Korean J Gastroenterol.  2013 Feb;61(2):75-81. 10.4166/kjg.2013.61.2.75.

Clinical Characteristics and Treatment Outcome of Colonic Diverticulitis in Young Patients

• Song ME
• Jung SA
• Shim KN
• Song EM
• Kwon KJ
• Kim HI
• Yoon SY
• Cho WY
• Kim SE
• Jung HK
• Moon IH

• KMID: 1775770
• DOI: http://doi.org/10.4166/kjg.2013.61.2.75

Abstract

BACKGROUND/AIMS
The clinical course and the most appropriate management of colonic diverticulitis in young patients are currently unresolved. This retrospective study was designed to compare young patients (< or =40 years) with older patients (>40 years) regarding clinical characteristics of acute colonic diverticulitis and to determine whether differences exist in treatment outcome.
METHODS
Three-hundred sixty eight patients presenting with acute colonic diverticulitis from March 2001 through April 2011 at Ewha Womans University Mokdong Hospital were reviewed retrospectively. The differences in clinical characteristics, treatment modality and recurrence between each group were analyzed.
RESULTS
Two-hundred and six patients were aged 40 years or younger and 162 patients were older than 40 years. The older group was diagnosed more frequently with severe diverticulitis. Surgical treatment was significantly more frequent in the older group than in the younger group (15.4% vs. 4.4%, p<0.001). No significant difference was found in treatment modality between the two groups in patients with recurrence. The difference in recurrence between groups was not statistically significant. In multivariate analysis, left colonic diverticulitis was significantly associated with severe diverticulitis (OR, 14.651; 95% CI, 4.829-44.457) and emergency surgery (OR, 13.745; 95% CI, 4.390-43.031).
CONCLUSIONS
When patients with colonic diverticulitis are treated conservatively, young age is no longer an independent risk factor for subsequent poor outcome. Diverticulitis in young patients does not have a particularly aggressive or fulminant course. Therefore, we recommend that diverticulitis management should be based on the severity and location of the disease, and not on the age of the patient.

Keyword

Diverticulitis, colonic; Age factors

MeSH Terms

Acute Disease
Adult
Age Factors
Body Mass Index
Diverticulitis, Colonic/*diagnosis/pathology/surgery
Female
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Recurrence
Retrospective Studies
Severity of Illness Index
Treatment Outcome

Reference

References

1. Berk JE. Bockus gastroenterology. 4th ed.Philadelphia: WB Saunder;1985.

2. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975; 4:53–69.

3. Wong WD, Wexner SD, Lowry A, et al. Practice parameters for the treatment of sigmoid diverticulitis–supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2000; 43:290–297.

4. Rafferty J, Shellito P, Hyman NH, Buie WD. Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006; 49:939–944.

5. Roberts P, Abel M, Rosen L, et al. Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 1995; 38:125–132.

6. Choi CS, Cho EY, Kweon JH, et al. The prevalence and clinical features of colonic diverticulosis diagnosed with colonscopy. Korean J Gastrointest Endosc. 2007; 35:146–151.

7. Kim JS, Cha SG, Kim YT, et al. The prevalence and clinical features of diverticular disease of the colon. Korean J Gastroenterol. 1993; 25:305–314.

8. Kim HU, Kim YH, Choe WH, et al. Clinical characteristics of colonic diverticulitis in Koreans. Korean J Gastroenterol. 2003; 42:363–368.

9. Song JH, Paik CD, Lee SH, Kim HS. The clinical analysis of colonic diverticulitis accompanying acute abdomen. J Korean Soc Coloproctol. 2002; 18:390–396.

10. Guzzo J, Hyman N. Diverticulitis in young patients: is resection after a single attack always warranted? Dis Colon Rectum. 2004; 47:1187–1190.

11. Schweitzer J, Casillas RA, Collins JC. Acute diverticulitis in the young adult is not “virulent”. Am Surg. 2002; 68:1044–1047.

12. Faria GR, Almeida AB, Moreira H, Pinto-de-Sousa J, Correia- da-Silva P, Pimenta AP. Acute diverticulitis in younger patients: any rationale for a different approach? World J Gastroenterol. 2011; 17:207–212.

13. Konvolinka CW. Acute diverticulitis under age forty. Am J Surg. 1994; 167:562–565.

14. Pautrat K, Bretagnol F, Huten N, de Calan L. Acute diverticulitis in very young patients: a frequent surgical management. Dis Colon Rectum. 2007; 50:472–477.

15. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C. Longterm follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum. 2002; 45:962–966.

16. Kotzampassakis N, Pittet O, Schmidt S, Denys A, Demartines N, Calmes JM. Presentation and treatment outcome of diverticulitis in younger adults: a different disease than in older patients? Dis Colon Rectum. 2010; 53:333–338.

17. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978; 12:85–109.

18. Wolff BG, Devine RM. Surgical management of diverticulitis. Am Surg. 2000; 66:153–156.

19. Jun S, Stollman N. Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol. 2002; 16:529–542.

20. Kim U, Dreiling DA. Problems in the diagnosis of diverticulitis in the young. Am J Gastroenterol. 1974; 62:109–115.

21. Freischlag J, Bennion RS, Thompson JE Jr. Complications of diverticular disease of the colon in young people. Dis Colon Rectum. 1986; 29:639–643.

22. Eusebio EB, Eisenberg MM. Natural history of diverticular disease of the colon in young patients. Am J Surg. 1973; 125:308–311.

23. Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis. Br J Surg. 2005; 92:133–142.

24. Mueller MH, Glatzle J, Kasparek MS, et al. Longterm outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol. 2005; 17:649–654.

25. Chapman J, Davies M, Wolff B, et al. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005; 242:576–581.

26. Salem L, Veenstra DL, Sullivan SD, Flum DR. The timing of elective colectomy in diverticulitis: a decision analysis. J Am Coll Surg. 2004; 199:904–912.

27. Hwang KY, Yang HW, Kim SH, et al. Clinical characteristics of colonic diverticulitis in young patients. Korean J Med. 2008; 74:250–257.

28. Choi KS, Byeon JS, Yoon SM, et al. Diverticulitis: focused on clinical course and relapse. Intest Res. 2008; 6:37–44.

29. Sung KJ, Park JH, Hong IS, Kim MS. Radiological evaluation of G-I tract diverticulum in Korean. J Korean Radiol Soc. 1986; 22:1051–1060.

30. Wagner DE, Zollinger RW. Diverticulitis of the cecum and ascending colon. Arch Surg. 1961; 83:436–443.

31. Yang SC, Lee KP, Sohn SK, Kim MW, Min JS. Clinical analysis of colonic diverticular disease in Koreans. Korean J Gastroenterol. 1987; 19:91–96.