Rs06p diverticular disease: the management of acute presentations and its outcomes – a regional hospital's experience

Background: Complications of diverticular disease commonly cause urgent admission yet there are no standard guidelines of the role of surgery. We aimed to review the management and outcome of patients with acute diverticular disease. Patients were managed by general surgeons with a conservative approach to diverticular disease. Methods: Emergency presentations for diverticular disease were identified in the period of Jan03–Aug08. Electronic databases provided discharge diagnosis, details of management, mortality and multiple admissions. Subgroup analysis compared surgical and conservative management subdivided for presentation type. Results: 435 admissions with a diagnosis of diverticular disease were identified. This constituted 8% (435/5069) of all emergency admissions for general surgery. Presentation types: Diverticulitis (57%), Haemorrhage (25%), Perforation (10%), Abscess (5%), Obstruction (2%) and Fistula (1%). 21% of admissions required urgent surgery while 8% were multiple admissions. Surgical management: Hartmann's Procedure (74%), Right Hemicolectomy (9%), High Anterior Resection (4%), Subtotal Colectomy (3%), Sigmoid Colectomy (2%), Total Colectomy (2%), Low Anterior Resection (1%), Laparoscopy (1%), Laparotomy & Washout/Abscess Drainage (2%). Mortality: Surgical group 5%, Conservative group 1.2%, Overall mortality 2%. Conclusion: Diverticulitis and Haemorrhage form most of the presentations. Conservative management is successful in these cases (93% and 89%) but less so for the complication of Abscess (36%), Perforation (22%), Obstruction (22%) and Fistula (0%). Here a conservative approach to surgical management of acute diverticular disease results in a low mortality of 5%, which is favourable compared to other series.