In nonoperatively managed patients, ≈7% of patients had recurrent episodes, and 2% required emergency surgery during 4 years of follow-up.
Some surgeons promote elective surgery after one or two episodes of uncomplicated diverticulitis to prevent recurrences that might require urgent operative intervention. However, this approach has been challenged in recent years. To provide additional data on the natural history of diverticulitis, Ontario researchers conducted a retrospective study using the province’s population-based administrative database. The cohort included 14,121 patients who were hospitalized with first episodes of acute diverticulitis between 2002 and 2012 and were managed nonoperatively. Patients readmitted within 30 days of index admissions were excluded because these cases likely represented persistent rather than recurrent disease.
During median follow-up of 4 years, 6.8% of patients were readmitted once, and 1.3% were readmitted more than once; only 1.8% required emergency surgery. Readmissions were most likely during the first 2 years and declined subsequently. Patients whose index episodes of diverticulitis were complicated by perforation or abscess were about three times more likely to require emergency surgery during follow-up than those with uncomplicated index episodes.
Li D et al. Risk of readmission and emergency surgery following nonoperative management of colonic diverticulitis: A population-based analysis. Ann Surg 2014 Sep; 260:423.