This prospective study focuses on the prediction of late outcome after acute left
colonic diverticulitis successfully treated conservatively and in which the diagnosis was confirmed radiologically (computed tomography [CT] and
gastrografin enema [GE]). Acute
diverticulitis was diagnosed in 226 patients. Sixty-six patients (29%) were operated on during their first hospitalization, and 2 of them died (3% mortality). The remaining 160 patients, successfully treated conservatively, had a CT and a GE within 72 hours of admission and entered this study. Signs of severity on CT included the presence of
abscess(es) and/or extraluminal air and/or extraluminal hydrosoluble contrast (
Gastrografin). Follow-up averaged 25 months (range 1 month to 5.3 years). Twenty-seven of these 160 patients (17%) had a poor outcome (persistent
diverticulitis in 12, colonic
stenosis in 6, recurrences in 7, residual parasigmoid
abscess and
colovesical fistula in one each). When comparing these 27 patients with the 133 others it appeared that: (1) men up to 50 years of age were significantly more prone to develop such complications (p = 0.003); (2) the probability of developing a complication was significantly greater when the initial CT had revealed an
abscess and/or extraluminal air and/or extraluminal
Gastrografin (p = 0.005). These results support the view that elective
colectomy can reasonably be proposed after a first attack of acute left
diverticulitis treated conservatively in men up to 50 years of age, and/or in patients whose initial CT revealed findings of severe
diverticulitis.