Outcome of a conservative policy for managing acute sigmoid diverticulitis.

Abstract

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. 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. Of the 232 patients admitted, 60 (25.9 per cent) 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. A conservative policy is safe in both the short term and the long term.