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Changing Trends in Acute Colonic Diverticulitis in South East Queensland- a Retrospective Observational Audit.
Aung Win1, Jaskiran Kaur1, Christopher Gillespie3, Sneha John*1, 2
1Gastroenterology, Logan Hospital, Logan, QLD, Australia; 2Gastroenterology and Hepatology, Gold Coast University Hospital, Southport, QLD, Australia; 3Colorectal Surgery, Logan Hospital, Logan, QLD, Australia
Background:The clinical burden of acute colonic diverticulitis is high with nearly 300,000 admissions annually in the US.While diverticulitis is thought to be a disease of the elderly,recent trends suggest an increase in the number of young patients with this condition.It has also been suggested that they may require a greater number of admissions.In South East Queensland, we have noted a significant number of admissions with acute diverticulitis in young patients.The aetiological factors are unclear.
Aim:To identify the age stratification of patients admitted with acute colonic diverticulitis to a single institution over a 16 month period and any disease or patient specific characteristics in the younger age group.
Methods:This was a retrospective observational audit from March 2012 to August 2013.All patients admitted with a clinical diagnosis of acute colonic diverticulitis were considered.Inclusion criteria was the radiological confirmation of the diagnosis by a CT scan reported by an experienced Radiologist.Data was analysed to separate the patients into 3 age groups;< 45 years,45-65 years and >65 years. We also recorded a history of smoking,aspirin use and diabetes status.CT findings were separated into uncomplicated and complicated disease based on the presence of perforation,abscess,fistulae,strictures or a mass.
Results: A total of 305 patients were admitted to a single institution with diverticulitis in the study period and 155 patients met the inclusion criteria.There were 83 women and 72 men in the study. 31 % of the patients were under the age of 45 years, 46.5% were 45-65 years and 22.5% were above 65 years.The median age was 53 years (range 24-93);this was 55years in women and 48 years in men.36 patients had complicated diverticulitis with CT findings of perforations in 26 patients with10 abscesses and10 fistulae.Strictures were seen on CT in 10 patients and one was reported to have a mass.Surgery was required in 10 patients. 44% of the patients with complicated disease were under 45 years.This was statistically significant with a p value of 0.049. Smoking, diabetes and aspirin use did not have statistically significant effects on severity of presentation.
Discussion. There are significant changes in the age related demographics of acute diverticulitis in recent years. In our study the median age was 53years with 31% of the study population under 45 years. Interestingly, 44% of complicated disease was also in the younger population. This is very different from previously reported data from the US and Australia .The study is limited by its retrospective design and the possibility of bias. However, it reflects the changing trends in acute colonic diverticulitis with increased admissions with more complex disease in the younger population in our area. The aetiological factors are uncertain and a prospective multi -centre study is planned.
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