This study examined clinical outcomes of patients with complicated diverticulitis managed nonoperatively. The researchers reviewed 256 patients diagnosed with complicated diverticulitis via CT scan over a 14-year period. 99 patients were initially managed nonoperatively with antibiotics and some receiving percutaneous drainage. These patients had a high rate of recurrence (46.4%) but a low risk of requiring emergency surgery. The risk of recurrence did not differ significantly between younger (<50 years) and older patients. While recurrence rates were high, the risk of complications requiring emergency surgery was low for patients managed nonoperatively initially. Patient factors, comorbidities, and preferences should all be considered when determining treatment for complicated diverticulitis.

1. R. Scott Nelson D.O , B. Mark Ewing B.S., Timothy J. Wengert M.D. and Alan G. Thorson M.D. Clinical outcomes of complicated diverticulitis managed nonoperatively The Southwestern Surgical Congress December 2008 (Vol. 196, Issue 6, Pages 969-974)

13. Age distribution of population per decade Age yr 21–30 31–40 41–50 51–60 61–70 71–80 81–90 91+ Operative group 2 24 38 19 38 24 9 3 Nonoperative group 3 8 11 27 33 12 5 0 Total group 5 32 49 46 71 36 14 3

14. 256 Complicated Diverticulitis 99 Followed 157 Operated 46 Recurrence 82 Anterior Resection 75 Hartmann 20 Operation 1 Hartmann

16. 86 ( < 50 Y ) 22 ( non – operative ) 64 ( Operative ) 4 (18.2 %) Surgery 77 (> 50 Y ) Non-operative 16 (20.8 %) Surgery

17. 157 Operated 82 Anterior Resection 75 Hartmann 27 (42% ) < 50 Y 48 ( 51.6 % ) > 50Y patients less than 50 years of age had fewer emergency operations

20. Reasons for nonoperative treatment patient response to medical management 32 no referral to a surgeon by the medical physicians 47 patient's refusal of an operation 9 patient being deemed too ill for an operation 11 total 99

21. Initial CT scan findings for both groups SD = sample deficiency . CT scan findings Nonoperative group (n = 99) Operative group (n = 156) P value Abscess 56 55 .0011 Localized perforation 35 21 .0006 Free perforation 1 66 <.0001 † Fistula 2 13 .0713 Phlegmon 5 0 SD Obstruction 0 2 SD

22. Non Operative Group 99 ( all recived Antibiotics ) 11 percutaneous drain placements 1 Hartmann procedure for obstruction 1 elective sigmoid resection

37. Thank You