Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years

OBJECTIVE: The surgical treatment of severe attacks of sigmoid diverticulitis and the indications for prophylactic surgery are currently matters of debate. We have analysed our experience in a university hospital, bringing new information into the discussion. METHOD: All patients admitted to our department between 1995 and 2002 for an attack of sigmoid diverticulitis were reviewed. There were 222 who had had a first attack and these formed the basis of the study. Analysis of short- and long-term outcomes was made. RESULTS: Of the 222 patients, 66 underwent an operation during the first admission (mainly Hartmann's operation) with no death. Twenty-five patients were operated during a subsequent admission, either for a deterioration of their symptoms or prophylaxis. One hundred and twenty-eight patients were managed conservatively, and were followed up for 5-12 years. Recurrence was observed in 43% of the patients with a trend to a higher incidence in patients under 50 years. Recurrent exacerbating diverticulitis were severe in 13% of cases. CONCLUSION: Complicated diverticulitis can be managed with a low mortality. Hartmann's operation was proven safe in our experience. The risk of recurrence was higher than observed in many recent studies but few recurrences were severe.