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

Manabe, Noriaki M.D., Ph.D.1; Haruma, Ken M.D.2; Nakajima, Atsushi M.D.3; Yamada, Masami M.D.4; Maruyama, Yasuhiko M.D.5; Gushimiyagi, Masanori M.D.6; Yamamoto, Takatsugu M.D.7

doi: 10.1097/DCR.0000000000000488
Original Contributions: Benign

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.

1 Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan

2 Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan

3 Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

4 Department of Gastroenterology, Hamamatsu Medical Center, Hamamatsu, Japan

5 Division of Gastroenterology, Fujieda Municipal General Hospital, Fujieda, Japan

6 Medical Examination Center of Chubu Medical Association, Chatan-cho, Japan

7 Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan

Financial Disclosure: None reported.

Correspondence: Noriaki Manabe, M.D., Ph.D., Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. E-mail: n_manabe@hkg.odn.ne.jp

© 2015 The American Society of Colon and Rectal Surgeons