Natural history of diverticular disease - When to operate?

PURPOSE: The natural history of patients admitted because of acute divertic ulitis is largely unknown, and the selection of patients for surgical treat ment varies notably. This study presents our experience concerning the outc ome for 366 patients admitted during a 10-year period. METHODS: Three hundr ed sixty-six patients admitted to our hospital with acute diverticulitis fr om 1981 to 1990 were identified from a computer database, and their clinica l data up to the end of 1996 were reviewed from the database and patient re cords. RESULTS: There were significantly more males than females in the age group less than 50 years old, and young males underwent surgical treatment during the first treatment period more frequently than the others. Young p atients were operated on without mortality, and all their temporary colosto mies were closed. Older patients died more often of diseases unrelated to t he diverticular disease during the years after the first episode of acute d iverticulitis. Recurrences of diverticular disease developed in 22 percent of patients, and they were significantly more common in patients less than 50 years old than in the older age groups. Males less than 50 years old mor e often developed complications of diverticular disease after two hospital admissions. CONCLUSIONS: Males first admitted when less than 50 years of ag e undergo more primary operations and develop more recurrences of diverticu lar disease than do older people. Based on our data, however, we recommend surgery for all patients after two episodes of acute diverticulitis that re solves after conservative treatment with antibiotics.