Background: No consensus exists regarding elective surgery in young patients with diverticulitis. We hypothesized that most young patients with diverticulitis do not require colectomy after the first event.

Design: We conduct a single-institution retrospective study using the hospital records and a phone survey. Fifty-four patients younger than 40 were treated for acute diverticulitis between years 2000-2013. We measure outcome by mean of subsequent hospitalizations after the first attack, continuing symptoms, and the need for emergency or elective colon surgery.

Results: 17 patients had right and 37 left colon diverticulitis. The mean age was of 33.2 and the mean follow-up was of 6.5 years. Most patients with right-sided disease suffered from solitary cecal diverticulitis (n=14), most of them were discovered intra-operatively for suspected appendicitis. Three patients had ascending colon diverticulitis and were successfully managed with antibiotics. 78% of the patients with left sided diverticulitis (n=29) didn't had recurrence but 2 patients ultimately underwent elective sigmoidectomy because of continuing symptoms. There were 6 patients with one or two recurrences, 2 of them underwent elective colectomy. One of the two patients with three or more recurrences required emergent sigmoidectomy during the 3^rd attack. No patient with left sided diverticulitis required an emergent operation during the first episode. The first attack was more severe and hospital stay was longer in the group with recurrent disease than in the group without recurrence.

Conclusions: Colonic diverticulitis in young people is usually a mild disease and few patients suffer recurrent disease. We recommend elective segmental colectomy for patients with continuing symptoms in the ambulatory setting and for the group of patients with a more severe first attack who suffer from recurrent episodes.

Raphael Fedidat