Affiliation:
1. Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
2. Faculty of Medicine University of New South Wales Sydney New South Wales Australia
3. Central Clinical School, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
4. Department of Colorectal Surgery Sydney Adventist Hospital Sydney New South Wales Australia
Abstract
AbstractBackgroundDiverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis.MethodA retrospective single‐centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018.ResultA total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III‐IV Clavien‐Dindo complication (P < 0.001).ConclusionImmunosuppressed patients with uncomplicated diverticulitis can be treated safely with non‐operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.