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Journal of Gastrointestinal Surgery

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01-04-2011 | Original Article

Sigmoid Diverticulitis in Young Patients—A More Aggressive Disease than in Older Patients?

Authors: Jörg-Peter Ritz, Kai S. Lehmann, Andrea Stroux, Heinz J. Buhr, Christoph Holmer

Published in: Journal of Gastrointestinal Surgery | Issue 4/2011

Abstract

Introduction

There is controversy over whether sigmoid diverticulitis (SD) is more aggressive with a higher risk of perforation in younger than in older patients. The aim of this study was to assess the clinical presentation and outcome of patients ≤40 and >40 years old with acute diverticulitis.

Patients and Methods

Consecutive admissions of all patients with acute SD were prospectively recruited from January 1998 to June 2010.

Results

A total of 1,019 patients were included: 513 (69 ≤40 years and 444 >40 years) presented with their first episode, while 506 (20 ≤40 years, 486 >40 years) had a prior history of SD. The percentage of patients with severe SD did not differ between the two age groups either for the first (covered perforation, 30.4% vs. 29.5%, p = 0.875; free perforation, 26.1% vs. 23.9%, p = 0.69) or for the recurrent episode (covered perforation, 15% vs. 8.2%, p = 0.287; free perforation, 5% vs. 4.1%, p = 0.846). Furthermore, the rate of emergency surgery did not differ between both age groups either for the first (26.1% vs. 23.9%, p = 0.690) or the recurrent episode (5% vs. 4.1%, p = 0.846). No differences in the rate of Hartmann’s procedure (52.6% vs. 68.3%, p = 0.180) and failure of conservative treatment (3.4% vs. 4.9%, p = 0.607) were observed between younger and older patients.

Conclusion

Acute SD in younger patients is not more aggressive and has no higher risk of perforation or need for emergency surgery compared to older patients.

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

Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A et al. Diverticular disease of the colon – on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003; 17: 1189–1195.PubMedCrossRef

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

Haglund U, Hellberg R, Johnsen C, Hulten L. Complicated diverticular disease of the sigmoid colon. An analysis of short and long term outcome in 392 patients. Ann Chir Gynaecol 1979; 68: 41–46.PubMed

Lee IK, Jung SE, Gorden DL, Lee YS, Jung DY, Oh ST, Kim JG, Jeon HM, Chang SK. The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Colorectal Dis 2008; 23:1151–1157.PubMedCrossRef

Antolovic D, Reissfelder C, Koch M, Mertens B, Schmidt J, Büchler MW, Weitz J. Surgical treatment of sigmoid diverticulitis—analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int J Colorectal Dis 2009; 24:577–584PubMedCrossRef

Schauer PR, Ramos R, Ghiatas AA, Sirinek KR. Virulent diverticular disease in young obese men. Am J Surg 1992; 164: 443–446.PubMedCrossRef

Spivak H, Weinrauch S, Harvey JC, Surick B, Ferstenberg H, Friedman I. Acute colonic diverticulitis in the young. Dis Colon Rectum 1997; 40: 570–574.PubMedCrossRef

Vignati PV, Welch JP, Cohen JL. Long-term management of diverticulitis in young patients. Dis Colon Rectum 1995; 38: 627–629.PubMedCrossRef

10.

Biondo S, Pares D, Marti Rague J, Kreisler E, Fraccalvieri D, Jaurrieta E. Acute colonic diverticulitis in patients under 50 years of age. Br J Surg 2002; 89: 1137–1141PubMedCrossRef

11.

Ambrosetti P, Robert JH,Witzig JA, Mirescu D, Mathey P, Borst F, Rohner A. Acute left colonic diverticulitis in young patients. J Am Coll Surg 1994; 179: 156–160.PubMed

12.

West S, Robinson EK, Delu AN, Ligon RE, Kao LS, Mercer DW. Diverticulitis in the younger patient. Am J Surg 2003; 186: 743–746.PubMedCrossRef

13.

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

14.

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

15.

Tursi A, Brandimarte G, Elisei W, Giorgetti GM, Inchingolo CD, Aiello F. Faecal calprotectin in colonic diverticular disease: a case–control study. Int J Colorectal Dis 2009; 24:49–55.PubMedCrossRef

16.

