25. Complicated Diverticulitis: Is It Time To Rethink the Rules?
Jennifer R. Chapman, MD*, Michael Davies, M.D., Bruce Wolff, M.D., Deron Tessier, M.D., Jeffrey Harrington, BS
Mayo Clinic, Rochester, MN (Sponsored by: Bruce Wolff, MD)
Objective: Our knowledge and treatment of complicated diverticulitis (CD) is based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study was to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD.
Methods: 337 patients who were hospitalized for CD were retrospectively analyzed. Statistical results were determined using chi-square and Fisher’s exact tests.
Results: Mean age of patients was 65. [See table] 47% had at least one prior diverticulitis episode while 53.4% presented with CD as their first episode. Overall mortality was 6.5% (86.4% associated with perforation, 9.1% anastomotic leak, 4.5% nonoperative management). 83% of perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation and mortality rates (p<0.001 and p=0.002). Diabetes, collagen-vascular disease, and immune compromise were highly associated with death also (p=0.006, p=0.009, and p=0.003). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity.
| % Overall | Mortality Rate% | |
| Perforation | 44.5 | 12.6 |
| Abscess | 29.5 | 1.3 |
| Obstruction | 22.6 | 0 |
| Phlegmon | 22.3 | 0 |
| Fistula | 13.4 | 0 |
| Bleeding | 4.5 | 0 |
Conclusion: CD mortality excluding perforation is reduced compared to past data. This, coupled with the majority of patients presenting with CD as their first episode, challenges the practice of elective resection as a strategem for reducing mortality. Immunocompromised patients may benefit from early resection. Prospective data is needed to redefine target groups for prophylactic resection.