Management of Complicated Diverticular Disease of the Colon

ABSTRACT

BACKGROUND: Colon diverticular disease is known to be prevalent in the western population and rare in the oriental population. Nowadays, the incidence in Korea is steadily increasing, so appropriate management has become clinically important. We must decide whether the patient needs surgical management and bowel preparation, or not. We must decide when and how to do it. METHODS: We retrospectively reviewed the medical records of 53 patients who were admitted with colon diverticular disease to Ewha Womans University Hospital from September 1993 to January 1999. RESULTS: They were 35 men and 18 women. The mean age was 47 years. The patients were divide into two groups the conservatively managed group (Group C, n=28) and the operatively managed group (Group O, n=25). The lesions were located in the right colon in 23 cases of Group C (82%) and 17 cases of Group O (62%). The barium enema was the most commonly used diagnostic tool (Group C 78.8%; Group O 56%). However, an abdomino-pelvic CT was a more effective diagnostic tool in emergency cases (66.7%). Recurrence (n=12) was the most common indication for an operation. Bowels were not prepared in some elective (n=5) and all emergency cases (n=6). One-stage operations were performed in 19 cases of elective operations and in three cases of emergency operations. Two-stage operations were performed in the other three cases of emergency operations. Postoperative complications were noted in six cases of elective operation, four with bowel preparation (28.5%) and two without preparation (40.0%) and in five cases of emergency operations (83%). Also we had one mortality. CONCLUSIONS: The barium enema was the most accurate and commonly used diagnostic tool. However, in emergency cases, an abdomino-pelvic CT was effective for deciding on the treatment. It seems better to do an elective operation with bowel preparation than to do an emergency operation without bowel preparation for colon diverticulitis, provided the patient's condition permits.