title: Does the presence of abscesses in diverticular disease prelude surgery?
abstract: BACKGROUND
  Information on long-term outcome of patients treated conservatively for diverticular abscess is scarce. This study aims to compare diverticulitis patients with abscess to patients without abscess with regard to readmission, complications, and surgical treatment during a follow-up period of at least 12 months.
  
  
  METHODS
  A chart review of all patients admitted for a primary manifestation of diverticulitis between January 2005 and January 2011 was performed.
  
  
  RESULTS
  Fifty-nine patients with abscess and 663 without abscess were identified. Median follow-up was 28 months (range 12-103). Initial conservative management was achieved in 54 (91.5 %) patients with diverticular abscess and 635 (96.8 %) without abscess. Readmission occurred more frequently among patients with abscess (hazard ratio (HR) 2.6; confidence interval (CI) 1.51-4.33) with a first-year risk of 27.3 versus 10.7 % and second-year risk of 8.2 versus 4.6 %. Surgery was more frequently performed in patients with diverticular abscess (HR 2.3; CI 1.42-3.66). The first-year risk was 35.1 versus 16.6 % and second-year risk was 12.9 versus 2.4 %. The most frequent indication for surgery was persisting or recurrent disease.
  
  
  CONCLUSIONS
  Patients with diverticular abscess have a higher risk of being readmitted and/or requiring surgical treatment. The pattern suggests that readmission and need for surgery are the results of an ongoing inflammation of the initial episode.
authors.affiliation: Department of Surgery, Meander Medical Center Amersfoort, P.O. Box 1502, 3800 BM, Amersfoort, The Netherlands.
authors.forename: B J M
authors.initials: BJ
authors.lastname: van de Wall
authors.forename: W A
authors.initials: WA
authors.lastname: Draaisma
authors.forename: E C J
authors.initials: EC
authors.lastname: Consten
authors.forename: R T
authors.initials: RT
authors.lastname: van der Kaaij
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: I A M J
authors.initials: IA
authors.lastname: Broeders
mesh_terms: D018784:Abdominal Abscess / Q000150:complications*; D000328:Adult; D016001:Confidence Intervals; D004239:Diverticulitis, Colonic / Q000145:classification / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000209:etiology; D012720:Severity of Illness Index; D013997:Time Factors