Prognostic indices in the treatment of acute diverticulitis: a retrospective study

A review of patients with acute diverticulitis admitted to the University of Maryland Hospital over the past ten years revealed a high frequency of surgical intervention. In addition to the usual indications for surgery (obstruction, perforation, and fistula), we found persistent mass combined with other clinical indices, such as fever, leukocytosis, tachycardia, or recurrence required surgical intervention. Medical therapy (i.e., intravenous hydration, antibiotics, diet, nasogastric suction, etc.) varied with the clinical presentation. Only 43 per cent of the medically treated patients received antibiotics. If the bowel can be adequately prepared, a one-stage operation may be possible. Otherwise more stages may be necessary. A prognostic index has been devised for acute diverticulitis for the evaluation of medical vs. surgical therapy. The higher the index, the more extensive the procedure that will be used. Our study supports the general usefulness of a Hartman (two-stage) procedure for those patients requiring surgery.