic Diver- ticulitis (ACD) is usually treated by parenteral way thus keeping the bowel at rest. To date there are no clear recommendations re- garding the route of nutrition administration. We study the safety of early feeding by oral energetic fiber-free liquid diet in non-surgi- cal complicated ACD patients. Patients and methods : From February 2008 to October 2011, 25 patients were admitted with complicated ACD and took part in this prospective study. Surgical and medical assessments were per- formed at admission. Initial treatment was given with perfusion, intravenous antibiotics and hydric diet. Within 72 hours of admis- sion, antibiotic therapy was switched to oral administration for 5 up to 15 days depending on the progression of the disease. At the same time the patient received oral liquid fiber-free feeding. Solid but fiber-free diet was introduced 24h hours before discharge. Results : 25 cases of ACD were complicated with covered perfo- ration and/or abscess. Mean hospitalisation time was 10.4 days. 23 cases had good recovery and discharged, while 1 case progressed to colonic stenosis during hospitalisation, requiring a sigmoidectomy with a one-time anastomosis with good recovery. One patient re- lapsed his abscess during hospitalisation despite CT guided drain- age and required sigmoidectomy with transient ileostomy. The mean daily treatment and nutrition cost for the non-surgical 23 patients was 30 euros. Conclusions : Early enteral nutrition in complicated ACD is fea- sible, not harmful, and reduce both, mean hospitalization time and treatment cost. Further studies comparing enteral with parenteral nutrition are necessary to confirm our hypothesis. (Acta gastro- enterol. belg., 2013, 76, 235-240).