Original Communication| Volume 149, ISSUE 5, P606-613, May 2011

Download started.


Outcome of patients with acute sigmoid diverticulitis: Multivariate analysis of risk factors for free perforation

Published:December 13, 2010DOI:


      Sigmoid diverticulitis (SD) is common in the West; its incidence is increasing as the average age of the population increases. The aim of this study was to assess the clinical outcomes of patients with acute SD and to determine whether emergency operation was associated more often with previous episodes of acute diverticulitis.


      All consecutive patients admitted for acute SD were recruited prospectively over an 11-year period from January 1998 to December 2008. Multiple logistic regression was used to identify risk factors for free perforation.


      We included 934 patients (490 men and 444 women; median age, 59.2 years): 450 (48.2%) presented for their first SD episode and 484 (51.8%) had a prior history of SD. Free perforation occurred in 152 patients: during the first episode of SD in 114 patients (25.3%), during the second in 29 (12.7%), during the third in 8 (5.9%), and during the fifth in 1 patient (0.9%; P < .001). No patient with >5 previous episodes of SD had free perforation. All 152 patients with free perforation required emergent operative intervention. After initial conservative therapy in 782 patients, 82 required early elective operative intervention owing to exacerbation of infection under antibiotic treatment. Late elective colectomy was performed in 299 patients during the inflammation-free interval, and operative intervention was recommended in 345 patients owing to complicated diverticulitis. Uncomplicated SD in 56 patients was managed conservatively. Comorbidity (>1 disorder) and the first episode of SD were identified as risk factors for free perforation on multiple logistic regression.


      The risk of free perforation in acute SD decreases with the number of previous episodes of SD. The first episode thus is the most dangerous for a free perforation. The indication for colectomy should not be made based on the potential risk of free perforation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jun S.
        • Stollmann N.
        Epidemiology of diverticular disease.
        Best Pract Res Clin Gastroenterol. 2002; 16: 529-542
        • Parks T.G.
        Natural history of diverticular disease of the colon.
        Clin Gastroenterol. 1975; 4: 53-69
        • Jacobs M.
        • Verdeja J.C.
        • Goldstein H.S.
        Minimally invasive colon resection (laparoscopic colectomy).
        Surg Laparosc Endosc. 1991; 1: 144-150
        • Kohler L.
        • Sauerland S.
        • Neugebauer E.
        Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of European Association for Endoscopic Surgery.
        Surg Endosc. 1999; 13: 430-436
        • Wong W.D.
        • Wexner S.D.
        • Lowry A.
        • Vernaca III, A.
        • Burnstein M.
        • Dentsman F.
        • et al.
        Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons.
        Dis Colon Rectum. 2000; 43: 290-297
        • Janes S.
        • Meagher A.
        • Frizelle F.A.
        Elective surgery after acute diverticulitis.
        Br J Surg. 2005; 92: 133-142
        • Rafferty J.
        • Shellito P.
        • Hyman N.H.
        • Buie W.D.
        Practice parameters for sigmoid diverticulitis.
        Dis Colon Rectum. 2006; 49: 939-944
        • Chapman J.R.M.
        • Dozois E.J.M.
        • Wolff B.G.M.
        • Gullerud R.E.B.
        • Larson D.R.M.
        Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?.
        Ann Surg. 2006; 243: 876-883
        • Holmer C.
        • Lehmann K.S.
        • Engelmann S.
        • Frericks B.
        • Loddenkemper C.
        • Buhr H.J.
        • et al.
        Microscopic findings in sigmoid diverticulitis—changes after conservative therapy.
        J Gastrointest Surg. 2010; 14: 812-817
        • Hansen O.
        • Stock W.
        Prophylaktische Operation bei der Divertikelkrankheit des Kolons—Stufenkonzept durch exakte Stadieneinteilung.
        Langenbecks Arch Chir Suppl. 1999; (II:1257)
        • Reissfelder C.
        • Buhr H.J.
        • Ritz J.P.
        What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection.
        Dis Colon Rectum. 2006; 49: 1842-1848
        • Ritz J.P.
        • Reissfelder C.
        • Holmer C.
        • Buhr H.J.
        Results of sigma resection in acute complicated diverticulitis: method and time of surgical intervention.
        Chirurgie. 2008; 79: 753-758
        • Reissfelder C.
        • Buhr H.J.
        • Ritz J.P.
        Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?.
        Surg Endosc. 2006; 20: 1055-1059
        • Lorimer J.W.
        Is prophylactic resection valid as an indication for elective surgery in diverticular disease?.
        Can J Surg. 1997; 40: 445-448
        • Nylamo E.
        Diverticulitis of the colon: role of surgery in preventing complications.
        Ann Chir Gynaecol. 1990; 79: 139-142
        • Pittet O.
        • Kotzampassakis N.
        • Schmidt S.
        • Denys A.
        • Demartines N.
        • Calmes J.M.
        Recurrent left colonic diverticulitis episodes: more severe than the initial diverticulitis?.
        World J Surg. 2009; 33: 547-552
        • Haglund U.
        • Hellberg R.
        • Johnsen C.
        • Hultén L.
        Complicated diverticular disease of the sigmoid colon: an analysis of short and long term outcome in 392 patients.
        Ann Chir Gynaecol. 1979; 68: 41-46