Diverticulitis in the Young Population : Reconsidering Conventional Recommendations

Background : In the past diverticulitis was believed to be uncommon in the young population. However, there is growing concern suggesting that these patients develop more severe clinical symptoms and may require more frequent intervention. Methods : We performed a retrospective chart review of patients with diverticulitis in individuals with age less than 40 years over an 8 year period (2007-2015). Diagnosis was confirmed with a CT scan. In addition to age we took into consideration race, gender, anemia (hematocrit< 41), leukocytosis (WBC > 12), BMI and whether it was an initial episode or recurrence. Our outcome variables were complications (abscess, fistula, and perforation, results of colonoscopy (polyps or colon cancer)) and whether the patient required surgery. Results : We identified 123 patients who were less than 40 years old with the diagnosis of diverticulitis. There was greater than a 3: 1 ratio of males to females (77% males and 23% females) with an average age of 32.6 year. The race of the patients was nearly entirely Hispanic (88.6%). With regards to the outcome variables, 18.7% had abscesses as a complication. Perforations were observed in 26% of the patients, of which one was complicated by a fistula. A total of 25 (20%) patients went to surgery. Of these, 21 had an abscess, perforation, or tubular adenomatous polyps (TAP). Follow-up colonoscopy post-diverticulitis results were available for 42 patients. Of those patients, 9 had hyperplastic polyps and 3 had TAP. The remaining 30 patients had no polyps. No colon cancer or villous polyps were found in the entire cohort. Conclusion : Our study highlights that young patients who have an index case of uncomplicated diverticulitis with no other risk factors or complications may not gain further benefit from routine colonoscopy as once traditionally thought.