Primary diverticulitis with abscess formation and young age increased the risk of recurrence .
Readmission risk was higher within the first year after remission .
Conclusions The best treatment strategy for recurrent diverticulitis is undetermined .
Purpose Several factors may influence the risk of recurrence after an episode of acute colonic diverticulitis .
Until now , a comprehensive systematic overview and evaluation of relevant risk factors have not been presented .
This review aim ed at assembling and evaluating current evidence on risk factors for recurrence after conservatively treated acute colonic diverticulitis .
Diverticular Abscess Managed With Long-term Definitive Nonoperative Intent Is Safe
BACKGROUND : Initial nonoperative management of diverticular abscess has become the st and ard of care ; however , the need for elective resection after this index episode is unclear . OBJECTIVE : The purpose of this study was to assess the long-term outcomes of expectant management after initial nonoperative treatment of diverticular abscess . DESIGN : This was a retrospective chart review with prospect i ve telephone follow-up of patients . SETTING S : The study was conducted at a large tertiary academic colorectal surgery practice in Canada . PATIENTS : Adult patients with CT-documented acute sigmoid diverticulitis complicated by abscess managed nonoperatively from 2000 to 2013 were included . INTERVENTIONS : Long-term definitive nonoperative management of diverticular abscess . MAIN OUTCOME MEASURES : The primary outcome was  emergency sigmoidectomy or death from recurrent diverticulitis . Secondary outcomes were recurrent diverticulitis and elective sigmoidectomy for diverticulitis . RESULTS : Of 135 patients with acute diverticulitis complicated by abscess , a total of 73 patients were managed with nonoperative intent and long-term expectant management . The median follow-up was 62 ( Q1 to Q3 : 28–98 ) months . After resolution of the index episode , 22 patients [ 30.1 % ( 95 % CI , 19.6%–40.6 % ) ] experienced a recurrent episode of diverticulitis at a median of 23 ( range , 9–40 ) months . Two patients [ 2.7 % ( 95 % CI , –1.0 % to 6.4 % ) ] had a recurrent episode with peritonitis that required sigmoidectomy with stoma at 6 and 64 months . Both patients underwent reversal after 4 and 8 months . Seven [ 9.6 % ( 95 % CI , 2.8%–16.4 % ) ] patients experienced a complicated recurrence and underwent an  elective sigmoidectomy  [ median time to colectomy , 33 ( range , 16–56 ) months ] . Thirteen patients [ 17.8 % ( 95 % CI , 9.0%–26.6 % ) ] experienced an uncomplicated recurrence , all of whom were managed with continued nonoperative intent [ median follow-up , 81 ( range , 34–115 ) months ] . No mortality occurred . On multivariate logistic regression , female gender ( p = 0.048 ) and a previous episode of uncomplicated diverticulitis before the index diverticular abscess ( p = 0.020 ) were associated with a recurrent episode . LIMITATIONS : This study was limited by its retrospective design and modest sample size . CONCLUSIONS : After initial successful nonoperative management of diverticulitis with abscess , expectant management with nonoperative intent is a safe long-term option with low rates of surgery , especially in the emergency setting . See Video , Supplemental Digital Content 1 , on the nonoperative management of diverticular abscess at http://links.lww.com/DCR/A234
Primary diverticulitis with abscess formation and young age increased the risk of recurrence .
Readmission risk was higher within the first year after remission .
Conclusions The best treatment strategy for recurrent diverticulitis is undetermined .
Purpose Several factors may influence the risk of recurrence after an episode of acute colonic diverticulitis .
Until now , a comprehensive systematic overview and evaluation of relevant risk factors have not been presented .
This review aim ed at assembling and evaluating current evidence on risk factors for recurrence after conservatively treated acute colonic diverticulitis .