Role of colonoscopy in patients with persistent acute diverticulitis

AIM： To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization. METHODS： All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study. Patients were followed during hospitalization and after discharge. Patients were considered to have a persistent course of acute diverticulitis if symptoms continued after 1 wk of conventional treatment with 1V antibiotics, or if symptoms recurred within 2 mo after discharge. Patients were considered to benefit from an early colonoscopy if the colonoscopy was therapeutic or if it changed a patient＇s outcome. RESULTS： Three hundred and six patients were hospitalized between July 2000 and December 2006 with the diagnosis of acute diverticulitis. Two hundred and twenty four of these were included in the study group. Twenty three patients （10.3%） fulfilled the criteria for a persistent course of acute diverticulitis. Of them, four patients （17.4%） clearly benefited from an early colonoscopy; these patients＇ clinical course is described. None of the patients with a regular non-persistent course demonstrated any benefit from colonoscopy. CONCLUSION： Early colonoscopy detected other significant pathology, which accounted for the clinical presentation in 17% of patients with persistent acute diverticulitis. Therefore, we believe an early colonoscopy should be considered in all patients with a persistent clinical course.

Diverticulitis in the young patient-Is it different?

AIM： To prospectively study the incidence and the natural history of acute diverticulitis in young patients. METHODS： A total of 207 patients hospitalized at our hospital between January 2000 to February 2005 with the diagnosis of acute diverticulitis were included. Their demographic characteristics, medical history, physical, radiographic and endoscopic findings as well as therapy were recorded. Patients were followed every 6 mo for the first year and later annually. RESULTS： The mean patients＇ age was 61 （range 27-92） years. Twenty- five patients （12%） were younger than 45 years. Acute diverticulitis was significantly more prevalent among male in the young age group as compared to the older age group （19/25, 76% vs 61/182, 33%, respectively, P = 0.0001）. Complications occurred more often in the young age group; 32% vs 13%, （P = 0.002）. During follow-up, 6 patients （28%） remained asymptomatic in the young age group as compared to 87 patients （55%） in the older age group （P = 0.024）. As a result, sigmoidectomies were performed twice as often in the young age group （38% vs 13%, P = 0.002）. CONCLUSION： Diverticulitis in young patients has a male predominance, a more aggressive course with a higher rate of complications and a higher recurrence rate. An earlier surgical approach might be considered in young patients with acute diverticulitis.