Spectrum of Disease and Outcome among Patients with Acute Diverticulitis

Abstract

Background: This study was designed to evaluate the natural history of patients admitted for acute diverticulitis. Methods: Nine hundred and seventy-seven patients admitted to Oulu University Hospital for acute symptoms of diverticular disease during the 20-year period from 1986 to 2005 were identified using a database. Results: Six hundred and ninety-five patients were admitted for uncomplicated diverticulitis and 282 for complicated diverticulitis. The patients admitted for uncomplicated diverticulitis were younger than the others and 66% of them were admitted only once. The number of admissions preceding perforation was higher in the 1980s, and the number of admissions was unrelated to the degree of perforation or the outcome of the patients. The annual prevalence of sigmoid diverticular perforation increased from 2.6/100,000 in 1986 to 4.2/100,000 in 2005. Seventy (10%) of the 695 patients admitted for the first time for acute diverticulitis underwent urgent surgery during the same admission and 66 (9%) had elective surgery during a later admission. Overall hospital mortality was 2.3%, being 1% among those admitted for acute diverticulitis and 5.5% among those admitted for diverticular perforation. Two hundred and thirty-four (42%) of the 555 nonoperated patients with acute diverticulitis developed a recurrent episode of diverticulitis. The course of recurrent disease was similar to the primary episode. Conclusion: Two or more preceding admissions for acute diverticulitis do not warrant sigmoid resection after diverticulitis. Young patients do not have a greater risk of complicated diverticulitis than older ones.

Sigmoid diverticulitis in 2011: many questions; few answers

“…Similarly, in a prospective study involving 232 patients with acute diverticulitis, Shaikh et al found that the incidence of subsequent surgery for the 191 surviving patients who were discharged without resection was statistically greater for patients under 50 years of age compared with those over 50 years of age (38% vs 15%; P = 0.015) [14]. This greater incidence of a complicated outcome in younger patients after successful medical treatment of acute diverticulitis has been challenged by four retrospective studies that did not find any difference in the outcome between younger and older patients [23][24][25][26]. However, all of these studies were underpowered.…”

2013 WSES guidelines for management of intra-abdominal infections

“…Recently, Makela et al published a review of 977 patients admitted for acute diverticulitis during a 20-year period [57]. The authors found that even with 2 or more previous admissions for acute diverticulitis, sigmoid resection remained unjustifiably excessive.…”

Características epidemiológicas de la enfermedad diverticular del colon y de la diverticulitis aguda en Castilla y León. Aspectos sobre el tratamiento médico y quirúrgico

“…Estudios de la historia natural de la diverticulitis no complicada (99) Después del adecuado tratamiento médico de un episodio de diverticulitis aguda, cerca de un tercio de los pacientes desarrollarán un segundo episodio y un tercio de estos pacientes tendrán un tercer episodio, por lo que la recomendación debe basarse en la edad del paciente, la comorbilidad asociada, la frecuencia y gravedad de los episodios de diverticulitis y la persistencia de la sintomatología después de la resolución del episodio agudo. La mayoría de los pacientes que tienen una diverticulitis complicada, la presentan en su primer episodio, por lo que una política de resección de colon programada posterior a la resolución del primer episodio de diverticulitis aguda no complicada, no parece que reduciría la probabilidad de requerir una cirugía de urgencia (3,22,29,30,99,101,103,104,105) .…”

“…La Sociedad de Cirugía del Colon y el Recto, en su guía más actual del tratamiento de la enfermedad diverticular, recomienda realizar la cirugía programada basándose en las características individuales de cada paciente (99) y varios estudios como el de Jyrky y cols. ratifican esta práctica (103) . Además indican que el número de episodios de diverticulitis no complicada, no es necesariamente una indicación quirúrgica (3,12,22,29,30,92,99,100,101,103,104,105) .…”

“…ratifican esta práctica (103) . Además indican que el número de episodios de diverticulitis no complicada, no es necesariamente una indicación quirúrgica (3,12,22,29,30,92,99,100,101,103,104,105) .…”