title: Multicentre observational study of the natural history of left-sided acute diverticulitis.
abstract: BACKGROUND
  The natural history of acute diverticulitis (AD) is still unclear. This study investigated the recurrence rate, and the risks of emergency surgery, associated stoma and death following initial medical or surgical treatment of AD.
  
  
  METHODS
  The Italian Study Group on Complicated Diverticulosis conducted a 4-year multicentre retrospective and prospective database analysis of patients admitted to hospital for medical or surgical treatment of AD and then followed for a minimum of 9 years. The persistence of symptoms, recurrent episodes of AD, new hospital admissions, medical or surgical treatment, and their outcome were recorded during follow-up.
  
  
  RESULTS
  Of 1046 patients enrolled at 17 centres, 743 were eligible for the study (407 recruited retrospectively and 336 prospectively); 242 patients (32·6 per cent) underwent emergency surgery at accrual. After a mean follow-up of 10·7 years, rates of recurrence (17·2 versus 5·8 per cent; P < 0·001) and emergency surgery (6·9 versus 1·3 per cent; P = 0·021) were higher for medically treated patients than for those treated surgically. Among patients who had initial medical treatment, age less than 40 years and a history of at least three episodes of AD were associated with an increased risk of AD recurrence. There was no association between any of the investigated parameters and subsequent emergency surgery. The risk of stoma formation was below 1 per cent and disease-related mortality was zero in this group. The disease-related mortality rate was 0·6 per cent among patients who had surgical treatment.
  
  
  CONCLUSIONS
  Long-term risks of recurrent AD or emergency surgery were limited and colectomy did not fully protect against recurrence.
authors: Department of General Surgery, Galliera Hospital, Genoa, Italy. gian.andrea.binda@galliera.it
authors: G A
authors: GA
authors: Binda
authors: A
authors: A
authors: Arezzo
authors: A
authors: A
authors: Serventi
authors: L
authors: L
authors: Bonelli
authors: M
authors: M
authors: Facchini
authors: M
authors: M
authors: Prandi
authors: P S
authors: PS
authors: Carraro
authors: M C
authors: MC
authors: Reitano
authors: G
authors: G
authors: Clerico
authors: L
authors: L
authors: Garibotto
authors: R
authors: R
authors: Aloesio
authors: A
authors: A
authors: Sganzaroli
authors: M
authors: M
authors: Zanoni
authors: G
authors: G
authors: Zanandrea
authors: F
authors: F
authors: Pellegrini
authors: S
authors: S
authors: Mancini
authors: A
authors: A
authors: Amato
authors: P
authors: P
authors: Barisone
authors: C
authors: C
authors: Bottini
authors: D F
authors: DF
authors: Altomare
authors: G
authors: G
authors: Milito
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004238:Diverticulitis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents