Outcome of a conservative policy for managing acute sigmoid diverticulitis

Background: A conservative policy for patients presenting with acute sigmoid diverticulitis is associated with a low operation rate, and low overall and operative mortality rates. The long-term consequences of such a policy were investigated. Methods: Data were collected prospectively for 232 patients with acute sigmoid diverticulitis between 1990 and 2004. Details of all subsequent readmissions were obtained and survival to August 2005 was analysed. Results: Of the 232 patients admitted, 60 (25.9 percent) were known to have diverticulosis; in 172 patients it was a new diagnosis. Thirty-eight patients (16.4 per cent) underwent sigmoid resection, with one death. Three elderly patients in whom a decision was made not to operate had perforated diverticulitis at autopsy: Of 191 patients discharged without resection, 35 (18.3 per cent) subsequently underwent sigmoid resection: 26 (13.6 per cent) elective and nine (4.7 per cent) emergency, with one death. Conclusion: A conservative policy is safe in both the short term and the long term.