Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Clinical Epidemiology

Background:

• Current understanding of complicated diverticulitis relies on outdated information.
• Previous diverticulitis episodes are believed to increase risks of complicated disease, morbidity, and mortality.
• Practice guidelines suggest elective resection after two diverticulitis episodes to mitigate risks.

Purpose of the Study:

• To investigate whether multiple prior diverticulitis episodes increase the risk of poor outcomes in complicated diverticulitis.
• To compare morbidity and mortality rates between patients with varying numbers of prior diverticulitis episodes who develop complicated diverticulitis.
• To inform clinical practice regarding the necessity of elective resection after recurrent diverticulitis.

Main Methods:

• Retrospective analysis of 150 patients hospitalized with complicated diverticulitis and prior episodes.
• Patients categorized into two groups: 1-2 prior episodes (n=118) and >2 prior episodes (n=32).
• Statistical analysis using chi-squared and Fisher exact tests.

Main Results:

• No significant differences in age or comorbid conditions between groups.
• Pericolonic abscess and inflammatory phlegmon were common presentations.
• Group A (1-2 prior episodes) had a higher rate of perforated diverticulitis and underwent more surgical diversions than Group B (>2 prior episodes).
• No significant differences in operative complications, morbidity, or mortality were observed between the groups.

Conclusions:

• Patients with multiple (>2) prior diverticulitis episodes do not exhibit increased risk for poor outcomes when developing complicated diverticulitis.
• Morbidity and mortality rates are comparable between patients with multiple prior attacks versus those with 1-2 prior attacks.
• Clinical practice guidelines recommending elective resection after two diverticulitis episodes warrant reevaluation.