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Management of Acute Diverticulitis in Immunocompromised Patients-The Mayo Clinic Experience

Shengliang He1, Patricia Lu1, David Etzioni1

  • 1Division of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona.

Diseases of the Colon and Rectum
|July 19, 2022
PubMed

Insights

Nonoperative management is safe for immunocompromised patients with uncomplicated acute diverticulitis. However, perforated diverticulitis in this population is linked to high morbidity and mortality rates, necessitating careful consideration of treatment strategies.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Gastroenterology
  • Immunology in Clinical Practice

Background:

  • Acute diverticulitis in immunocompromised patients presents a management challenge due to high morbidity and mortality rates.
  • The optimal treatment approach, particularly for nonperforated disease, remains controversial in this vulnerable patient group.
  • This study reports the Mayo Clinic's experience in managing acute diverticulitis within an immunocompromised patient cohort.

Discussion:

  • Nonoperative management demonstrated a high success rate (93%) for acute uncomplicated diverticulitis in immunocompromised patients.
  • Even complicated cases with abscesses showed a high success rate (95.4%) with initial nonoperative treatment.
  • Conversely, perforated diverticulitis in this cohort was associated with substantial morbidity and a significant mortality rate (27.3%).

Key Insights:

  • Nonoperative management is a safe and feasible strategy for immunocompromised patients with nonperforated acute diverticulitis.
  • Perforated diverticulitis in immunocompromised individuals carries a considerably higher risk of severe complications and death.
  • Surgical intervention during the same admission for complicated or perforated disease was associated with a 50% major complication rate and 18.8% mortality.

Outlook:

  • Further research could explore refined algorithms for managing complicated and perforated diverticulitis in immunocompromised patients.
  • Investigating specific risk factors and predictive markers for treatment success or failure in this population is warranted.
  • Comparative studies evaluating different nonoperative and operative strategies could optimize outcomes.
Abstract

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