Acute and complicated diverticulitis: are there significant differences between young and elderly patients?
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Abstract
AIM: The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD).
MATERIAL OF STUDY: 279 patients with diagnosis of AD treated at the General Surgery Department of Trieste from January 2007 to December 2015 were retrospectively examined and then followed for a minimum of 4 years. We divided patients in two categories: young ≤ 50 years and elderly > 50. Gender, American Society of Anesthesiologists status (ASA score), Hinchey’s stage, type and timing of surgery, morbidity, length of hospital stay, recurrence, and overall mortality were retrospectively analyzed.
RESULTS: There were 279 patients, 64 (22,9 %) were young and 215 (77,1%) were elderly. Female gender was more frequent in elderly cohort (150 pts 69,7 % F vs 65 pts 30,3 % M) than in the young (16 pts, 25% F vs 48 pts, 75% M), (p<0,001). Higher ASA scores were registered in elderly patients with statistically significant correlation with Hinchey’s stage. 229 patients ( 82,07 %) received as initial treatment antibiotic therapy (conservative treatment), 50 (17,93 %) pts underwent EM-S, and 11 underwent to DEL-S.
DISCUSSION: In our experience, none significant differences were recorded about Hinchey’s stage, timing of surgery, morbidity, length of hospital stay, and recurrence; whereas, regarding the type of surgery (resection-anastomosis (R-A), Hartmann’s procedures, and Lavage/Drainage) there were a significant difference (p=0,04).
CONCLUSIONS: Hartmann’s procedures have been effectuated more frequently in the elderly than in the young with recanalization in less than half of elderly. These data seems to confirm that there is no significant difference in incidence or the natural course of acute and complicated colonic diverticulitis among the young or the elderly. The best surgical treatment, with the least morbidity, may be resection with primary anastomosis.