Multifocal Versus Conventional Unifocal Diverticulitis: A Comparison of Clinical and Transcriptomic Characteristics

  • Bryan P. Kline
  • Kathleen M. Schieffer
  • Christine S. Choi
  • Tara Connelly
  • Jeffrey Chen
  • Leonard Harris
  • Sue Deiling
  • Gregory S. Yochum
  • Walter A. KoltunEmail author
Original Article



The management of diverticulitis is compromised by difficulty in identifying patients who require surgery for recurrent or persistent disease. Here, we introduce the concept of multifocal diverticulitis (MFD), characterized by multiple episodes of diverticulitis occurring at different locations within the colon.


To compare clinical characteristics, success of surgical management, and colonic transcriptomes of MFD patients to patients with conventional unifocal diverticulitis (UFD).


This retrospective study included 404 patients with CT-confirmed diverticulitis episodes. Patients with diverticulitis seen in at least two different colonic locations were classified as the MFD group and compared to the UFD group based on number of episodes, sites of disease, family history, surgeries performed, and postoperative recurrence. RNA-seq was conducted on full-thickness colonic tissues of ten MFD and 11 UFD patients.


Twenty-eight patients (6.9%) with MFD were identified. MFD patients had more diverticulitis episodes and were more likely to have positive family history, have right-sided disease, require surgery, and have recurrence after surgery. All MFD patients treated with segmental resection had recurrence, while recurrence was less common in patients undergoing more extensive surgery (P < 0.001). Using RNA-seq, we identified 69 genes that were differentially expressed between MFD and UFD patients. Significantly down-regulated genes were associated with immune response pathways.


MFD appears to be a more severe subset of diverticulitis with a possible genetic component. Transcriptomic data suggest that MFD may be associated with alteration of the immune response.


Diverticulitis Diverticular disease Recurrence Surgery RNA-seq 



This research was supported by the Carlino Fund for IBD Research.

Compliance with ethical standards

Conflict of interest


Supplementary material

10620_2018_5403_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Bryan P. Kline
    • 1
  • Kathleen M. Schieffer
    • 1
  • Christine S. Choi
    • 1
  • Tara Connelly
    • 1
  • Jeffrey Chen
    • 2
  • Leonard Harris
    • 1
  • Sue Deiling
    • 1
  • Gregory S. Yochum
    • 1
    • 3
  • Walter A. Koltun
    • 1
    Email author
  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryThe Pennsylvania State University, College of MedicineHersheyUSA
  2. 2.Department of RadiologyThe Pennsylvania State University, College of MedicineHersheyUSA
  3. 3.Department of Biochemistry and Molecular BiologyThe Pennsylvania State University, College of MedicineHersheyUSA

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