Elective operation after acute complicated diverticulitis:Is it still mandatory?

AIM: To investigate recurrence rates, patterns and complications after nonoperatively managed complicated diverticulitis(CD).METHODS: A retrospective study of patients treated for CD was performed. CD was defined on computed tomography by the presence of a localized abscess, pelvic abscess or extraluminal air. For follow-up, patients were contacted by telephone. Numbers of elective surgeries, recurrences and abdominal pain were analyzed.RESULTS: A total of 114 patients(median age 57 years(range 29-97)), were admitted for CD. Nine patients required surgical intervention for failure of conservative therapy(Hartmann’s procedure: n = 6; resection and colorectal anastomosis: n = 3). Of the 105 remaining patients, 24(22.9%) underwent elective sigmoid resection. The 81(71%) non-operated patients were all contacted after a median follow-up of 32 mo(4-63). Among them, six had developed a recurrent episodeof diverticulitis at a median follow-up of 12 mo(6-36); however, no patient required hospitalization. Sixtyeight patients(84%) were asymptomatic and 13(16%) had recurrent abdominal pain.CONCLUSION: Conservative policy is feasible and safe in 71% of cases, with a low medium-term recurrence risk.