Acute diverticulitis (AD) is the most common presentation of diverticular disease with high morbidity and mortality. We report our experience with the management of AD and we examined several clinical parameters in order to evaluate their predictive role for early discharge or prolonged hospitalization/surgery. Patients and
Methods: We prospectively evaluated all patients with AD admitted to our teaching Institution between January 2005 and October 2007. AD requiring admission was defined by the presence of lower abdominal pain and tenderness and/or guarding in left iliac fossa associated with systemic inflammatory response as shown by the presence of one or more of the following: fever (>38°C),WBC count > 12.000 or CRP elevation (>20 mg/dl). Patient’s related data including age, gender, co-morbidities, onset and duration of symptoms before admission as well as clinical data were prospectively entered in a database and analyzed to assess their predictive role for prolonged hospitalization/surgery.
Results: According to our criteria, 146 patients were identified (68 M, 78 F; mean age 64 years, range 27-91). Duration of symptoms before admission averaged 5 days (1- 30 days). At admission, fever was present in 58.2% of patients, increased WBC count in 61% and raised CRP in 78.1%. Nine-two patients (63%) had a previous diagnosis of diverticular disease, 31 (21.2%) had one or more previous admission for AD. Ten patients (6.8%) required immediate surgery, while the remaining were initially treated conservatively (analgesia, bowel rest and appropriate antibiotics). Medical treatment alone was effective in 94.1% of patients and 84.6% were discharged within 4 days. Twenty-one patients required prolonged hospitalization (average 11 days, range 5-112). Two patient required abscess percutaneos drainage . Medical treatment failed in 6 patients (4.4%) after 5.5 days+/-3.5 days. Overall, 16 patients (11%) underwent surgery: 9 Hartmann’s procedure, 5 bowel resections with primary anastomosis , 1 subtotal colectomy and 1 laparoscopy with abscess drainage. Overall mortality and morbidity rates were 2.1% and 12.3%. Surgical mortality and morbidity were 12.5 % and 56.2% including intra-operative bleeding managed with Mikulicz packing (1), surgical site infections (5), pneumonia (2) and cardiac arrhythmia (1). Previous AD, duration of symptoms before admission(>3 days), obesity, and steady elevation of CRP predicted prolonged hospitalization or surgery.
Conclusions: After admission for AD the risk of hospitalization or surgery is significantly higher if patient is obese, experienced previous similar admissions or if CRP mantains steady elevation.