Long-Term Evolution of Acute Colonic Diverticulitis After Successful Medical Treatment Long-Term Follow-up After an Initial Episode of Diverticulitis: What Are the Predictors of Recurrence? Effectiveness of different therapeutic strategies in preventing diverticulitis recurrence. Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment Prediction and management of recurrent right colon diverticulitis Diverticula and Diverticulitis: Time for a Reappraisal. Colonic diverticulitis: impact of imaging on surgical management – a prospective study of 542 patients Assessment of recurrence and complications following uncomplicated diverticulitis Diverticular Abscess Managed With Long-term Definitive Nonoperative Intent Is Safe One year intermittent rifaximin plus fibre supplementation vs. fibre supplementation alone to prevent diverticulitis recurrence: a proof-of-concept study. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial) Colorectal Adenoma Characteristics as Predictors of Recurrence Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance Acute recurrent diverticulitis is prevented by oral administration of a polybacterial lysate suspension. [The ambulatory medical treatment of colonic diverticulitis. An open clinico-endoscopic-histological study with rifaximin, a nonaminoglycoside enteric antibiotic]. Primaryvs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV) Conservative treatment of acute colonic diverticulitis: Are antibiotics always mandatory?
Background The evidence is sparse concerning the natural history of acute diverticulitis after successful conservative management . This observational study aim ed to evaluate the rate , severity , and need of surgery for recurrence after a first episode of acute diverticulitis successfully managed conservatively . Methods All patients admitted for acute diverticulitis between 1994 and 2011 were considered for inclusion in the study . Severity of the first episode , demographic data , comorbidities , management , recurrence , and elective or emergency surgery during the follow-up period were prospect ively recorded . Results The study included 560 patients . The mean follow-up period was of 67.2 ± 44.4 months . Severe diverticulitis was diagnosed in 22.3 % of the cases . Recurrence was observed in 14.8 % of the patients , and the rate of severe recurrence was 3.4 % . Most of the recurrences occurred during the first year of follow-up evaluation . Chronic corticoid therapy ( P = 0.043 ) and the presence of more than one abscess ( P < 0.001 ) were significantly related to recurrence . In the event of a mild recurrence , the first episode was either mild or severe ( P = 0.172 ) . In the case of severe recurrence , most patients presented with a previous severe diverticulitis ( P < 0.001 ) . During the follow-up period , 6.8 % of the patients needed an elective operation , and 1.4 % of them underwent emergency surgery . Conclusion The rate of severe recurrence after successful nonoperative management of acute diverticulitis was low , and emergency surgery was rare . Prophylactic surgery , even in cases of recovered severe diverticulitis , should be considered on a case-by-case basis . Strict follow-up assessment during the first year is advised PURPOSE : The purpose of our study was to determine the clinical and CT predictors of recurrent disease after a first episode of diverticulitis that was successfully managed nonoperatively . METHODS : We retrospectively analyzed 954 consecutive patients who presented to our institution with diverticulitis from 2002 to 2008 . Patients were identified with International Classification of Diseases , 9th Revision/Current Procedural Terminology codes . Patients were excluded if they had subsequent colectomy based on the first attack ( n = 81 ) , or if the attack they had between 2002 and 2008 was not their first attack ( n = 201 ) . We evaluated CT variables chosen by a panel of expert gastrointestinal radiologists . These radiologists review ed the available published literature for CT imaging characteristics thought to predict diverticulitis severity . CT variables ( n = 20 ) were determined by prospect i ve reevaluation of scans by blinded study radiologists . Clinical variables ( n = 43 ) were coded based on a retrospective chart review . Univariate analysis of variables in relation to recurrent disease was performed by a log-rank test of Kaplan-Meier estimates . Multivariate analysis was performed using Cox proportional hazards modeling . Variables with P < .2 on univariate analysis were included in a stepwise