Acute diverticulitis in very young patients: a frequent surgical management.
OBJECTIVE
The natural history of sigmoid diverticulitis in terms of the virulence and management in young patients is an ongoing controversy. This retrospective study was designed to assess the severity and early management of acute diverticulitis according to age.


METHODS
From 2000 to 2004, 284 patients were admitted for acute diverticulitis. Fifty-two patients (18 percent) were aged 50 years or younger and were divided in two groups: aged 40 years or younger (Group 1, n = 20), and patients older than aged 40 years (Group 2, n = 32). The diagnosis was confirmed by computed tomography in 49 patients (94 percent).


RESULTS
Radiologic findings showed that the rate of complicated lesions (i.e., diverticular perforation and/or abscess) was significantly higher for patients younger than aged 40 years than patients older, respectively 72 and 35 percent (P = 0.02). The risk of requiring immediate surgical treatment was significantly more frequent in Group 1 than Group 2 (40 vs.13 percent; P = 0.04). There was a trend toward a higher risk of "major surgery" (i.e., Hartmann's procedure) in Group 1 than Group 2 (15 vs. 0 percent; P = 0.05).


CONCLUSIONS
Diverticulitis in patients younger than aged 40 years seems to have a particularly aggressive and fulminant course and requires early surgical procedures for complications (associated abscess, colonic perforation) in 40 percent of cases. The use of "major procedure" (i.e., stoma) is more frequent in these patients.
Pautrat
Karine
K
Department of Digestive Surgery, Trousseau Hospital, Tours, France.
Bretagnol
Frederic
F
Huten
Noel
N
de Calan
Loic
L
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D004239:Diverticulitis, Colonic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012810:Sigmoid Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*