ORIGINAL ARTICLE Does the Presence of Abscesses in Diverticular Disease Prelude Surgery? B. J. M. van de Wall & W. A. Draaisma & E. C. J. Consten & R. T. van der Kaaij & M. J. Wiezer & I. A. M. J. Broeders Received: 10 August 2012 / Accepted: 14 November 2012 / Published online: 14 December 2012 # 2012 The Society for Surgery of the Alimentary Tract Abstract Background Information on long-term outcome of patients treated conservatively for diverticular abscess is scarce. This study aims to compare diverticulitis patients with abscess to patients without abscess with regard to readmission, compli- cations, and surgical treatment during a follow-up period of at least 12 months. Methods A chart review of all patients admitted for a primary manifestation of diverticulitis between January 2005 and January 2011 was performed. Results Fifty-nine patients with abscess and 663 without abscess were identified. Median follow-up was 28 months (range 12–103). Initial conservative management was achieved in 54 (91.5 %) patients with diverticular abscess and 635 (96.8 %) without abscess. Readmission occurred more frequently among patients with abscess (hazard ratio (HR) 2.6; confidence interval (CI) 1.51–4.33) with a first-year risk of 27.3 versus 10.7 % and second-year risk of 8.2 versus 4.6 %. Surgery was more frequently performed in patients with diverticular abscess (HR 2.3; CI 1.42–3.66). The first-year risk was 35.1 versus 16.6 % and second-year risk was 12.9 versus 2.4 %. The most frequent indication for surgery was persisting or recurrent disease. Conclusion Patients with diverticular abscess have a higher risk of being readmitted and/or requiring surgical treatment. The pattern suggests that readmission and need for surgery are the results of an ongoing inflammation of the initial episode. Keywords Diverticulitis . Abscess . Surgery . Readmission Introduction Diverticulitis puts a significant burden on health care. Approximately 112,000 patients present with symptoms consistent with diverticulitis at the general practi- tioners’ office annually in the Netherlands. 1 Hospitali- zation for confirmed diverticulitis occurs is 13,500 of these patients. 2 The majority of patients present with uncomplicated diverticulitis. Between 10 and 20 % present with com- plications including abscess, perforation, stricture, or fistulae. 3,4 Although consensus exists on the surgical management of the latter three, controversy persists on the optimal treatment of patients presenting with abscess. After conservative management of patients with divertic- ular abscess, elective resection is typically advised. 5 It is thought that 40 % of these patients will develop severe recurrent disease. 4,5 However, with evolving knowledge on diverticular disease, indications for elective resection are shifting and principles on treatment strategies should be reconsidered. 6 Literature on long-term outcome of patients treated con- servatively for diverticulitis with concomitant abscess is scarce. This study aims to compare patients with abscess at presentation for a primary episode of diverticulitis to patients without abscess with regard to readmission, com- plications, and surgical treatment during a follow-up period of at least 12 months. B. J. M. van de Wall : W. A. Draaisma : E. C. J. Consten : R. T. van der Kaaij : I. A. M. J. Broeders (*) Department of Surgery, Meander Medical Center Amersfoort, P.O. Box 1502, 3800 BM Amersfoort, The Netherlands e-mail: iamj.broeders@meandermc.nl M. J. Wiezer Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands J Gastrointest Surg (2013) 17:540–547 DOI 10.1007/s11605-012-2097-x