selection algorithm . RESULTS : The study population included 672 patients ; mean age , 61 ± 15 years ; mean follow-up , 42.8 ± 24 months . The index presentation of diverticulitis was most commonly located in the sigmoid colon ( 72 % ) , followed by descending colon ( 33 % ) , right colon ( 5 % ) , and transverse colon ( 3 % ) . Overall recurrence at 5 years was 36 % by ( 95 % CI 31.4%–40.6 % ) Kaplan-Meier estimate . Complicated recurrence ( fistula , abscess , free perforation ) occurred in 3.9 % ( 95 % CI 2.2%–5.6 % ) of patients at 5 years by Kaplan-Meier estimate . Family history of diverticulitis ( HR 2.2 , 95 % CI 1.4–3.2 ) , length of involved colon > 5 cm ( HR 1.7 , 95 % CI 1.3–2.3 ) , and retroperitoneal abscess ( HR 4.5 , 95 % CI 1.1–18.4 ) were associated with diverticulitis recurrence . Right colon disease ( HR 0.27 , 95 % CI 0.09–0.86 ) was associated with freedom from recurrence . CONCLUSION : Although diverticulitis recurrence is common following an initial attack that has been managed medically , complicated recurrence is uncommon . Patients who present with a family history of diverticulitis , long segment of involved colon , and /or retroperitoneal abscess are at higher risk for recurrent disease . Patients who present with right-sided diverticulitis are at low risk for recurrent disease . These findings should be taken into consideration when counseling patients regarding the potential benefits of prophylactic colectomy BACKGROUND Colonic diverticulitis shows a high recurrence rate . AIMS To assess the efficacy of three different therapeutic strategies in preventing diverticulitis recurrence . MATERIAL S AND METHODS One hundred thirty patients suffering from Acute Uncomplicated Diverticulitis ( AUD ) ( 81 males , 49 females , mean age 64.71 years , range 40 - 85 ) were prospect ively assessed . After obtaining remission , considered present when both endoscopic and histological damage were absent , the patients were treated with mesalazine 1.6 g/day ( 59 patients , group A ) , or rifaximin 800 mg/day for 7 days every month ( 52 patients , group B ) . Clinical , endoscopic and histological follow-up was performed after 6 , 12 and thereafter every 12 months after diagnosis of AUD . RESULTS Seven patients were excluded from final evaluation because they were lost to follow-up . Fifty-five group A patients and 49 group B patients patients were available for the final assessment at the end of a 24-month follow-up . Sustained remission was significantly higher in group A with respect to group B. CONCLUSIONS Patients taking mesalazine have lower risk of diverticulitis recurrence than patients taking rifaximin because of the lower prevalence of persisting endoscopic and histological inflammation Purpose This study included all patients treated at the University Hospital of Geneva for a first episode of uncomplicated diverticulitis . Risks of recurrence and treatment failure were evaluated by comparing the results between short-course and long-course intravenous ( IV ) antibiotic therapy groups . Methods The records of all patients hospitalized at our facility from January 2007 to February 2012 for a first episode of uncomplicated diverticulitis ( Hinchey Ia ) , as confirmed by computed tomography , were prospect ively collected . We published an auxiliary analysis from this registered study at Clinical trials.gov ( identifier number : NCT01015378 ) . Two groups of patients were considered : one received a short-course IV antibiotic arm ( ceftriaxone and metronidazole ) for up to 5 days ( followed by 5 days of oral antibiotics ) ; the other received a long-course IV arm between days 5 and 10 . The primary outcome was the recurrence-free survival time . Results Follow-up was completed for 256 patients -50 % men and 50 % women , with a median age of 56 years ( range , 24 - 85 years ) . The average follow-up was 50 months ( range , 19 - 89 months ) . Of the 256 patients included in the study , 46 patients received a short-course IV antibiotic treatment and 210 received a long-course treatment .  