Clinical Characteristics and Treatment Outcome of Colonic Diverticulitis in Young Patients

Myung Eun Song; Sung-Ae Jung; Ki-Nam Shim; Eun Mi Song; Kyoung Joo Kwon; Hye In Kim; So Yoon Yoon; Won Young Cho; Hye-Kyung Jung; Seong-Eun Kim; Il Hwan Moon

doi:10.4166/kjg.2013.61.2.75

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Song, Jung, Shim, Song, Kwon, Kim, Yoon, Cho, Jung, Kim, and Moon: Clinical Characteristics and Treatment Outcome of Colonic Diverticulitis in Young Patients

Original Article

Korean J Gastroenterol 2013;61(2):75-81.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.2.75

Clinical Characteristics and Treatment Outcome of Colonic Diverticulitis in Young Patients

Myung Eun Song, Sung-Ae Jung, Ki-Nam Shim, Eun Mi Song, Kyoung Joo Kwon, Hye In Kim, So Yoon Yoon, Won Young Cho, Hye-Kyung Jung, Seong-Eun Kim, Il Hwan Moon

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

Correspondence to: Sung-Ae Jung, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: +82-2-2650-5053, Fax: +82-2-2650-2076, E-mail: jassa@ewha.ac.kr

Received 13 August 201213 September 2012 Accepted 14 September 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The clinical course and the most appropriate management of colonic diverticulitis in young patients are currently unresolved. This retrospective study was designed to compare young patients (≤40 years) with older patients (＞40 years) regarding clinical characteristics of acute colonic diverticulitis and to determine whether differences exist in treatment outcome.

Methods

Three-hundred sixty eight patients presenting with acute colonic diverticulitis from March 2001 through April 2011 at Ewha Womans University Mokdong Hospital were reviewed retrospectively. The differences in clinical characteristics, treatment modality and recurrence between each group were analyzed.

Results

Two-hundred and six patients were aged 40 years or younger and 162 patients were older than 40 years. The older group was diagnosed more frequently with severe diverticulitis. Surgical treatment was significantly more frequent in the older group than in the younger group (15.4% vs. 4.4%, p＜0.001). No significant difference was found in treatment modality between the two groups in patients with recurrence. The difference in recurrence between groups was not statistically significant. In multivariate analysis, left colonic diverticulitis was significantly associated with severe diverticulitis (OR, 14.651; 95% CI, 4.829–44.457) and emergency surgery (OR, 13.745; 95% CI, 4.390–43.031).

Conclusions

When patients with colonic diverticulitis are treated conservatively, young age is no longer an independent risk factor for subsequent poor outcome. Diverticulitis in young patients does not have a particularly aggressive or fulminant course. Therefore, we recommend that diverticulitis management should be based on the severity and location of the disease, and not on the age of the patient.

Keywords: Diverticulitis, colonic, Age factors

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Table 1.

Baseline Characteristics of Patients with Colonic Diverticulitis

Characteristic	Age ≤40 yr (n=206)	Age ＞40 yr (n=162)	p-value
Gender (M/F)	105/101	85/77	0.775 ^b
BMI ≥25 kg/m²	51 (25.0)	57 (36.5)	0.018 ^b
Underlying disease
Diabetes mellitus	1 (0.5)	10 (6.2)	0.002 ^c
Hypercholesterolemia	2 (1.0)	5 (3.1)	0.248 ^c
Hypertension	10 (4.9)	41 (25.3)	＜0.001 ^b
Ischemic cardiopathy	0 (0)	2 (1.2)	0.193 ^c
Laboratory finding
Leukocytosis ^a	128 (62.1)	111 (68.5)	0.203 ^b
WBC count (×10⁹/L)
At admission	10.7±1.4	10.8±1.5	0.818 ^d
Maximal	10.9±1.4	11.0±1.5	0.779 ^d
CRP (mg/dL)
At admission	4.14±3.40	4.80±4.10	0.453 ^d
Maximal	3.60±3.60	4.57±3.90	0.183 ^d
Location
Right colon	199 (96.6)	142 (87.7)	0.001 ^b
Left colon	7 (3.4)	20 (12.3)	0.001 ^b

Values are presented as number of patients (%) or mean±SD, unless otherwise specified.

^a WBC ≥ 10,000/μ L. The p-values were calculated by

^b chi-square test

^c Fisher's exact

^d t-test for comparison of the mean value of the natural test; logarithms of WBC and CRP. M, male; F, female; WBC, white blood cell.

