Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy

Abstract

Background: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. Hypothesis: Acute diverticulitis initially treated nonoperatively does not require elective colectomy.

Case Report: Unusual Presentation of Complicated Diverticulitis at Colostomy Site

“…In case of diverticulitis associated with abscess data reported by Broderick -villa and others in 2005, long term nonoperative management and several small series report higher recurrence [15].…”

Comparison of long-term quality of life in patients with diverticular disease. Are there any benefits to surgery?

“…However, these concerns were not confirmed, for example by Guzzo [15] or by a review from New Zealand [16]. The effectivnes of conservative therapy is increasing compared to the past.…”

Review article: the pathogenesis and management of acute colonic diverticulitis

“…A population-based study of 314 patients treated non-operatively for acute diverticulitis from California reported a recurrence rate of 13.3% with a median follow-up of 8.9 years with age >50 years associated with a lower recurrence rate and those with higher comorbidity having the greatest recurrent rate. 12 In a prospective study of 280 patients with proven uncomplicated acute diverticulitis with a median follow-up of 24 months, 46 (16.4%) experienced a second episode of acute diverticulitis with just four patients requiring surgery. 13 In a recent meta-analysis of 23 078 patients from eight studies, patients under the age of 50 years were more likely to have a recurrent attack (RR 1.73; 95% CI 1.40-2.13) than those older than 50 years.…”

“…71,72 Prior episodes of acute diverticulitis have long been thought to predispose to the development of complicated diverticular disease and therefore guidance stated that prophylactic resection following two episodes of acute diverticulitis was indicated. 78 Subsequent studies have found, however, that recurrence of acute diverticulitis is low, 12 the majority of patients presenting with complicated diverticular disease have no prior history of acute diverticulitis 35 and the outcomes for those with two prior episodes of acute diverticulitis are no worse than those with fewer episodes. 79 Therefore, it has been suggested that the indications for elective surgery should be for those with complications of diverticular disease and the number of prior episodes of acute diverticulitis should not be the only factor determining the indication for surgery with patients being assessed on an individual basis.…”