25. Complicated Diverticulitis: Is It Time To Rethink the Rules?
Jennifer R. Chapman, MD*, Michael Davies, M.D., Bruce Wolff, M.D., Deron Tessier, M.D., Jeffrey Harrington, BS
Mayo Clinic, Rochester, MN (Sponsored by: Bruce Wolff, MD)

Objective: Our knowledge and treatment of complicated diverticulitis (CD) is based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study was to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD.
Methods: 337 patients who were hospitalized for CD were retrospectively analyzed. Statistical results were determined using chi-square and Fisher’s exact tests.
Results: Mean age of patients was 65. [See table] 47% had at least one prior diverticulitis episode while 53.4% presented with CD as their first episode. Overall mortality was 6.5% (86.4% associated with perforation, 9.1% anastomotic leak, 4.5% nonoperative management). 83% of perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation and mortality rates (p<0.001 and p=0.002). Diabetes, collagen-vascular disease, and immune compromise were highly associated with death also (p=0.006, p=0.009, and p=0.003). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity.

	% Overall	Mortality Rate%
Perforation	44.5	12.6
Abscess	29.5	1.3
Obstruction	22.6	0
Phlegmon	22.3	0
Fistula	13.4	0
Bleeding	4.5	0

Conclusion: CD mortality excluding perforation is reduced compared to past data. This, coupled with the majority of patients presenting with CD as their first episode, challenges the practice of elective resection as a strategem for reducing mortality. Immunocompromised patients may benefit from early resection. Prospective data is needed to redefine target groups for prophylactic resection.

Back to 125th Annual Meeting
Back to Program Outline