CURRENT STATUS The Place of Elective Surgery Following Acute Diverticulitis in Young Patients: When is Surgery Indicated? An Analysis of the Literature Simon Janes, B.M.B.S., B.Med.Sci., M.R.C.S. 1 & Alan Meagher, M.B.B.S., F.R.A.C.S. 2 Ian G. Faragher, M.B.B.S., F.R.A.C.S., F.R.C.S. (Edinb.) 3 Susan Shedda, M.B.B.S., F.R.A.C.S. 4 Frank A. Frizelle, M.B.Ch.B., M.Med.Sci., F.R.A.C.S. 5 1 Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom 2 Colorectal Unit, St. Vincent_s Hospital, Sydney, Australia 3 Colorectal Unit, Department of Surgery, Western Hospital, Footscray, Melbourne, Australia 4 Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia 5 Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand ABSTRACT: Diverticulitis in the young is often regarded as a specific entity. Resection after a single attack because of a more ‘‘virulent’’ course of the disease has been accepted as conventional wisdom. The evidence for such a recommendation and the place of elective surgery was reviewed by a search of Medline, PubMed, Embase, and the Cochrane library for articles published between January 1965 and March 2008 using the terms diverticular disease and diverticulitis. Publications had to give specific information on at least ten younger patients (age e 50 years). Much of the older literature suggests that young patients experience a more virulent course with diverticulitis. Previous studies have shown misclassification and selection bias. As a result leading to a bias for more severe cases to be recognized mild cases may not be included. Young patients appear more likely to undergo operations to resolve an uncertain diagnosis. Recent studies have raised doubts about a virulent course with diverticulitis suggesting that recurrence may be associated with disease severity on CT scan, and supporting a conservative approach to diverticular disease. The diagnosis of diverticulitis is often delayed in younger patients because it is not considered, resulting in presenting cases being found at surgery or appearing more severe and more likely to be complicated. There is a lack of evidence to support the hypothesis that elective surgery should follow a single attack of diverticulitis. Any increased risk appears be a chronologic rather than pathologic phenomenon. Most patients will not have further episodes of diverticulitis. KEY WORDS: Diverticular disease; Diverticulitis; Surgery; Young. S ymptomatic diverticular disease is relatively uncom- mon before the age of 50 years, and is traditionally considered a distinct entity from the diverticular dis- ease experienced in the older age group. Many early studies suggest a more virulent course in the young age group, with higher recurrence rates. Based on this some authorities have previously suggested that elective resec- tion is indicated after two attacks of uncomplicated diver- ticulitis in older patients, but this view has recently been challenged. 1 The most recent American Society of Colon and Rectal Surgeons practice parameters on diverticular disease 2 state, W. Donald Buie, M.D., Editor 1008 DISEASES OF THE COLON &RECTUM VOLUME 52: 5 (2009) Address of correspondence: Frank A. Frizelle, M.B.Ch.B., M.Med.Sci., F.R.A.C.S., Colorectal Unit, Department of Surgery, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand. E-mail: frank.frizelle@cdhb.govt.nz Dis Colon Rectum 2009; 52: 1008Y1016 DOI: 10.1007/DCR.0b013e3181a0a8a9 BThe ASCRS 2009 Copyright @ The ASCRS 2009. Unauthorized reproduction of this article is prohibited.