The recurrence-free survivals were very similar between the two groups , which was supported by a log rank test ( P = 0.772 ) . Four treatment failures , all in the long-course IV antibiotic treatment group , occurred . Conclusion Treatment of diverticulitis with a short IV antibiotic treatment is possible and does not modify the recurrence rate in patients with uncomplicated diverticulitis Purpose While the incidence of right colonic diverticulitis ( RCD ) is rare in Western countries , the right colon is the most common site of diverticulitis in Asian countries . However , its recurrent pattern and management were rarely studied . This study was design ed to eluci date the pattern of recurrence in RCD . Methods Of the 154 patients admitted as right colonic diverticulitis between February 2004 and March 2012 , 104 patients were enrolled , prospect ively . The recurrence rate , size , multiplicity , location , diagnostic criteria score , and predisposing factors were evaluated based on Hinchey ’s classification of diverticulitis . Results There were 104 patients with right colonic diverticulitis in this study , and 20 patients ( 19.2 % ) recurred after medical treatment . When the diverticula were not located in the right colon , the recurrence rate was significantly higher than the diverticula located only in the right colon ( p = 0.004 ) . The recurrence rate of diverticulitis for a single diverticulum was significantly lower than that for multiple diverticula ( p = 0.02 ) . Of the 20 patients with recurrence , 1 ( 5 % ) patient underwent laparoscopic diverticulectomy due to a misdiagnosis of diverticulitis as appendicitis . The remaining 19 patients ( 95 % ) received nonoperative management and recovered without any sequelae . Conclusions The recurrence rate was 19.2 % , and the predisposing factors were the location of diverticula and the multiplicity of primary diverticula . The re-recurrence rate of recurred patients was 26.3 % . The recurred lesions were controlled simply by nonoperative management . Elective surgery was also a treatment option Colonic diverticula are very common and may be associated with symptoms or complicated by diverticulitis and its associated problems . Many of the traditional concepts relating to the pathophysiology , prevention , and management of these entities have been question ed recently based on findings from high- quality prospect i ve studies . Although dietary fiber may protect against symptoms and complications , its impact on the formation of diverticula may be limited . It is now evident that the risk for an episode of diverticulitis in an individual with diverticula is lower than previously thought . Furthermore , the necessity for antibiotic use in uncomplicated diverticulitis has been question ed and serious doubt cast upon the belief that surgery should be performed when a second attack occurs . Although data are far from conclusive , there is some evidence to suggest that diverticulosis may be associated with chronic abdominal symptoms , with or without underlying chronic inflammatory changes in the involved segment of the colon . In addition , colonoscopy is not routinely required after an attack of acute uncomplicated diverticulitis , as the risk of cancer in this population is not much higher than in the general population Abstract . The aim of this study was to compare the performance of the CT and the water-soluble contrast enema ( CE ) in the diagnosis and the severity of acute left-colonic diverticulitis , and to recognize the impact of CT during the acute phase and after a first acute episode successfully treated medically . From 1986 to 1997 , all patients admitted in our emergency center with clinical ly suspected left-colonic diverticulitis had a CE and a CT  within 72 h of their admission , unless clinical findings required immediate laparotomy . They were prospect ively included in the study if one or both radiological exams showed signs of acute diverticulitis and /or diverticulitis was surgically removed and histologically proven . Diverticulitis was considered moderate when CT showed localized thickening of the colonic wall ( 5 mm or more ) and inflammation of pericolic fat and CE showed segmental lumen narrowing and tethered mucosa ; it was considered severe when abscess and /or extraluminal air and /or contrast were observed on CT and when one or both of the latter signs were seen on CE . Five hundred forty-two patients entered the study ; 465 patients ( 86 % ) had a CT exam , 439 ( 81 % ) had a CE , and 420 ( 77 % ) had both exams . The performance of CT is significantly superior to CE in terms of sensitivity ( 98 vs 92 % , p<0.01 ) , and in the evaluation of the severity of the inflammation ( 26 vs 9 % , p<0.02 ) . Moreover , of 69 patients who had an associated abscess seen on CT , only 20 ( 29 % ) had indirect signs of this complication on CE . During the acute phase the chances of medical treatment failure are statistically greater when diverticulitis is considered severe on CT than when it is considered moderate ( 26 % for the severe