PURPOSE:
Diverticulitis has been described as a more virulent disease in young patients, necessitating an aggressive surgical approach. We hypothesized that the subgroup of young patients who do not require surgery on their initial presentation are unlikely to present at a later date with perforation and do not always require prophylactic resection as commonly recommended.
METHODS:
A retrospective chart review was conducted of all patients presenting to Fletcher Allen Health Care, the teaching hospital of the University of Vermont, from January 1, 1990 to June 30, 2001. Outcomes in patients aged 50 years or younger (Group 1) were compared with patients older than aged 50 years (Group 2) using a log-rank test.
RESULTS:
A total of 762 patients were admitted with sigmoid diverticulitis during the study period, 238 (31 percent) of whom underwent surgery. Two hundred fifty-nine patients (34 percent) were younger than aged 50 years (Group 1). The risk of requiring surgery on initial hospital presentation was similar between the two groups (24 vs. 22 percent, respectively; P = 0.8). However, Group 1 patients were more likely to be treated operatively at some point during the study period (40 vs. 26 percent; P = 0.001) because of an increase in elective resections. Of 196 patients in Group 1 who had an initial medically managed admission, only 1 presented at a later date with perforation (0.5 percent).
CONCLUSIONS:
The risk of subsequent diverticular perforation in medically managed young patients with sigmoid diverticulitis is very low. As such, the frequently espoused policy of routine surgery after a single attack of diverticulitis in young patients may not be warranted. A more selective approach seems to be safe.
Similar content being viewed by others
REFERENCES
To the article
U Kim D Dreiling (1974) ArticleTitleProblems in the diagnosis of diverticulitis in the young Am J Gastroenterol 62 109–15
E Eusebio M Isenberg (1973) ArticleTitleNatural history of diverticular disease of the colon in young patients Am J Surg 125 308–11
J Freischlag RS Bennion JE Thompson SuffixJr (1986) ArticleTitleComplications of diverticular disease of the colon in young people Dis Colon Rectum 29 639–43
CW Chappuis I Cohn SuffixJr (1988) ArticleTitleAcute colonic diverticulitis Surg Clin North Am 68 301–13
GV Rodkey CE Welch (1984) ArticleTitleChanging patients in the surgical treatment of diverticular disease Ann Surg 200 466–78
K Ouriel SI Schwartz (1983) ArticleTitleDiverticular disease in the young patients Surg Gynecol Obstet 156 1–5
GW Chodak DM Rangel E Passaro (1981) ArticleTitleColonic diverticulitis in patients under age 40: need for earlier diagnosis Am J Surg 141 699–702
TG Parks (1969) ArticleTitleNatural history of diverticular disease of the colon. A review of 521 cases BMJ 4 639–45
PR Schauer R Ramos AA Ghiatas KR Sirinek (1992) ArticleTitleVirulent diverticular disease of the colon in young obese men Am J Surg 164 443–8
J Makela S Vuolio H Kiviniemi S Laitinen (1998) ArticleTitleNatural history of diverticular disease: when to operate? Dis Colon Rectum 41 1523–8
CW Konvolinka (1994) ArticleTitleAcute diverticulitis under age forty Am J Surg 167 562–5
H Spivak S Weinrauch JC Harvey B Surick H Ferstenberg I Friedman (1997) ArticleTitleAcute colonic diverticulitis in the young Dis Colon Rectum 40 570–4
P Ambrosetti JH Robert JA Witzig et al. (1994) ArticleTitleAcute left colonic diverticulitis in young patients J Am Coll Surg 179 156–60
WD Wong SD Wexner A Lowry et al. (2000) ArticleTitlePractice parameters for the treatment of sigmoid diverticulitis Dis Colon Rectum 43 289–97
PV Vignati JP Welch JL Cohen (1995) ArticleTitleLong-term management of diverticulitis in young patients Dis Colon Rectum 38 627–9
U Haglund R Hellberg C Johnsen L Hulten (1979) ArticleTitleComplicated diverticular disease of the sigmoid colon. An analysis of short and long term outcome in 392 patients Ann Chir Gynaecol 68 41–6
D Simonowitz D Paloyan (1977) ArticleTitleDiverticular disease of the colon in patients under 40 years of age Am J Gastroenterol 67 69–72
To the Invited Commentary
RC Chautems P Ambrosetti A Ludwig B Mermillod PH Morel C Soravia (2002) ArticleTitleLong-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 110 patients Dis Colon Rectum 45 962–6
P Ambrosetti C Becker F Terrier (2002) ArticleTitleColonic diverticulitis: impact of imaging on surgical management. A prospective study of 542 patients Eur Radiol 12 1145–9
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Guzzo, J., Hyman, N. Diverticulitis in Young Patients: Is Resection After a Single Attack Always Warranted?. Dis Colon Rectum 47, 1187–1191 (2004). https://doi.org/10.1007/s10350-004-0546-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0546-7