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Connelly TM, Cheong JY, Lincango EP, Foley N, Duraes LC, Kessler H. Surgery for young onset diverticulitis: is it curative? Int J Colorectal Dis 2023; 38:195. [PMID: 37452913 DOI: 10.1007/s00384-023-04479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 07/18/2023]
Abstract
PURPOSE Previously considered a disease of old age, diverticular disease is increasingly prevalent in younger populations. Guidelines on surgical resection have shifted from recommending resection for all young onset patients to an individualized approach. Therefore, we aim to determine demographics and outcomes including radiographic and surgical recurrence rates in patients < 40 years old undergoing resection for diverticular disease. METHODS A retrospective, single center study was performed. All patients ≤ 39 years undergoing operative intervention for left-sided diverticular disease between Jan 2010 and July 2017 were included. Recurrence was determined by individual review of imaging and operative reports. RESULTS Overall, 147 (n = 107/72.8% male, mean age = 34.93 ± 4.12 years) patients were included. The majority were ASA 1 or 2 (n = 41/27.9% and n = 82/55.8%). The most common surgical indication was uncomplicated diverticulitis (n = 77, 52.4%) followed by perforation (n = 26/17.7%). The majority (n = 108/73.5%) of cases were elective. Seventy-nine (57.3%) of all cases were performed laparoscopically. Primary anastomosis without diversion was the most common surgical outcome (n = 108/73.5%). Median length of stay was 5 (4, 7) days. There was no mortality. There were three (2.0%) intraoperative and 38 (25.9%) postoperative complications. The most common complication was anastomotic leak (n = 6/4.1%). The majority (n = 5) of leaks occurred after elective surgery. Two neoplastic lesions (1.3% of cohort) were found (1 adenoma with low-grade dysplasia/1 polyp cancer). Over a mean follow-up of 96 (74, 123) months, only 2 (1.3%) patients experienced a surgical or radiological recurrence. CONCLUSION Both neoplasia and recurrence after resection for diverticular disease in young onset patients are rare. Leaks after primary anastomosis even in the elective setting warrant careful consideration of a defunctioning ileostomy.
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Affiliation(s)
- Tara M Connelly
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Ju Yong Cheong
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Eddy P Lincango
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Niamh Foley
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Leonardo C Duraes
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
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Turner GA, O'Grady MJ, Purcell RV, Frizelle FA. Acute Diverticulitis in Young Patients: A Review of the Changing Epidemiology and Etiology. Dig Dis Sci 2022; 67:1156-1162. [PMID: 33786702 DOI: 10.1007/s10620-021-06956-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years, especially in patients under 50 years old. Historically, acute diverticulitis in younger patients was felt to represent a separate entity, being more virulent and associated with a higher rate of recurrence. Accordingly, young patients were often managed differently to older counterparts. Our understanding of the natural history of this condition has evolved, and current clinical practice guidelines suggest age should not alter management. The purpose of this review is to evaluate the changing epidemiology of acute diverticulitis, consider potential explanations for the observed increased incidence in younger patients, as well as review the natural history of acute diverticulitis in the younger population.
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Affiliation(s)
- Greg A Turner
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Michael J O'Grady
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Rachel V Purcell
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Frank A Frizelle
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
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Abuelazm S, Kanumalla H, Taborda-Alvarez M, Eisdorfer J, Basak R. Acute Right-Sided Abdominal Pain in an Adolescent: Expect the Unexpected. Cureus 2021; 13:e16649. [PMID: 34462683 PMCID: PMC8387207 DOI: 10.7759/cureus.16649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/19/2022] Open
Abstract
Acute right lower quadrant (RLQ) abdominal pain is a common presenting complaint in the emergency department (ED). The most common cause is acute appendicitis, generally requiring surgical intervention. We present a rare cause of RLQ abdominal pain mimicking acute appendicitis.