diverticulitis vs 4 % for the moderate ones , p<0.0001 ) . After successful medical treatment of the acute episode , patients with severe diverticulitis on the CT had statistically greater incidence of secondary bad outcome than patients with moderate diverticulitis ( 36 vs 17 % , p<0.0001 ) . Computed tomography should be preferred to CE as the initial radiological exam of diverticulitis because of its statistically significant superiority in sensitivity and for its statistically much higher performance in the detection of severe infection , especially when an abscess is associated with the disease . The severity of diverticulitis on CT is statistically predictive of the risk of medical treatment failure during the acute phase and of the chances of bad secondary outcome after a successful medical treatment of the first episode The natural history of sigmoid diverticulitis has been inferred from population ‐based or retrospective studies . This study assessed the risk of a recurrent attack following the first episode of uncomplicated diverticulitis BACKGROUND : Initial nonoperative management of diverticular abscess has become the st and ard of care ; however , the need for elective resection after this index episode is unclear . OBJECTIVE : The purpose of this study was to assess the long-term outcomes of expectant management after initial nonoperative treatment of diverticular abscess . DESIGN : This was a retrospective chart review with prospect i ve telephone follow-up of patients . SETTING S : The study was conducted at a large tertiary academic colorectal surgery practice in Canada . PATIENTS : Adult patients with CT-documented acute sigmoid diverticulitis complicated by abscess managed nonoperatively from 2000 to 2013 were included . INTERVENTIONS : Long-term definitive nonoperative management of diverticular abscess . MAIN OUTCOME MEASURES : The primary outcome was  emergency sigmoidectomy or death from recurrent diverticulitis . Secondary outcomes were recurrent diverticulitis and elective sigmoidectomy for diverticulitis . RESULTS : Of 135 patients with acute diverticulitis complicated by abscess , a total of 73 patients were managed with nonoperative intent and long-term expectant management . The median follow-up was 62 ( Q1 to Q3 : 28–98 ) months . After resolution of the index episode , 22 patients [ 30.1 % ( 95 % CI , 19.6%–40.6 % ) ] experienced a recurrent episode of diverticulitis at a median of 23 ( range , 9–40 ) months . Two patients [ 2.7 % ( 95 % CI , –1.0 % to 6.4 % ) ] had a recurrent episode with peritonitis that required sigmoidectomy with stoma at 6 and 64 months . Both patients underwent reversal after 4 and 8 months . Seven [ 9.6 % ( 95 % CI , 2.8%–16.4 % ) ] patients experienced a complicated recurrence and underwent an  elective sigmoidectomy  [ median time to colectomy , 33 ( range , 16–56 ) months ] . Thirteen patients [ 17.8 % ( 95 % CI , 9.0%–26.6 % ) ] experienced an uncomplicated recurrence , all of whom were managed with continued nonoperative intent [ median follow-up , 81 ( range , 34–115 ) months ] . No mortality occurred . On multivariate logistic regression , female gender ( p = 0.048 ) and a previous episode of uncomplicated diverticulitis before the index diverticular abscess ( p = 0.020 ) were associated with a recurrent episode . LIMITATIONS : This study was limited by its retrospective design and modest sample size . CONCLUSIONS : After initial successful nonoperative management of diverticulitis with abscess , expectant management with nonoperative intent is a safe long-term option with low rates of surgery , especially in the emergency setting . See Video , Supplemental Digital Content 1 , on the nonoperative management of diverticular abscess at http://links.lww.com/DCR/A234 BACKGROUND Evidence supporting appropriate medical therapy to prevent recurrence of colonic diverticulitis is limited . Our goal was to evaluate the potential of rifaximin given periodically in addition to fibre for the prophylaxis of recurrences . METHODS We conducted a multicentre , r and omized , open controlled study in patients with a recent episode of colonic diverticulitis , currently in remission . Patients received 3.5 g of high-fibre supplementation b.d . with or without one week per month of the non-absorbable antibiotic rifaximin ( 400 mg b.d . ) for 12months . Primary endpoint was recurrence of diverticulitis , encompassing acute symptomatic flare with or without complications , analyzed by multivariable logistic regression analysis and by Cox proportional hazard method . RESULTS