Diverticular disease is a common entity. The presentation, investigations performed,
and management are variable. Our objectives were to assess the presentation, extent
of disease, and treatment of a cohort of patients with colonic diverticulitis.
All patients with a diagnosis of diverticulitis over a 9-year period were reviewed.
Patients were assessed as to age, sex, presenting symptoms, diagnostic studies, extent
of disease, treatment, and outcome.
Over a 9-year period (1992 to 2001), 192 patients were admitted with a diagnosis of
colonic diverticulitis. The mean age was 61 years (range 28 to 90); 113 of 192 (59%)
were female. The mean duration of symptoms prior to presentation was 14 days (range
1 to 270 days). One hundred eighteen of 192 (61%) had a previous documented attack
of diverticulitis. Of the investigations performed 128 of 192 (66.7%) had a computed
tomography (CT) scan of the abdomen and pelvis, 37 of 192 (20%) underwent a contrast
enema, 61 of 192 (32%) underwent colonoscopy and 2 of 192 (1%) underwent a small bowel
series. The abnormal findings on the CT scan were as follows: diverticular abscess
(16%), diverticulitis (37%), diverticulosis without inflammation (15%), free air (10%)
and fistula (1%). The locations of the diverticular abscesses were: pelvic (36%),
pericolic sigmoid (36%), and “other,” which included interloop (28%). Preoperative
abscess drainage occurred in 10 of 192 (5%), which were either percutaneous, 6 of
192 (3%), or transrectal, 4 of 192 (2%). Nine of 192 (6%) presented with a fistula,
colovesical fistulae (3%), colocutaneous (1%), enterocolic (1%), or colovaginal (1%).
Overall, 73 of 192 (38%) underwent surgery. All patients undergoing surgery had a
resection of their colon. The operative findings were localized abscess in 16 of 73
(22%), purulent/feculent peritonitis in 12 of 73 (17%), and phlegmon in 10 of 73 (14%).
Sixty-seven of 73 (92%) had a primary resection with anastomosis; 38 of 67 (56%) had
a protecting stoma. Five of 73 (7%) patients were found to have an unsuspected carcinoma.
Overall, 29 of 192 (15%) developed a complication related to diverticulitis. Morbidity
was 15.1%, of which 34% was infection related. Four of 192 patients (2%) died.
In our experience, most patients presented with abdominal pain predominantly in the
left lower quadrant. The symptoms were present on average of 14 days, most were female
(59%), and most patients had a previous attack of diverticulitis. The commonest investigation
performed was a CT scan (66.7%); however, other investigations were performed, for
example, barium enemas. The practice of resection and primary anastomosis for acute
diverticulitis has an acceptable morbidity and mortality. For high-risk anastomoses,
a covering loop ileostomy and not a Hartmann's procedure is preferred. Surgery remains
safe for the majority of patients and is associated with resolution of symptoms. We
believe that because of the high number of patients in our series who had a previous
attack of diverticulitis, therapy should be focused on preventing recurrent and virulent
attacks by earlier operative intervention.