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Critical evaluation: surgery for uncomplicated diverticulitis.

Platell C

School of Surgery and Pathology, St John of God Hospital, Subiaco, University of Western Australia, Subiaco, Western Australia, Australia.

AIM: To examine the influence of previous episodes of uncomplicated diverticulitis on the prognosis of patients who subsequently develop complicated diverticulitis. PATIENTS: One hundred and fifty patients with previous episodes of diverticulitis who were admitted to the Mayo Clinic (Rochester, MN, USA) with complicated diverticulitis (perforation, abscess, obstruction, phlegmon, fistula, or bleeding). DESIGN: The retrospective analysis was based on two groups of patients: group A had one or two prior episodes of diverticulitis (n = 118) and group B had more than two prior episodes of diverticulitis (n = 32). MEASUREMENT OF OUTCOME: The following criteria were used: phlegmon was a symptomatic inflammatory mass separate from and not associated with a purulent fluid collection; pericolic abscess was a collection of purulent material localized near the colon or in the pelvis; obstruction was characterized by obstructive symptoms and a stricture or stenosis diagnosed by radiographic studies or pathological evaluation; fistulas included colovaginal and colovesicular connections; perforation was either a collection of contained air outside the bowel wall or a large amount of free intra-abdominal air; and patients who required a transfusion for a lower gastrointestinal haemorrhage associated with symptoms and signs of diverticulitis were placed in the bleeding category. RESULTS: Perforated diverticulitis occurred more often in patients from group A; because of this, patients in group A underwent more surgical diversions. There were no appreciable differences in operative complications, morbidity or mortality rates. CONCLUSION: Patients with more than two episodes of uncomplicated diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis.

Published 17 January 2008 in ANZ J Surg, 78(1): 96-8; discussion 98.
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