Recurrence Following Nonoperative Management of 1st Episode of Hinchey II Diverticulitis

Should Elective Resection Follow Nonoperative Management of First Episode of Diverticulitis of the Colon With Abscess and/or Extraluminal Air? A Randomized Controlled Trial.

Patients will agree to be randomized to either surgery or observation following nonoperative management of a first episode of Hinchey II diverticulitis. Information will be collected on recurrence rates and major complications in both groups.

This study will randomize patients with first episode of acute diverticulitis of the colon with extraluminal air and/or abscess as defined by CT scan following nonoperative management (NPO, IV antibiotics, percutaneous drainage, and TPN followed by colonoscopy) to observation or elective resection. The primary endpoint is recurrent diverticulitis of the colon defined as an acute episode confirmed at CT scan and requiring hospitalization with IV antibiotics.

Inclusion Criteria:

• older than or equal to 18
• history of resolved first episode of diverticulitis with abscess (Hinchey class II) who were successfully treated by our standard protocol
• the diagnosis confirmed by colonoscopy
• Signed informed consent

Exclusion Criteria:

• Prior episode of diverticulitis
• Right sided diverticulitis
• Failure of recovery from first episode, defined as recurrence within one month.
• Cancer found at the site on screening colonoscopy
• Comorbidities prohibiting surgery (as measured by colorectal POSSUM score)
• Immunosuppressed patients
• Hinchey I, III, or IV (diverticulitis with peritonitis and/or free air under the diaphragm)
• Patients who are unable to sign the informed consent