Inflammatory complications of colon diverticular disease: current therapeutic challenges [Le complicanze infiammatorie della malattia diverticolare del colon: problematiche terapeutiche attuali]

Inflammatory complications of diverticular disease are still responsible for high mortality rates. The aim of the present study was to analyse the factors that primarily influence the type of treatment and prognosis of such pathologies. From 1996 to 2006, 88 patients were admitted to our department for inflammatory complications secondary to diverticular disease. The majority of the patients were emergency room referrals, and nearly half of them were elderly (over 65 years of age). The most frequently observed complications were acute diverticulitis (45.5%), which was almost always resolved with medical therapy, and diverticular perforations (43.2%), for which surgical therapy was always necessary. The main treatment for localised peritonitis was one-stage colorectal resection, whereas for generalized peritonitis a two-stage resection was the procedure of choice. The highest degrees of peritonitis were observed in elderly patients. Restoration of bowel continuity was performed in nearly all patients below 65 years of age, but was not possible in 44.4% of those aged above 65. Postoperative mortality occurred in two cases, both with diffuse peritonitis, advanced age, and elevated anaesthetic risk. The present series seems to confirm the findings of other Authors, namely that the prognosis of diverticular perforation is influenced more by patient-related factors (older age, sepsis, comorbidity) than by the type of surgical procedure. Thus, it is probable that a decrease in the mortality rate and improvements in the quality of life can be achieved through more aggressive diagnostic protocols and new preventive strategies.