Fleming FJ, Gillen P. Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything? Int J Colorectal Dis 2009; 24:1219–1225.PubMedCrossRef

17.

Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee os European Association for Endoscopic Surgery. Surg Endosc 1999; 13: 430–436PubMedCrossRef

18.

Wong WD 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: 290–297PubMedCrossRef

19.

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 (7): 939–944PubMedCrossRef

20.

Anaya DA, Flum DR. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 2005; 140: 681–685.PubMedCrossRef

21.

Pautrat K, Bretagnol F, Huten N, de Calan N. Acute diverticulitis in very young patients: a frequent surgical management. Dis Colon Rectum 2007; 50(4):472–477.PubMedCrossRef

22.

Hansen O, Stock W. Prophylaktische Operation bei der Divertikelkrankheit des Kolons – Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir Suppl 1999; II: 1257

23.

Ritz JP, Reissfelder C, Holmer C, Buhr HJ. Results of sigma resection in acute complicated diverticulitis : method and time of surgical intervention. Chirurg. 2008 Aug;79(8): 753–758.PubMedCrossRef

24.

Favuzza J, Friel JC, Kelly JJ, Perugini R, Counihan TC. Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis Int J Colorectal Dis 2009; 24:797–801PubMedCrossRef

25.

Ritz JP, Lehmann KS, Loddenkemper C, Frericks B, Buhr HJ, Holmer C. Preoperative CT staging in sigmoid diverticulitis-does it correlate with intraoperative and histological findings? Langenbecks Arch Surg. 2010; 395(8): 1009–15PubMedCrossRef

26.

Nelson RS, Velasco A, Mukesh BN. Management of diverticulitis in younger patients. Dis Colon Rectum 2006; 49: 1341–5.PubMedCrossRef

27.

Al-Sahaf O, Al-Azawi D, Fauzi MZ, El-Masry S, Gillen P. Early discharge policy of patients with acute colonic diverticulitis following initial CT scan. Int J Colorectal Dis 2008: 23:817–820PubMedCrossRef

28.

Holmer C, Lehmann KS, Engelmann S, Frericks B, Loddenkemper C, Buhr HJ, Ritz JP. Microscopic findings in sigmoid diverticulitis--changes after conservative therapy. J Gastrointest Surg. 2010;14(5): 812–817.PubMedCrossRef

29.

Konvolinka CW. Acute diverticulitis under age forty. Am J Surg 1994; 167: 562–5.PubMedCrossRef

30.

Makela J, Vuolio S, Kiviniemi H, Laitinen S. Natural history of diverticular disease: when to operate? Dis Colon Rectum 1998; 41: 1523–8.PubMedCrossRef

31.

Jeyarajah S, Papagrigoriadis S. Diverticular disease increases and effects younger ages: an epidemiological study of 10-year trends. Int J Colorectal Dis 2008; 23:619–627PubMedCrossRef

32.

Slim K, Raspado O, Brugère C, Lanay-Savary MV, Chipponi J. Failure of a meta-analysis on the role of elective surgery for left colonic diverticulitis in young patients. Int J Colorectal Dis 2008; 23:665–667PubMedCrossRef

33.

Hjern F, Josephson T, Altman D, Holmström B, Johansson C. Outcome of younger patients with acute diverticulitis. Br J Surg. 2008; 95(6): 758–764.PubMedCrossRef

34.

Pittet O, Kotzampassakis N, Schmidt S, Denys A, Demartines N, Calmes JM. Recurrent left colonic diverticulitis episodes: more severe than the initial diverticulitis? World J Surg. 2009;33(3): 547–552PubMedCrossRef

Title: Sigmoid Diverticulitis in Young Patients—A More Aggressive Disease than in Older Patients?
Authors: Jörg-Peter Ritz
Kai S. Lehmann
Andrea Stroux
Heinz J. Buhr
Christoph Holmer
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 4/2011
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1457-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sigmoid Diverticulitis in Young Patients—A More Aggressive Disease than in Older Patients?

Abstract

Introduction

Patients and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and Methods

Results

Conclusion

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