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Affiliation(s)
- Somaya Abuelazm
- Pediatrics, Brookdale University Hospital Medical Center, New York City, USA
| | - Harsha Kanumalla
- Pediatrics, Brookdale University Hospital Medical Center, New York City, USA
| | | | - Jacob Eisdorfer
- Colorectal Surgery, Brookdale University Hospital Medical Center, New York City, USA
| | - Ratna Basak
- Pediatrics, Brookdale University Hospital Medical Center, New York City, USA
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Kamal MU, Baiomi A, Balar B. Acute Diverticulitis: A Rare Cause of Abdominal Pain. Gastroenterology Res 2019; 12:203-207. [PMID: 31523330 PMCID: PMC6731043 DOI: 10.14740/gr1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/05/2019] [Indexed: 01/26/2023] Open
Abstract
There is an increasing incidence of diverticulosis and diverticulitis in the younger populations; and its occurrence in very young individual is concerning. Here we report a rare and interesting case of a 20-year-old man who presented with 3-day history of epigastric abdominal pain associated with diarrhea and nausea. His abdominal examination revealed mild tenderness in the right lower abdominal quadrant. Computed tomography (CT) scan of abdomen with intravenous contrast revealed scattered diverticula throughout the colon with focal thickening, pericolonic infiltrative changes suggestive of acute diverticulitis in the distal ascending colon. He was treated with intravenous hydration and antibiotics and discharged when his clinical status improved. He underwent colonoscopy 1 month later which showed pan diverticulosis. This case illustrates the importance of considering acute diverticulitis in the differential diagnosis of right lower quadrant pain when evaluating a young patient.
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Affiliation(s)
| | - Ahmed Baiomi
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA.,Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USA
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Cammarota S, Cargiolli M, Andreozzi P, Toraldo B, Citarella A, Flacco ME, Binda GA, Annibale B, Manzoli L, Cuomo R. Increasing trend in admission rates and costs for acute diverticulitis during 2005-2015: real-life data from the Abruzzo Region. Therap Adv Gastroenterol 2018; 11:1756284818791502. [PMID: 30159036 PMCID: PMC6109850 DOI: 10.1177/1756284818791502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Scarce data are available on the epidemiological trend of diverticulitis and its financial burden in Italy. The aim of this work was to explore a potential variation in the rate and costs of hospital admissions for uncomplicated and complicated diverticulitis over the last decade. METHODS We selected all hospitalizations for diverticulitis of residents in the Abruzzo Region, Italy between 2005 and 2015. Age-standardized hospitalization rates (HRs) per 100,000 inhabitants for overall, uncomplicated and complicated diverticulitis were calculated. A linear model on the log of the age-standardized rates was used to calculate annual percentage changes (APC). Costs were derived from the official DRG tariff. RESULTS From 2005 to 2015, the HR for acute diverticulitis increased from 38.9 to 45.2 per 100,000 inhabitants (APC + 1.9%). The HR for complicated diverticulitis increased from 5.9 to 13.3 (APC + 7.6%), whereas it remained stable for uncomplicated diverticulitis. The mean hospital cost was 1.8-times higher for complicated diverticulitis compared with that for uncomplicated disease and 3.5-times higher for patients with a surgery stay compared with that for patients with a medical stay. CONCLUSION During the last decade, in the Abruzzo Region, the HRs for diverticulitis and their costs increased significantly, mainly due to disease complications. Further studies are needed to explore strategies to prevent complications and to realise cost-saving policies.
