title: Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?
abstract: BACKGROUND
  Our understanding of complicated diverticulitis is based on outdated literature. Antecedent episodes of diverticulitis are felt to increase the risk of developing complicated diverticulitis, as well as its subsequent morbidity and mortality. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce this morbidity and mortality.
  
  
  METHODS
  A total of 150 patients with prior episodes of diverticulitis who were hospitalized with complicated diverticulitis were retrospectively analyzed. Statistical analysis was conducted using chi and Fisher exact test tests.
  
  
  RESULTS
  Patients were separated into 2 groups for analysis: group A = those with 1 or 2 prior diverticulitis episodes (n = 118) versus group B = patients with more than 2 prior episodes (n = 32). Characteristics of the groups were similar for age and preexistent comorbid conditions. The majority of patients presented with pericolonic abscess and inflammatory phlegmon. Perforated diverticulitis occurred more often in group A compared with patients with >2 episodes of diverticulitis. Because of the higher rate of perforation, patients in group A underwent surgical diversion more often than group B patients. No significant differences in operative complications, morbidity, or mortality rates were identified between the groups.
  
  
  CONCLUSIONS
  Patients with multiple (>2) episodes of diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis. Morbidity and mortality rates are not significantly different between patients with multiple episodes of diverticulitis compared with those with 1 or 2 prior attacks. Reevaluation of the practice of elective resection as a strategy for reducing the mortality and morbidity from complicated diverticulitis is needed.
authors.affiliation: Division of Colon & Rectal Surgery, Mayo Clinic and Mayo Foundation, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Wolff
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Gullerud
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
mesh_terms: D000368:Aged; D003082:Colectomy; D018450:Disease Progression; D004239:Diverticulitis, Colonic / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate