Long-Term Follow-up After an Initial Episode of Diverticulitis: What Are the Predictors of Recurrence?

被引:169
作者
Hall, Jason F. [1 ]
Roberts, Patricia L. [1 ]
Ricciardi, Rocco [1 ]
Read, Thomas [1 ]
Scheirey, Christopher [2 ]
Wald, Christoph [2 ]
Marcello, Peter W. [1 ]
Schoetz, David J. [1 ]
机构
[1] Lahey Clin Fdn, Dept Colon & Rectal Surg, Burlington, MA 01805 USA
[2] Lahey Clin Fdn, Dept Radiol, Burlington, MA 01805 USA
关键词
Diverticulitis; Recurrence; Diverticulosis; LEFT COLONIC DIVERTICULITIS; NATURAL-HISTORY; SIGMOID DIVERTICULITIS; PRACTICE PARAMETERS; DISEASE; MANAGEMENT; DIAGNOSIS;
D O I
10.1007/DCR.0b013e3182028576
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: The purpose of our study was to determine the clinical and CT predictors of recurrent disease after a first episode of diverticulitis that was successfully managed nonoperatively. METHODS: We retrospectively analyzed 954 consecutive patients who presented to our institution with diverticulitis from 2002 to 2008. Patients were identified with International Classification of Diseases, 9th Revision/Current Procedural Terminology codes. Patients were excluded if they had subsequent colectomy based on the first attack (n = 81), or if the attack they had between 2002 and 2008 was not their first attack (n = 201). We evaluated CT variables chosen by a panel of expert gastrointestinal radiologists. These radiologists reviewed the available published literature for CT imaging characteristics thought to predict diverticulitis severity. CT variables (n = 20) were determined by prospective reevaluation of scans by blinded study radiologists. Clinical variables (n = 43) were coded based on a retrospective chart review. Univariate analysis of variables in relation to recurrent disease was performed by a log-rank test of Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards modeling. Variables with P<.2 on univariate analysis were included in a stepwise selection algorithm. RESULTS: The study population included 672 patients; mean age, 61 +/- 15 years; mean follow-up, 42.8 +/- 24 months. The index presentation of diverticulitis was most commonly located in the sigmoid colon (72%), followed by descending colon (33%), right colon (5%), and transverse colon (3%). Overall recurrence at 5 years was 36% by (95% CI 31.4%-40.6%) Kaplan-Meier estimate. Complicated recurrence (fistula, abscess, free perforation) occurred in 3.9% (95% CI 2.2%-5.6%) of patients at 5 years by Kaplan-Meier estimate. Family history of diverticulitis (HR 2.2, 95% CI 1.4-3.2), length of involved colon >5 cm (HR 1.7, 95% CI 1.3-2.3), and retroperitoneal abscess (HR 4.5, 95% CI 1.1-18.4) were associated with diverticulitis recurrence. Right colon disease (HR 0.27, 95% CI 0.09-0.86) was associated with freedom from recurrence. CONCLUSION: Although diverticulitis recurrence is common following an initial attack that has been managed medically, complicated recurrence is uncommon. Patients who present with a family history of diverticulitis, long segment of involved colon, and/or retroperitoneal abscess are at higher risk for recurrent disease. Patients who present with right-sided diverticulitis are at low risk for recurrent disease. These findings should be taken into consideration when counseling patients regarding the potential benefits of prophylactic colectomy.
引用
收藏
页码:283 / 288
页数:6
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