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 27 May 2018

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News

Rethinking the rules on complicated diverticulitis

The majority of patients present with complicated diverticulitis as their first episode, calling into question the current practice of elective resection to reduce mortality, reports this month's Annals of Surgery.

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Much of our knowledge and treatment of complicated diverticulitis are based on outdated literature reporting mortality rates of 10%.

Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality.

Dr Jennifer Chapman and colleagues considered morbidity, mortality, characteristics, and outcomes of complicated diverticulitis.

The investigators retrospectively analyzed 337 patients hospitalized for complicated diverticulitis.

Characteristics and outcomes were determined using chi-squared and Fisher exact tests.

Immunocompromised patients may benefit from early resection
Annals of Surgery

The investigative team reported that the mean age of patients was 65 years, and 70% had 1 or more comorbidities.

A total of 47% had a history of at least one prior diverticulitis episode, whereas 53% presented with complicated diverticulitis as their first episode.

The investigators found that the overall mortality rate was 7%, associated with perforation, anastomotic leak, patient managed nonoperatively.

The investigative team noted that a total of 90% of the perforation patients who died had no history of diverticulitis.

Steroid use was significantly associated with perforation rates as well as mortality.

The team observed that comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death.

Overall morbidity was 41%, and older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity.

Dr Chapman's team concludes, “Today, mortality from complicated diverticulitis excluding perforation is reduced compared with past data.”

“This, coupled with the fact that the majority of these patients presented with complicated diverticulitis as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality.”

“Immunocompromised patients may benefit from early resection.”

“New prospective data is needed to redefine target groups for prophylactic resection.”

Ann Surg 2005: 242(4): 576-83
05 October 2005

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