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Acute diverticulitis in younger patients: any rationale for a different approach?
Gil R Faria1, Ana B Almeida, Herculano Moreira
1Department of General Surgery, Hospital de São João, Al. Prof. Hernâni Monteiro, HSJ, 4200-319 Porto, Portugal. gilfaria@netcabo.pt
Aim:
To compare the natural history and course of acute diverticulitis in a younger age group with an older population and to evaluate whether younger patients should be managed differently.
Methods:
This study was a retrospective review of 157 patients treated with acute diverticulitis between January 1, 2004 and December 31, 2007. Diverticulitis was stratified according to the Hinchey classification. Patients were divided into 2 populations: group A ≤ 50 years (n = 31); group B > 50 years (n = 126). Mean patient follow-up was 15 mo.
Results:
The median age was 60 years. A significantly higher proportion of patients in group B presented with complicated diverticulitis (36.5% vs 12.9%, P = 0.01). Recurrence was more frequent in group A (25.8% vs 11.1%, P = 0.03) and the mean time-to-recurrence was shorter (12 mo vs 28 mo, P = 0.26). The most severe recurrent episodes of acute diverticulitis were classified as Hinchey stage I and none of the patients required emergency surgery. In multivariate analysis, only age (P = 0.024) was identified as an independent prognostic factor for recurrence.
Conclusion:
Based on the results of this study, the authors recommend that diverticulitis management should be based on the severity of the disease and not on the age of the patient.
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