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Features of colonic diverticulitis in children and adolescents: A multicenter study
Ji-Won Han1, Joonhyuk Son2, Chaeyoun Oh3
1Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, South Korea.
Insights
Colonic diverticulitis (CD) in children and adolescents is rare but increasing. Most cases involve solitary lesions in the right colon and are less severe than in adults, often responding to conservative treatment.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Radiology
Background:
- Colonic diverticulitis (CD) is increasingly prevalent globally, yet data on pediatric and adolescent cases remain limited.
- This study addresses the scarcity of information by investigating the characteristics of CD in individuals under 20 years old.
Purpose of the Study:
- To characterize colonic diverticulitis in pediatric and adolescent populations.
- To analyze the clinical presentation, diagnostic methods, severity, and treatment outcomes of CD in young patients.
Main Methods:
- A multicenter, retrospective review of 104 patients under 20 years diagnosed with CD.
- Data collected from June 2003 to December 2020 across four Korean tertiary hospitals.
- Diagnosis confirmed via abdominal CT scans; severity assessed using the modified Hinchey classification.
Main Results:
- CD predominantly occurred in the cecum or ascending colon (99%) in patients aged 17.24 ± 2.4 years (59.6% male).
- Most cases presented as solitary lesions (89.4%) and were mild (modified Hinchey stage 0, Ia, or Ib).
- Conservative management with antibiotics was effective in most cases (92.3%), with a 7.8% recurrence rate.
Conclusions:
- Colonic diverticulitis in children and adolescents, though uncommon, is characterized by right-sided, solitary lesions with typically lower severity than in adults.
- Conservative, non-surgical management is generally effective, highlighting the need for specific pediatric CD guidelines.
- Early diagnosis and conservative approaches are recommended, with surgery reserved for rare, complicated cases.
Background:
Colonic diverticulitis (CD), typically seen in the elderly of Western countries, is increasingly prevalent worldwide, yet data on CD in children and adolescents are scarce. This study explores the characteristics of CD in this younger demographic.
Methods:
In a multicenter, retrospective review, 104 patients under 20 years diagnosed with CD at four Korean tertiary hospitals from June 2003 to December 2020 were analyzed. Abdominal CT scans were used for diagnosis, with the modified Hinchey classification assessing the severity of CD.
Results:
CD was found in the cecum or ascending colon in 103 (99%) of cases. The mean patient age was 17.24 ± 2.4 years, with males constituting 59.6% of cases. Solitary lesions were noted in 93 (89.4%) of patients. Severity was classified as modified Hinchey stage 0 in 58.7%, stage Ia in 29.8%, and stage Ib in 11.5%, with no cases of stage II or higher. Misdiagnosis as acute appendicitis occurred in six instances. IV antibiotics were administered to 68.3%, and oral antibiotics were sufficient for 24%. Surgical treatment was necessary for two patients. A 7.8% recurrence rate was noted among first-time CD patients, yet all cases were amenable to conservative management.
Conclusion:
While uncommon, CD in children and adolescents is a growing concern, with most cases presenting as solitary lesions in the cecum or ascending colon. The severity is typically less than that in adults, and conservative treatment is generally effective. These findings underscore the need for specific management guidelines for pediatric CD, advocating for non-surgical initial approaches.
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