Surgical Management of Chronic Smoldering Sigmoid Diverticulitis: A Case Series Analysis

Smoldering diverticulitis is a form of chronic uncomplicated diverticulitis with continuous non-resolving abdominal pain that commonly requires surgical intervention. In this study, we aimed to evaluate post-operative outcomes in patients undergoing colon resection for smoldering diverticular disease. We performed a single tertiary historical records review including all patients operated for diverticular disease of the sigmoid between January 2009 and January 2020. Only patients with smoldering diverticulitis were included in the final analysis. Demographic, peri-operative, and post-operative outcomes were collected from patient medical charts and analyzed. We reviewed the data of 3124 patients that were hospitalized due to diverticulitis during 2009–2020. Overall, 184 patients were operated due to diverticular disease. Of those, 18 patients (9.78%) were operated for smoldering diverticulitis. Eight (42%) patients were men; mean patient age was 62 SD 11 years. Median Charlson’s comorbidity score was 1 (0–3). Ten patients were operated laparoscopically (55.56%), with a conversion rate of 40% (n=4\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$n = 4$$\end{document}). Three patients (16.67%) underwent primary stoma formation. Post-operative complications were seen in 6 (33%) patients with a median Clavien-Dindo score of 3 (1–4) and 2 patients underwent re-operation (11.11%). Median length of stay was 8 days (range 4–26). Five (27.78%) patients required an unplanned re-admission following their surgical procedure. Median follow-up time was 5.3 months (1–127). Thirteen (72.22%) patients were free of symptoms at the last follow-up. Quality of life questionnaire demonstrated significant improvement after surgery (P<0.01\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$P<0.01$$\end{document}) that lasts during follow-up time (P=0.52\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$P=0.52$$\end{document}). Length of stay was correlated with age (P<0.01\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$P<0.01$$\end{document}, Pearson’s coefficient = 1) and serum white blood counts (< 0.01, 0.79). Smoldering diverticulitis is a fairly rare surgical condition with unneglectable risk for post-operative complications. However, most patients report improvement of symptoms after surgery and both short-term and long-term surveillance.