Brief Article
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World J Gastroenterol. Oct 21, 2013; 19(39): 6613-6617
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6613
Colonic diverticulitis with comorbid diseases may require elective colectomy
Kevin CW Hsiao, Joseph G Wann, Chien-Sheng Lin, Chang-Chieh Wu, Shu-Wen Jao, Ming-Hsin Yang
Kevin CW Hsiao, Chang-Chieh Wu, Shu-Wen Jao, Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Joseph G Wann, Department of Physiology, College of Medicine, National Taiwan University, Taipei 106, Taiwan
Chien-Sheng Lin, Department of Emergency and Critical Care Medicine, Cheng Hsin Rehabilitation Medical Center, Taipei 112, Taiwan
Ming-Hsin Yang, Department of Emergency, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Hsiao KCW, Wann JG, Lin CS, Wu CC, Jao SW, Yang MH perform the research; Hsiao KCW, Yang MH analyzed the data and wrote the paper.
Correspondence to: Min-Hsin Yang, MD, Department of Emergency, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan. dr.hsiao@msa.hinet.net
Telephone: +886-2-87923311 Fax: +886-2-87927411
Received: April 27, 2013
Revised: September 11, 2013
Accepted: September 16, 2013
Published online: October 21, 2013
Processing time: 194 Days and 21.5 Hours
Abstract

AIM: To investigate the comorbid disease could be the predictors for the elective colectomy in colonic diverticulitis.

METHODS: A retrospective chart review of 246 patients with colonic diverticulitis admitted between 2000 and 2008 was conducted, and 19 patients received emergent operation were identified and analyzed. Data were collected with regard to age, sex, albumin level on admission, left or right inflammation site, the history of recurrent diverticulitis, preoperative comorbidity, smoking habits, medication, treatment policy, morbidity, and mortality. Preoperative comorbid diseases included cardiovascular disease, diabetes, pulmonary disease, peptic ulcer disease, gouty arthritis, and uremia. Medications in use included non-steroidal anti-inflammatory drugs, acetylsalicylic acid (Aspirin), and corticosteroids. Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.

RESULTS: The mean age of the 246 patients was 69.5 years (range, 24-94 years). Most diverticulitis could be managed with conservative treatment (n = 227, 92.3%), and urgent colectomy was performed in 19 patients (7.7%). There were three deaths in the surgical group and four deaths in the nonsurgical group. The overall mortality rate in the study was 1.7% among patients with conservative treatment and 15.7% among patients undergoing urgent colectomy. Multiple logistic regression analysis indicated that comorbidities were risk factors for urgent colectomy for diverticulitis.

CONCLUSION: To avoid high mortality and morbidity related to urgent colectomy, we suggest that patients with colonic diverticulitis and comorbid diseases may require elective colectomy.

Keywords: Colonic diverticulitis; Colectomy; Comorbid disease

Core tip: Colonic diverticulitis can usually be managed with conservative treatment. However, in select groups of patients with recurrent persistent infection causing life-threatening septic shock, emergent and risky surgical management may be necessary. Elective colectomy for diverticulitis has been discussed in many reports. However, the criteria for elective surgery for colonic diverticulitis still remain controversial. Our data indicate that diverticulitis with comorbid disease increases the operative risk in urgent surgery. Therefore, if a patient has diverticulitis with comorbid disease, an elective colectomy may prevent the consequences of an urgent operation.