Table 2.

Grade of Peritonitis according to Hinchey Classification in Relation to Age Group

Hinchey score	Age ≤40 yr (n=206)	Age ＞40 yr (n=162)	p-value
I, II	201 (97.6)	144 (88.9)	0.001
III, IV	5 (2.4)	18 (11.1)	0.001

Data are number of patients (%). The p-value was calculated by chi-square test.

Table 3.

Treatment Modality in Relation to Age Group

Variable	All patients	Age ≤40 yr	Age ＞40 yr	p-value
Overall (n=368)				＜0.001
Conservative	334 (90.8)	197 (95.6)	137 (84.6)
Surgery	34 (9.2)	9 (4.4)	25 (15.4)
Recurrence (n=35)				0.708 ^a
Conservative	22 (62.9)	16 (66.7)	6 (54.5)
Surgery	13 (37.1)	8 (33.3)	5 (45.5)
First recurrence (n=29)				0.675 ^a
Conservative	21 (72.4)	15 (75.0)	6 (66.7)
Surgery	8 (27.6)	5 (25.0)	3 (33.3)
Second recurrence (n=6)				0.999 ^a
Conservative	1 (16.7)	1 (25.0)	0 (0.0)
Surgery	5 (83.3)	3 (75.0)	2 (100.0)

Values are presented as number of patients (%).

^a The p-values were calculated by Fisher's exact test.

Table 4.

Comparison of the Recurrence Interval in Patients with Recurrence

Recurrence interval (month)	All patient (n=35)	Age ≤40 yr (n=24)	Age ＞40 yr (n=11)	p-value
Mean±SD	9.53±12.4	9.29±8.6	10.06±18.7	0.867 ^a
Median (Q1,Q3)	5.0	5.5	2.3	0.081 ^b
	(2.0, 13.0)	(4.0, 13.0)	(1.0, 8.0)

The p-value was

^a calculated using an independent t-test

^b analyzed using the Mann-Whitney U test for nonparametric statistical analysis between two groups. Q1, quartile 1; Q3, quartile 3.

Table 5.

Univariate Analysis of Risk Factors for the Severity of the Diverticulitis and Emergency Surgery

Factor	Severity of the diverticulitis			Emergency surgery
Factor	OR	95% CI	p-value	OR	95% CI	p-value
Gender (F/M)	0.850	0.365–1.979	0.706 ^a	0.688	0.283–1.674	0.407 ^a
Age	5.025	1.824–13.847	0.001 ^a	5.921	1.951–17.963	＜0.001 ^a
BMI ≥25 kg/m²	2.739	1.169–6.418	0.016 ^a	3.375	1.378–8.268	0.005 ^a
Underlying disease Diabetes mellitus	10.165	2.736–37.770	0.003 ^b	7.063	1.726–28.900	0.020 ^b
Hypercholesterolemia	2.568	0.296–22.280	0.366 ^b	0.942	0.918–0.966	0.999 ^b
Hypertension	6.990	2.893–16.885	＜0.001 ^b	6.785	2.714–16.963	＜0.001 ^b
Ischemic cardiopathy	15.636	0.946–258.454	0.121 ^b	17.300	1.043–286.840	0.111 ^b
Location (left colon)	30.736	11.505–82.113	＜0.001 ^b	29.511	10.778–80.806	＜0.001 ^b

The p-values were calculated by

^a chi-square test

^b Fisher's exact test. F, female; M, male.

Table 6.

Multivariate Analysis of Risk Factors for the Severity of the Diverticulitis and Emergency Surgery

Parameter	Severity of the diverticulitis			Emergency surgery
Parameter	OR	95% CI	p-value	OR	95% CI	p-value
Age (yr)
≤40
＞40 BMI (kg/m²)	2.209	0.675–7.233	0.190	2.805	0.785–10.021	0.112
＜25
≥25	1.688	0.590–4.833	0.329	2.097	0.714–6.157	0.178
DM
No
Yes	4.442	0.686–28.785	0.118	2.275	0.334–15.502	0.401
Hypertension
No
Yes	2.175	0.680–6.957	0.190	2.001	0.606–6.609	0.255
Location
Right
Left	14.651	4.829–44.457	＜0.001	13.745	4.390–43.031	＜0.001

DM, diabetes mellitus.

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