After r and omizing 165 patients , the study was interrupted since the recruitment rate was largely below the minimum anticipated , and the trial was switched from evidence -gathering to proof-of-concept . Recurrences occurred in 10.4 % of patients given rifaximin plus fibres vs. 19.3 % of patients receiving fibres alone . The logistic analysis adjusted for sex , age , illness duration , time from last episode , disease localization and centre recruitment rate , yielded a significant treatment effect ( odds ratio 3.20 ; 95 % confidence interval : 1.16 - 8.82 ; P=0.025 ) . Patients with diverticulitis diagnosed since ≥1 year receiving rifaximin  also had a lower incidence of recurrences ( 10 % ; 95 % confidence interval : 2 - 47 % vs. 67 % ; 95 % confidence interval : 37 - 100 % ) . Both treatments were safe . CONCLUSIONS This study represents a proof-of concept of the efficacy of cyclic rifaximin treatment , added to fibre supplements , to reduce the risk of recurrences of diverticulitis in patients in remission Background Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy . It is , however , uncertain whether patients with acute diverticulitis indeed benefit from antibiotics . In most guidelines issued by professional organizations antibiotics are considered m and atory in the treatment of mild diverticulitis . This advice lacks evidence and is merely based on experts ' opinion . Adverse effects of the use of antibiotics are well known , including allergic reactions , development of bacterial resistance to antibiotics and other side-effects . Methods A r and omized multicenter pragmatic clinical trial comparing two treatment strategies for uncomplicated acute diverticulitis . I ) A conservative strategy with antibiotics : hospital admission , supportive measures and at least 48 hours of intravenous antibiotics which subsequently are switched to oral , if tolerated ( for a total duration of antibiotic treatment of 10 days ) . II ) A liberal strategy without antibiotics : admission only if needed on clinical grounds , supportive measures only . Patients are eligible for inclusion if they have a diagnosis of acute uncomplicated diverticulitis as demonstrated by radiological imaging . Only patients with stages 1a and 1b according to Hinchey 's classification or " mild " diverticulitis according to the Ambrosetti criteria are included . The primary endpoint is time-to-full recovery within a 6-month follow-up period . Full recovery is defined as being discharged from the hospital , with a return to pre-illness activities , and VAS score below 4 without the use of daily pain medication . Secondary endpoints are proportion of patients who develop complicated diverticulitis requiring surgery or non-surgical intervention , morbidity , costs , health-related quality of life , readmission rate and acute diverticulitis recurrence rate . In a non-inferiority design 264 patients are needed in each study arm to detect a difference in time-to-full recovery of 5 days or more with a power of 85 % and a confidence level of 95 % . With an estimated one percent of patients lost to follow up , a total of 533 patients will be included . Conclusion A clinical ly relevant difference of more than 5 days in time-to-full recovery between the two treatment strategies is not expected . The liberal strategy without antibiotics and without the strict requirement for hospital admission is anticipated to be more a more cost-effective approach . Trial registration Trial registration number : PURPOSE The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians . This study was design ed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence . METHODS The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial . At both baseline and three-year examinations , the characteristics of adenomas were recorded according to a st and ardized protocol . The main outcomes measured were the three-year overall recurrence , recurrence of multiple adenomas , recurrence of advanced adenomas ( size ≥ 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia ) , and proximal and distal recurrence . RESULTS A three-year recurrence was observed in 122 patients ( 22.1 percent ) , and more than one-half of them had recurrent adenomas on the proximal colon . After adjustment for patient characteristics and treatment allocation , the number of adenomas and their proximal location at baseline were the main predictors of recurrence . In comparison with patients who had one or two adenomas on the distal colon , patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence ( 5.3 ; 95 percent confidence interval , 2.7–10.3 ) , proximal recurrence ( 8.5 ; 95 percent confidence interval , 4.1–18 ) , and advanced adenoma recurrence ( 5.5 ; 95 percent confidence interval , 2.4–12.6 ) . CONCLUSIONS Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon . The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas Objective : The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection ( SSI ) in both elective colon and rectal surgery . Summary Background Data : SSI is a frequent complication after elective colorectal resection . The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together , without differentiating the type of colorectal surgery performed . However , rectal surgery may have a higher risk for SSI , and identifying risk factors that are more specific to each procedure would be more predictive . Methods : We conducted prospect i ve SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004 . The data for colon and rectal surgeries were collected separately . The outcome of interest was incisional SSI . Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery . Results : A total of 556 colorectal resections , consisting of 339 colon and 217 rectal surgeries , were admitted to the program . The incisional SSI rates in colon and rectal surgeries were 9.4 % and 18.0 % , respectively ( P = 0.0033 ) . Risk factors for developing incisional SSI in colon surgery were ostomy closure ( OR = 7.3 ) and lack of oral antibiotics ( OR = 3.3 ) , while in rectal surgery , risk factors were preoperative steroids ( OR = 3.7 ) , preoperative radiation ( OR = 2.8 ) , and ostomy creation ( OR = 4.9 ) . Conclusions : Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI . SSI surveillance for such surgeries should be performed separately , as this should lead to more efficient identification of risk factors and a reduction in SSI AIM The main cause of acute diverticulitis is the abnormal accumulation of fecal bacteria within the diverticular lumen , leading to a balancing between normal probiotic microflora and pathogenic species ; Gram negative Entero-bacteriaceae , mainly Escherichia coli and Proteus spp , are the genders that usually cause the disease-related symptoms , due to their ability to adhere to intestinal mucosa . The intestine is well known as the largest human lymphoepithelial organ and daily produces more antibodies , mainly secretory IgAs , than do all other lymphoid tissues . IgAs have different immune and anti-inflammatory properties . The aim of this study was to verify the efficacy of an oral immunostimulant highly-purified , polymicrobial lysate in the prevention of recurrent attacks of diverticulitis and in the improvement of symptoms . METHODS The study was carried out on 83 consecutive patients suffering from recurrent symptomatic acute diverticulitis and with at least 2 attacks in the previous year ; patients were r and omly assigned to receive ( group A ) an oral polybacterial lysate suspension or to a no-treatment clinical follow-up as controls ( group B ) . RESULTS A total of 76 patients ( 41 in group A and 35 in group B ) terminated the study period . the sums of the scores for symptoms , reported on day schedules , were calculated and examined by means of ANOVA statistical analysis . Statistical differences between group A vs group B were recorded after 1 month ( p<0.05 ) and 3 months ( p<0.01 ) of treatment with the oral polybacterial lysate suspension . CONCLUSIONS Our data suggest that the administration of an oral enterovaccine for the prophylaxis of recurrent diverticulitis is effective and well tolerated , probably due to a direct stimulation of IgA-mediated mucosal defences Twenty patients with mild acute diverticulitis of the colon were treated with rifaximine 400 mg b.i.d . per os per 10 days . From a clinical point of view , spontaneous and evoked abdominal pain , diarrhoea , nausea , leukocytosis and hyperthermia result ed in marked significant reduction at the end of treatment , as compared to the basal data ( P less than 0.01 ) . A significant reduction of the peridiverticular oedema , mucosal redness , submucosal haemorrhage and diffuse granular pattern was observed endoscopically at the end of treatment ( P less than 0.05 ) . Only a trend toward degrees of vasodilation and submucosa hemorrhage was observed from the histological point of view . No side-effect was observed during and after the treatment period PURPOSE : Our hypothesis was that in patients with perforated sigmoid colon diverticulitis and peritonitis ( Hinchey Stage III