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Predictive factors for colonic resection in patients less than 49 years with symptomatic diverticular disease
Stephen F Murphy1, Peadar S Waters1, Ronan M Waldron1
1Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.
Insights
Most younger patients with acute diverticulitis can be managed conservatively. However, factors like age (40-49) and elevated C-reactive protein predict a need for surgery in complicated diverticular disease.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Clinical Medicine
Background:
- Diverticular disease is linked to low-fiber diets and obesity.
- Increasing incidence observed in individuals under 49 years old.
- Study focuses on complicated diverticular disease in younger populations.
Purpose of the Study:
- Evaluate management strategies for complicated diverticular disease in patients under 49.
- Identify predictors of a more severe disease course in this demographic.
Main Methods:
- Analysis of a prospectively updated database (2005-2013) of acute diverticulitis admissions.
- Data included patient demographics, inflammatory markers, CT scans, and Hinchey Classification.
- Statistical analysis using SPSS, with significance set at P < 0.05.
Main Results:
- 120 patients (<49 years) diagnosed with acute diverticulitis.
- 10% (12 patients) required colonic resection for complicated cases (stricture, obstruction, perforation).
- Predictors for surgery included age 40-49 and elevated C-reactive protein; females were less likely to undergo resection.
Conclusions:
- Conservative management is effective for most younger patients with acute diverticulitis.
- A subset of patients necessitates aggressive surgical intervention for complicated disease.
Background:
Diverticular disease is a condition strongly associated with low-fiber intake and obesity. There have been reports of an increasing incidence in younger individuals ranging from 12% to 21% of all cases. The aim of this study was to evaluate the management of complicated diverticular disease in patients less than 49 years and attempt to identify factors predictive of a more virulent course.
Methods:
An analysis of a prospectively updated database of all patients admitted with a primary diagnosis of acute diverticulitis from 2005 to 2013 was performed. Data collected included age, length of stay, inflammatory markers on admission, use of computed tomography (CT), and Hinchey Classification. SPSS version 22 was used for statistical analysis, and a P value of .05 or less was considered significant.
Results:
A total of 120 (54 female and 66 male) patients less than 49 (28 to 49, 42.1) years were noted to have a diagnosis of acute diverticulitis. Twelve patients (10%) required colonic resection for complicated diverticulitis. Histological evaluation revealed 5 cases of stricture, 2 obstruction, and 5 perforations. On multivariate analysis, predictors of operative intervention and/or colonic resection included, (hazard ratio [95% confidence interval]) patients aged 40 to 49 years (.92 [.9 to .95]) and elevated C-reactive protein on index admission (1.4 [1.32 to 1.54]). Females were less likely to undergo colonic resection compared with males (1.18 [1.15 to 1.2]). Median length of stay was 4 days (1 to 48) for patients managed nonoperatively and 13 days (5 to 27) for those who underwent surgery.
Conclusions:
Most younger patients with acute diverticulitis can be treated successfully by conservative means. However, a proportion of patients require aggressive surgical management.
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