A Prospective Study of Acute Admissions in a Surgical Unit due to Diverticular Disease

Abstract

Introduction: Considerable controversy exists in the surgical literature on the most appropriate treatment modality for patients with recurrent diverticular disease. We aim to assess the clinical outcome of acute surgical admissions with diverticular disease, and in particular patients with recurrent admissions. Methods: 100 consecutive emergency admissions with suspected diverticular disease were prospectively recruited from November 1, 2002 to May 31, 2004. Results: The majority of the patients were female (64%) and the median age was 74 (45–97) years. The follow-up period was up to 30 months. Four patients with tumour and polyps as definitive diagnosis were excluded from further analysis. Fifty-four patients had a known history of diverticular disease with a median duration of 4 (range 1–40) years; 44 of them had 1–7 previous emergency admissions (median 2). Acute diverticulitis (42%) and acute rectal bleeding (23%) were the commonest presentations. Patients with complicated diverticulitis requiring an emergency operation had a median C-reactive protein of 281 mg/l compared to 58 mg/l in the conservatively treated patients with acute diverticulitis (Mann- Whitney U test, Z –3.943, p < 0.001). Nine of 14 patients operated had at least two previous admissions with complications of diverticular disease. Emergency operative treatment was associated with prolonged hospital stay (21 vs. 5 days; Mann-Whitney U test, Z –4.367, p < 0.001), increased morbidity and postoperative mortality. Conclusions: Symptomatic diverticular disease is associated with recurrent emergency admissions. The majority of patients who required emergency laparotomy had previous recurrent emergency admissions, which was associated with increased morbidity and prolonged hospital stay.