Characteristics of Colonic Diverticulitis and Factors Associated With Complications: A Japanese Multicenter, Retrospective, Cross-Sectional Study

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Abstract

BACKGROUND:

Little is known about the epidemiology of diverticulitis in Japan. Additional information is needed about its clinical characteristics and the factors associated with complications of diverticulitis.

OBJECTIVE:

This study was designed to determine the clinical characteristics of diverticulitis and factors associated with its complications in Japanese patients.

DESIGN:

This was a retrospective, multicenter, large-scale, cross-sectional study.

SETTINGS:

All of the consecutive patients in 21 Japanese hospitals with a final diagnosis of acute colonic diverticulitis were included in this study.

PATIENTS:

A total of 1112 patients, including 658 men and 454 women, with a mean age of 54.8 years, who were diagnosed by CT and/or ultrasonography between January 2006 and May 2011, were included in this study.

INTERVENTIONS:

Data on medical history, investigations, treatments, and prognosis were collected using a standard form to create a dedicated database.

MAIN OUTCOME MEASURES:

Clarification of the clinical characteristics of Japanese patients with acute diverticulitis was the main outcome measured.

RESULTS:

Diverticulitis was detected mainly in men and women aged 40 to 60 years. Although diverticulitis more frequently affected the right colon (70.1%), diverticulitis of the left colon was significantly more frequent (61.0%) in elderly patients. Of the 1112 patients with diverticulitis, 179 (16.1%) developed complications, including abscess formation, perforation, stenosis, and/or fistula, some of which required surgical treatment, such as drainage or colonic resection. The duration of hospitalization (24.1 ± 19.5 days) and mortality rate (2.8%) were significantly higher in patients with versus without complications. Factors associated with complications were fever (>38.5°C), involvement of the left colon, higher age, and delayed diagnosis.

LIMITATIONS:

Limitations included the nonconsideration of diverticulitis treatment, the effect of dietary fiber, and the retrospective design of the study.

CONCLUSIONS:

Complications were more frequent in elderly men with left-sided diverticulitis, although diverticulitis was more common in middle-aged people and on the right side of the colon. Factors associated with complications were fever, site of involvement, older age, and longer time until diagnosis.

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