Long-term evolution of acute colonic diverticulitis after successful medical treatment.

Abstract

The evidence is sparse concerning the natural history of acute diverticulitis after successful conservative management. This observational study aimed to evaluate the rate, severity, and need of surgery for recurrence after a first episode of acute diverticulitis successfully managed conservatively. All patients admitted for acute diverticulitis between 1994 and 2011 were considered for inclusion in the study. Severity of the first episode, demographic data, comorbidities, management, recurrence, and elective or emergency surgery during the follow-up period were prospectively recorded. The study included 560 patients. The mean follow-up period was of 67.2 ± 44.4 months. Severe diverticulitis was diagnosed in 22.3 % of the cases. Recurrence was observed in 14.8 % of the patients, and the rate of severe recurrence was 3.4 %. Most of the recurrences occurred during the first year of follow-up evaluation. Chronic corticoid therapy (P = 0.043) and the presence of more than one abscess (P < 0.001) were significantly related to recurrence. In the event of a mild recurrence, the first episode was either mild or severe (P = 0.172). In the case of severe recurrence, most patients presented with a previous severe diverticulitis (P < 0.001). During the follow-up period, 6.8 % of the patients needed an elective operation, and 1.4 % of them underwent emergency surgery. The rate of severe recurrence after successful nonoperative management of acute diverticulitis was low, and emergency surgery was rare. Prophylactic surgery, even in cases of recovered severe diverticulitis, should be considered on a case-by-case basis. Strict follow-up assessment during the first year is advised.