Acute Diverticulitis in the Elderly

Abstract

Colonic diverticular disease is a relatively common entity, which varies in severity from mild diverticulitis amenable to outpatient treatment with or without oral antibiotics, to lower gastrointestinal bleeding (LGIB) of variable clinical significance, to acute perforation with uncontrolled intraperitoneal spillage requiring emergency surgery. The ability to appropriately diagnose and manage acute diverticulitis is a critical requirement in surgical training and practice with significant impact on patient outcomes. The clinical presentation of acute diverticulitis differs in elderly patients, who present less frequently with fever and more commonly with bleeding and atypical symptoms compared to younger patients. Changes in the innate and acquired immune system as individuals age are partly responsible for the atypical clinical presentations of acute diverticulitis in the elderly. Some authors have commented on lower recurrence rates of acute diverticulitis in elderly individuals when compared to younger patients. Computed tomographic scanning remains the imaging modality of choice in elderly patients. The decision to operate on elderly patients with acute diverticulitis depends on a number of factors including the mode of presentation, quality of life, life expectancy, initial or recurrent episode, and the presence of complications at the time of presentation. If diagnosed and treated expeditiously, taking into account the unique complexities of the elderly patient, the management of this condition in this patient cohort will yield appreciably good outcomes.