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Affiliation(s)
- Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | - Martina Cargiolli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | - Paolo Andreozzi
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | | | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | | | | | - Bruno Annibale
- Medical-Surgical Science and Translational Medicine Department, Sapienza University, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy; Regional Healthcare Agency of Abruzzo, Pescara, Italy
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Pilgrim SM, Hart AR, Speakman CTM. Diverticular disease in younger patients--is it clinically more complicated and related to obesity? Colorectal Dis 2014; 15:1205-10. [PMID: 23531175 DOI: 10.1111/codi.12225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/21/2012] [Indexed: 12/19/2022]
Abstract
AIM The aims of this systematic review were to determine the presentations of diverticular disease in patients under 40 years of age and to assess whether obesity is an important factor. METHOD The PubMed and EMBASE databases and the Cochrane Library were searched to identify all original articles published between 1990 and 2011 on diverticular disease severity in obese patients (body mass index of ≥ 30 kg/m(2) ) under 40 years of age. RESULTS Twenty-three clinical case series (two of which were prospective) were identified plus two large aetiological population-based studies. These reported that young patients with diverticular disease were presenting more frequently, that diverticular disease in this age group was less likely to be complicated but that emergency operation rates were higher. The majority (63.1-96.5%) of patients under 40 years of age with diverticular disease were obese. CONCLUSION The studies suggest that in the young, obese patient with lower abdominal pain, diverticulitis and appendicitis are included in the differential diagnosis. CT and/or laparoscopy should be considered where the diagnosis is in doubt.
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Affiliation(s)
- S M Pilgrim
- Department of General Surgery, Norfolk & Norwich University Hospital, Norwich, UK
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Kijsirichareanchai K, Mankongpaisarnrung C, Sutamtewagul G, Nugent K, Rakvit A. Diverticulitis in the Young. J Prim Care Community Health 2014; 6:29-34. [DOI: 10.1177/2150131914548512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Colonic diverticulitis is relatively uncommon in young patients, especially those younger than 40 years. We compared demographic data, clinical presentation, management, and clinical course of diverticulitis in patients ≤40 years old compared with patients >40 years old. Methods: This study included all patients who presented to the emergency department with a diagnosis of diverticulitis between October 1, 2009 and September 30, 2010. Patients were divided into 2 groups: group 1 (≤40 years old) and group 2 (>40 years old). Demographic characteristics, clinical presentation and management, and short-term outcomes were compared. Results: Ninety-four patients were included in the study (37 patients in group 1 and 57 patients in group 2). A higher percentage of obese and Hispanic men was found in group 1 ( P > .05). The rate of discharge from the emergency department was significantly higher in group 1 (56.8% in group 1 vs 7.0% in group 2, P < .01). Group 2 patients had a shorter median length of stay than group 1 patients (3.1 vs 5.7 days, P = .16). There were no differences in vital signs, laboratory data (including complete blood count and basic metabolic panel), and in-hospital mortality rates between the 2 groups. Conclusions: This study demonstrates that young Hispanic men develop diverticulitis and that this diagnosis needs to be considered when they present to emergency rooms with abdominal symptoms. A longitudinal study is needed to determine the long-term outcomes in these patients and to investigate the pathogenesis.
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Affiliation(s)
- Kunut Kijsirichareanchai
- University of Nebraska Medical Center, Omaha, NE, USA
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ariwan Rakvit
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Acute diverticulitis in the young: the same disease in a different patient. Gastroenterol Res Pract 2013; 2013:867961. [PMID: 23554811 PMCID: PMC3608115 DOI: 10.1155/2013/867961] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/12/2013] [Indexed: 01/27/2023] Open
Abstract
Background. Natural history and risk factors for diverticulitis in young patients are still debatable. This study aimed to assess whether difference exists in patients aged 50 and younger when compared to older patients and to identify risk factors for acute diverticulitis in the young. Patients and Methods. From January 2006 to December 2011, 80 patients were admitted to our department for acute diverticulitis. We carried out a cross-sectional study in 23 patients (28.7%) aged 50 and younger and 57 older patients (71.3%). Results. Acute diverticulitis in the young was not more aggressive than in the older patient. Diverticulitis at patient's admission was similar with respect to Hinchey's stage and prior history of diverticulitis. No significant difference was found for both medical and surgical treatment. The rate of recurrent diverticulitis in nonoperated patients was similar. Male gender, body mass index ≥25, and assumption of alcohol were independent risk factors for the occurrence of an acute diverticulitis in the young. Conclusions. The same disease seems to be affecting young patients such as overweight or obese male individual. Current policies to prevent diverticular disease and its related complications must include obesity control together with high-fiber diet and regular exercise.
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