The Place of Elective Surgery Following Acute Diverticulitis in Young Patients

Abstract

Diverticulitis in the young is often regarded as a specific entity. Resection after a single attack because of a more "virulent" course of the disease has been accepted as conventional wisdom. The evidence for such a recommendation and the place of elective surgery was reviewed by a search of Medline, PubMed, Embase, and the Cochrane library for articles published between January 1965 and March 2008 using the terms diverticular disease and diverticulitis. Publications had to give specific information on at least ten younger patients (age <or= 50 years). Much of the older literature suggests that young patients experience a more virulent course with diverticulitis. Previous studies have shown misclassification and selection bias. As a result leading to a bias for more severe cases to be recognized mild cases may not be included. Young patients appear more likely to undergo operations to resolve an uncertain diagnosis. Recent studies have raised doubts about a virulent course with diverticulitis suggesting that recurrence may be associated with disease severity on CT scan, and supporting a conservative approach to diverticular disease. The diagnosis of diverticulitis is often delayed in younger patients because it is not considered, resulting in presenting cases being found at surgery or appearing more severe and more likely to be complicated. There is a lack of evidence to support the hypothesis that elective surgery should follow a single attack of diverticulitis. Any increased risk appears be a chronologic rather than pathologic phenomenon. Most patients will not have further episodes of diverticulitis.

Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

“…One group of investigators could find no difference in conversion rate in both groups [1], however other studies [2,18,26] presented higher conversion rates in early elective laparoscopic surgery. Although we found a conversion rate of 9% in group A and 3% in group B, a trend without reaching clear statistical significance (p = 0.070), this tendency shouldn't be ignored.…”

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

“…This assumption is based on outdated studies in which 48-88% of the patients who had surgery for suspected diverticulitis appeared to have another diagnosis at surgery. Recent studies, using CT to diagnose ACD, did not find a higher risk of complications in young patients (level C [7,18,19,20,25,34,35,39,40]). In young patients, the reported high risk of recurrent disease is caused by a higher accumulated risk due to higher life expectancy rather than absolute risk (level C [18,19,20,40]).…”

“…Recent studies, using CT to diagnose ACD, did not find a higher risk of complications in young patients (level C [7,18,19,20,25,34,35,39,40]). In young patients, the reported high risk of recurrent disease is caused by a higher accumulated risk due to higher life expectancy rather than absolute risk (level C [18,19,20,40]). There is no evidence that younger patients should be treated differently than older patients (level C [20,25,34,35,39,40]).…”

Failure to Use Ultrasound Is a Glaring Shortcoming

“…Die kumulative Wahrscheinlichkeit über 10.8 Jahre eine Divertikulitis zu entwickeln betrug 4.3%, sie lag für 40-jährige mit 11% am höchsten und nahm mit steigendem Lebensalter mit jeder zusätzlichen Dekade um 24% ab [73]. Der von einigen Autoren beschriebene aggressivere Verlauf der Divertikelkrankheit bei jüngeren Patienten [74,75] scheint sich in neueren Arbeiten nicht zu bestätigen [76][77][78]. Die Daten zu einer Geschlechterpräferenz bei der Divertikulose sind inhomogen [67,69].…”