GS13 - Diverticulitis in the Under 40 Population

Introduction/Purpose: Diverticulosis is a disease of the gastrointestinal tract that results in outpouchings of mucosa, commonly in the sigmoid colon, that can lead to the development of inflammation, infection, and possible colonic perforation. Diverticulosis is thought to be a disease of the aging, with some research showing as a much as 60% of the population over the age of 60 contain diverticula. When diverticula become inflamed or infected, this disease is now known as diverticulitis. Since diverticulitis classically has been diagnosed in older populations, and guidelines are written based on the clinical outcomes of this specific population. As obesity and other lifestyle factors become more prevalent in younger populations, we are diagnosing and treating younger patients. The rise in younger patients with acute diverticulitis has started to be described in the literature, but still much is unknown. Therefore, in this study, the demographics and risk factors for the development of acute diverticulitis will be assessed as it pertains to patients under the age of 40. This study will attempt to investigate any significant changes in trends that contribute to this disease affecting this demographic.

Methods or Case Description: Adult Institutional Review Board (IRB) approval was received from St.Vincent Medical Center. A retrospective review of the electronic medical records of a cohort of subjects diagnosed with diverticulitis between the years of 2008-2019 was performed. Inclusion criteria included patients aged 18-40 that were treated at St.Vincent’s Medical Center in Bridgeport, CT, with a diagnosis of acute diverticulitis or diverticulitis with any complications including abscess, fistula, stricture, or perforation. Demographic data collected included age, sex, height, weight, past medical, surgical, and family history. Clinical data collected included radiographic imaging results, serological laboratory results, microbiology, and pathology data. 135 patient charts were reviewed and 109 patients met inclusion criteria. Categorical variables are summarized with number and percentage.

Outcomes: Of the 109 patients, 40 required surgery (33 elective, 7 emergency) and 69 patients were managed conservatively. One way ANOVA and an individual ad hoc analysis revealed the following variables had significant differences in resulting diverticulitis management type: Hinchey classification (p < 0.001), presence of any complication (p=0.015), and the individual complications of perforation (p=0.022), fistula (p=0.023), and acute abdomen (p=0.017). There was no significant difference between management type for abscess (p=0.406) or strictures (p=0.808), elevated white count (p=0.636), or symptoms of nausea (p=0.473) and diarrhea (p=0.337). Further, there was no significant difference in conservative management vs. elective surgery for any complication (p=0.582).

Conclusion: In the under 40 population, it is shown that those with diverticulitis resulting in perforation, fistula, or acute abdomen require emergent surgery. Using Hinchey classification to stratify risk was the single best predictor for management type. It was found that these younger patients with elevated white count, abscess, or stricture formation may not need emergent surgery at the time of presentation. Future research should focus on whether location of resection in primary diverticulitis is associated with risk of recurrence of diverticulitis. Further analysis should also examine the utility of the individual levels of the Hinchey classification to predict outcomes.With this information, we are able to open up a broad discussion as to the best treatment modalities for these young patients.