Abstract
PURPOSE: This study was designed to evaluate the long-term natural history of sigmoid diverticulitis in patients treated nonoperatively after a first acute episode and to assess the role of elective colectomy. METHODS: Between 1986 and 1991, 144 patients were admitted for acute diverticulitis diagnosed by abdominal computed tomography and had a successful nonoperative treatment. Remote complications (persisting or recurring diverticulitis) were also diagnosed by computed tomography. Patients had a poor outcome if they had one of these complications. Diverticulitis was graded mild or severe on computed tomography according to Ambrosetti’s criteria. We determined statistically whether young age (≤50 years old) and severe diverticulitis were risk factors for a poor outcome. RESULTS: One hundred eighteen patients with a contributive computed tomographic scan at admission were followed up. Median age was 63 (range, 23–93) years, with a median follow-up of 9.5 (range, 0.2–13.8) years. Eighty patients had no complications, and 38 had remote complications. The incidence of remote complications was the highest (54 percent at 5 years) for young patients with severe diverticulitis on computed tomography and the lowest (19 percent at 5 years) for older patients with mild disease. Young age and severe diverticulitis taken separately were both statistically significant factors of poor outcome (P = 0.007 and P = 0.003, respectively), although age was no longer significant after stratification for disease severity on computed tomography (P = 0.07). Twenty-four patients died. The cause of death was unrelated to diverticulitis in 21 cases and unknown in the remaining 3. CONCLUSIONS: We propose that after a first acute episode of diverticulitis treated nonoperatively, elective colectomy should be offered to young patients (≤50 years old) with severe diverticulitis on computed tomography.
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References
P Bernades (1986) ArticleTitleHistoire naturelle de la maladie diverticulaire du côlon Ann Gastroenterol Hepatol 22 209–211
P Ambrosetti A Jenny C Becker F Terrier P Morel (2000) ArticleTitleAcute left colonic diverticulitis: compared performance of computed tomography and water-soluble contrast enema. Prospective evaluation of 420 patients Dis Colon Rectum 43 1363–1367
J Mäkelä S Vuolio H Kiviniemi S Laitinen (1998) ArticleTitleNatural history of diverticular disease Dis Colon Rectum 41 1523–1528
PV Vignati JP Welch JL Cohen (1995) ArticleTitleLong-term management of diverticulitis in young patients Dis Colon Rectum 38 627–629
S Sarin PB Boulos (1994) ArticleTitleLong-term outcome of patients presenting with acute complications of diverticular disease Ann R Coll Surg Engl 76 117–120
B Millat K Fourati H Larrieu F Gayral (1986) ArticleTitleInfectious complications of sigmoid diverticulitis J Chir 123 79–82
GE Linhardt RC Moore GR Mason (1982) ArticleTitlePrognostic indices in the treatment of acute diverticulitis Am Surg 48 217–220
WD Wong SD Wexner A Lowry (2000) ArticleTitlePractice parameters for the treatment of sigmoid diverticulitis: supporting documentation. The Standards Task Force of The American Society of Colon and Rectal Surgeons Dis Colon Rectum 43 289–297
NH Stollman JB Raskin (1999) ArticleTitleDiagnosis and management of diverticular disease of the colon in adults Am J Gastroenterol 94 3110–3121
L Köhler S Sauerland E Neugebauer (1999) ArticleTitleDiagnosis and treatment of diverticular disease Surg Endosc 13 430–436
PM Rao JT Rhea RA Novelline (1998) ArticleTitleHelical CT with only colonic contrast material for diagnosing diverticulitis AJR Am J Roentgenol 170 1445–1449
P Ambrosetti J Robert JA Witzig (1992) ArticleTitlePrognostic factors from computed tomography in acute left colonic diverticulitis Br J Surg 79 117–119
D Simonowitz D Paloyan (1977) ArticleTitleDiverticular disease of the colon in patients under 40 years Am J Gastroenterol 67 69–72
G Chodak D Rangel E Passaro (1981) ArticleTitleColonic diverticulitis in patients under age 40 Am J Surg 141 699–702
K Ouriel S Schwartz (1983) ArticleTitleDiverticular disease in the young patient Surg Gynecol Obstet 156 1–5
N Farmakis RG Tudor MR Keighley (1994) ArticleTitleThe 5-year natural history of complicated diverticular disease Br J Surg 81 733–735
TB Elliott S Yego TT Irvin (1997) ArticleTitleFive-year audit of the acute complications of diverticular disease Br J Surg 84 535–539
TG Parks (1969) ArticleTitleNatural history of diverticular disease of the colon Br Med J 4 639–645
DM Larson SS Masters HM Spiro (1976) ArticleTitleMedical and surgical therapy in diverticular disease Gastroenterology 71 734–737
U Haglund R Hallberg C Johnsen L Hulten (1979) ArticleTitleComplicated diverticular disease of the sigmoid colon Ann Chir Gynaecol 68 41–46
EH Farthmann KD Rückauer RU Häring (2000) ArticleTitleEvidence-based surgery Langenbecks Arch Surg 385 143–151
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Chautems, R.C., Ambrosetti, P., Ludwig, A. et al. Long-Term Follow-Up After First Acute Episode of Sigmoid Diverticulitis: Is Surgery Mandatory?. Dis Colon Rectum 45, 962–966 (2002). https://doi.org/10.1007/s10350-004-6336-4
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DOI: https://doi.org/10.1007/s10350-004-6336-4