Introduction. Young age has been identified in the literature as a risk factor for complications and emergency surgery among patients with acute diverticulitis. Our objective was to determine whether or not factors such as (1) duration of symptoms before admission to the hospital, (2) body mass index (BMI), and (3) smoking affected their outcome. Materials and methods. After IRB approval, a retrospective review was conducted at a community teaching hospital. The study included 107 patients 45 years of age and younger admitted with diverticulitis between January 1997 and December 2001. Comparison was made between patients who either underwent surgery or received antibiotics alone upon first admission for diverticulitis. The results were evaluated using either a Mann--Whitney Rank Sum or Chi-Square test. Results. The mean age of the 107 patients was 38.5 years (22–45), 64% males, and 36% females. There were a total of 126 admissions. Fourteen patients were excluded from this analysis since they were readmissions for elective surgery. Twenty-five patients (26.9%) required surgery during the first admission. Among this subgroup, the duration of symptoms was 5.1 days. Antibiotic management alone was successful in 73.1% of patients. Obesity was found in 86.3% (mean BMI 32.5 ± 8.2 kg/m 2). Among the subgroup that required surgery during the first admission, the BMI was 28.5. Smoking history was present in 56% (1.25 ± 0.6 packs a day × 18.4 ± 6.1 years) of all study patients, and there was no significant difference in smoking history between the two outcome groups. Mortality was zero. Conclusions. Diverticulitis in young patients can usually be managed at first presentation nonoperatively; patients that require surgery urgently tended to have a longer duration of symptoms. Obesity and smoking do not increase the risk for needing surgery at initial admission. TABLE—ABSTRACT P39 Factor Antibiotic alone Emergency surgery P value Symptoms 2.6 days 5.1 days 0.248 BMI 34.3 28.5 0.004 Smoke 35 (53%) 14 (56%) 0.986