and IV ) a one-stage sigmoid colon resection is safe and cost effective when performed by an experienced colorectal surgeon . We evaluated outcome and cost of one-stagevs . two-stage sigmoid colon resection after diverticulitis perforation and peritonitis . METHODS : Patients undergoing emergency resection for perforated sigmoid colon diverticulitis and peritonitis ( Hinchey Stage III and IV ) . Outcome , costs , and insurers reimbursement were compared between 13 patients undergoing sigmoid colon resection and primary anastomosis ( Group A ) and 42 patients undergoing sigmoid colon resection with Hartmann 's procedure and secondary descendorectostomy ( Group B ) . RESULTS : Group A patients were comparable to Group B patients in age , gender , preoperative risk and severity of peritonitis ( Mannheim Peritonitis Index and C-reactive protein ) . Operating room time for sigmoid colon resection with primary anastomosis ( 3.3±1.2 hours ) was identical to the time for sigmoid colon resection with colostomy ( 3.3±1 hour ) , and morbidity and mortality , intensive care unit , and in-hospital stay were not significantly different between the two groups . In Group B patients ' intestinal continuity was restored 169±74 days after the primary resection in 32 of 42 patients only ( 78 percent ) . The second procedure took on average 1.4 hours longer than the first procedure . Patients in Group B received more antibiotics ( 2.2vs . 2 ) albeit for a shorter period of time ( 4.5vs . 5.7 days , P = not significant ) . Overall expenses for restoration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients . Reimbursement was 18,191±16,761 SFr ( Group A ) and 41,321±26,983 SFr ( Group B ) respectively . CONCLUSION : With meticulous surgical technique and extensive intraoperative lavage , perforated sigmoid colon diverticulitis with peritonitis can be treated by a one-stage sigmoid colon resection and anastomosis with a low mortality and morbidity . A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage Objective . Most patients admitted for acute colonic diverticulitis ( AD ) are managed conservatively and receive antibiotics , although it is uncertain whether all patients with AD benefit from this treatment . The aim of this study was to evaluate the influence of antibiotic treatment on outcome in the conservative management of patients with mild AD . Material and methods . A retrospective audit of 311 patients ( 64 % F , mean age 60 years ) hospitalized for AD was carried out . All patients were initially treated conservatively with observation and restriction of oral intake . Patients receiving antibiotics ( n=118 ) were compared with patients treated with observation and restriction of oral intake only ( n=193 ) . Mean follow-up time ( FU ) was 30 months . Results . Inflammation in patients treated with antibiotics was more pronounced ( laboratory parameters ( C-reactive protein , white blood cell count ) were higher ( p<0.01 ) , fever was more common ( p<0.01 ) and CT grading of inflammation was classified as severe in a higher proportion ( p<0.01 ) ) compared with patients treated without antibiotics . When initially treated with antibiotics , 3 patients ( 3 % ) failed to respond to treatment and had to undergo surgery . There were 7 ( 4 % ) failures in patients initially treated without antibiotics , and antibiotics were then added . During FU , 29 % of patients treated with antibiotics had further events ( recurrent AD and /or subsequent surgery ) compared with 28 % ( NS ) among those treated without antibiotics . In a multivariate analysis , the risk of a further event was not influenced by antibiotic treatment ( OR 1.03 , CI 95 % 0.61–1.74 ) . Conclusions . Our results indicate that antibiotics are not m and atory in mild AD . Treatment without antibiotics appears to be safe and seems not to change the rate of further events . These results warrant further r and omized prospect i ve studies
Primary diverticulitis with abscess formation and young age increased the risk of recurrence .
Readmission risk was higher within the first year after remission .
Conclusions The best treatment strategy for recurrent diverticulitis is undetermined .
Purpose Several factors may influence the risk of recurrence after an episode of acute colonic diverticulitis .
Until now , a comprehensive systematic overview and evaluation of relevant risk factors have not been presented .
This review aim ed at assembling and evaluating current evidence on risk factors for recurrence after conservatively treated acute colonic diverticulitis .