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Natural History of Acute Diverticulitis - Low Risk of Recurrence Following Non-Operative Management in a Population-Based Study
Jennifer D. Stanger*, George Roxin, Anthony R. Maclean, William D. Buie
Department of Surgery, University of Calgary, Calgary, AB, Canada

Background: The natural history of acute diverticulitis remains poorly understood, and the role of surgical intervention is controversial. The purpose of this study was to determine the rates of recurrence and associated complications following non-operative management of acute diverticulitis in a population-based setting.

Methods: All patients admitted to an adult hospital in a large urban area between January 2007 and March 2010 were identified using a health records search (ICD-10 codes K 572, 573, 578 and 579). Patients who underwent emergency surgery were excluded. Demographic, clinical, radiologic, treatment, complication and recurrence data were collected. Data was analysed with logistic regression; a two-sided p-value of 0.05 was considered significant.

Results: A total of 645 patients presented with acute diverticulitis. 502 patients were managed non-operatively (49 percutaneous drains, 456 antibiotics). Median age of patients was 55 (range 24 - 103), 51% of patients were female, median follow-up was 34 months (range 14 - 50). Seventy eight patients (15.5%) required acute readmission to hospital, of which 67 (85.9%) were related to recurrent diverticulitis. 14 (20.9%) patients required urgent surgical intervention. Of the remaining 53 patients managed non-operatively, 8 (15.1%) required a second acute readmission (6 due to recurrent diverticulitis, 2 requiring surgery). On univariate analysis only a Charlson Comorbidity score of 1 or greater was a predictor of recurrence (p = 0.02). Of the 559 total admissions for diverticulitis managed non-operatively, there were 51 (9.1%) in hospital complications (Dindo- Clavien grade 1 = 20, grade 2 = 25, grade 3 = 6). 10 (1.9%) patients were readmitted to hospital with complications following non-operative management including bowel obstruction, fistula, clostridium difficile infection and lower GI bleed.

Conclusion: Conservative management of diverticulitis results in a low rate of recurrence, further supporting a non-operative approach. The only predictor of recurrence was patient comorbidity. Non-operative management is associated with a low rate of complications.


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