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Diverticular disease in patients under 50 years of age
D N Anderson1, C P Driver, A I Davidson
1Aberdeen Royal Hospitals NHS Trust, Foresterhill, UK.
Insights
Sigmoid diverticular disease in young adults presents aggressively, often leading to severe complications. Early surgical consideration may be beneficial after managing acute episodes.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Colorectal Surgery
Background:
- Sigmoid diverticular disease can exhibit a more aggressive clinical course in younger individuals compared to the elderly.
- Complications such as peritonitis, abscess, obstruction, fistula, and hemorrhage are more frequent in younger patients.
Purpose of the Study:
- To describe the presentation and management of sigmoid diverticular disease in patients under 50 years of age.
- To evaluate the incidence of complications and surgical outcomes in this demographic.
Main Methods:
- Retrospective analysis of 77 patients under 50 years old with sigmoid diverticular disease over a 6-year period.
- Detailed review of patient demographics, clinical presentation, management strategies, and surgical interventions.
Main Results:
- Eighteen patients (23%) required surgery for complications, including peritonitis, abscess, bowel obstruction, fistula, and hemorrhage.
- Colonic resection was performed in 14 patients, with primary anastomosis in six and Hartmann's procedure in eight.
- Thirty-day mortality was zero. Twenty-five percent of all patients and 67% of surgical patients had prior hospitalizations for diverticular disease complications.
Conclusions:
- Younger patients with sigmoid diverticular disease experience a high rate of serious complications and recurrence.
- Elective surgery should be considered for patients who have successfully managed an acute episode of diverticulitis, given the recurrent nature and potential for severe complications.
Abstract:
Sigmoid diverticular disease, when it occurs in a young age group, may follow a more aggressive course with a higher incidence of complications than in elderly. The mode of presentation and management in 77 patients under 50 years of age presenting with sigmoid diverticular disease over a 6-year period is described. Surgery for complications (peritonitis, abscess, bowel obstruction, fistula and haemorrhage) was performed in 18 (23%) individuals. Colonic resection was carried out in 14 (78%) of the operated group with primary anastomosis in six patients and Hartmann's procedure in eight patients. The mortality (30 day) was zero. Nineteen (25%) of the entire group, and 12 (67%) of those undergoing surgery had been previously hospitalized with a complication of diverticular disease. The recurrent nature and frequency of serious complications in this group, suggests that elective surgery should be considered if an acute infective episode is successfully managed conservatively.