Diverticulitis: the effect of age and location on the course of disease

Abstract

To examine the effect of patient's age and the location of diverticular disease on the course of the acute disease we retrospectively collected demographic data, symptoms, laboratory findings, imaging techniques, type of treatment (conservative vs. surgical), early and late complications, and follow-up data on 119 patients with acute diverticulitis (74 women, 45 men; mean age 64+/-14 years; follow-up 7-102 months, median 40). Patients were divided by their age into two groups (42 aged 60 years or younger, 77 aged over 60) and on the location of their disease (108 to the left of the middle transverse, 11 to the right). Lower abdominal pain, abdominal tenderness, and fever were the most common complaints (70-97%). In the younger patients we found a significantly greater preponderance in the right colon (P = 0.02) than in older patients. Abdominal abscesses and fistulas were more common in right-sided diverticulitis (P = 0.01). Patients with right-sided colon diverticulitis were treated surgically (82%) and on an emergency basis more often than patients with left-side colon diverticulitis (25%; P = 0.001). Older patients treated conservatively suffered more than younger patients (61% and 33% respectively; P = 0.04) from recurrent abdominal pain but not from recurrent, confirmed diverticulitis. Patients with right-sided diverticulitis treated conservatively suffered more from recurrent diverticulitis episodes than patients with left-sided diverticulitis (P = 0.05). Younger patients thus do not have a more aggressive form of diverticulitis than older patients. Patients with acute diverticulitis in the right colon are likely to be operated earlier and for mistaken diagnoses than patients with left-sided diverticulitis.

Disease Course of Right- and Left-sided Diverticulitis in a Western Population

“…The 8% prevalence of RCD is in accordance with that reported in literature [24,27,36]. For comparison, this percentage varies between 60-90% in Asians with acute diverticulitis [4,30].…”

“…Successful results of non-operative management of uncomplicated RCD in both Western and Asian patients have been published before [6,12,14,24,[28][29][30][31]37,40]. All but one of our RCD patients received antibiotics as part of their conservative treatment.…”

“…operative, treatment of RCD in Caucasians [3,5,[19][20][21][23][24][25]. The historical concept that RCD in the Western world was a more aggressive disease than LCD was merely a reflection of the unfamiliarity with this disease, an inadequate diagnostic workup and decision making in the operating room.…”

“…However, results of this approach in Caucasian RCD patients is hardly supported by evidence. The data consist mainly of case series, evaluating patients in whom RCD was diagnosed postoperatively, and point into a more aggressive therapy in RCD [3,5,[19][20][21][23][24][25]. However, a high operative rate of RCD precludes knowledge on the natural disease course of RCD.…”

“…Studies describing Caucasian RCD patients that were diagnosed after radiological imaging are even more scarce and compromise only a total of 81 patients [2,24,[26][27][28] (Table 1). Only one study compared LCD with RCD in Caucasian patients and concluded that RCD is associated with more complications than LCD [24]. In contrast, several Asian studies demonstrate good results of a conservative management of RCD patients.…”