title: Recurrent left colonic diverticulitis episodes: more severe than the initial diverticulitis?
abstract: BACKGROUND
  Until recently, it was accepted that the rate of complications and failure of medical therapy were higher during recurrent episodes of diverticulitis. New data and new interpretation of older studies have challenged this opinion. The aim of the present study was to determine whether recurrent diverticulitis in comparison with the initial episode has a different short-term outcome after medical or surgical treatment.
  
  
  METHODS
  This was a retrospective cohort study of 271 consecutive patients admitted for diverticulitis confirmed by computed tomography (CT) between 2001 and 2004. Altogether 202 patients had an initial episode (group I), and 69 had recurrent diverticulitis (group R). A total of 20 clinical and 15 radiologic parameters were analyzed and compared between the two groups, including need for surgery, clinical presentation at admission, response to treatment, complications, laboratory parameters, and pathologic CT features (colonic wall thickening, abscess, pneumoperitoneum, free intraperitoneal fluid). An unpaired Student's t-test and Fisher's and Wilcoxon's tests were applied for statistical analysis.
  
  
  RESULTS
  None of the clinical or radiologic parameters was statistically different between the two groups. Regarding surgery, 15.8% of the group I patients needed surgery at admission compared to 5.8% in group R (p = 0.04). Conservative treatment failure was similar in the two groups (10.7% vs. 10.0%; p = 0.84). There was 3% mortality at 30 days in group I compared to 0% in group R.
  
  
  CONCLUSIONS
  Recurrent episodes of diverticulitis do not lead to more complications and more conservative treatment failure. Moreover, surgery at admission was less frequent among patients who presented with a recurrence.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, CH-1011, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pittet
authors.forename: Nikos
authors.initials: N
authors.lastname: Kotzampassakis
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmidt
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Calmes
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003125:Colostomy / Q000379:methods; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome