Conservative management of complicated colonic diverticulitis in early and late elderly

Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65-74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 $\pm$ 6.8 years (range 65-92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88\%). Average white cells count was 10.04 $\pm$ 5.05 $\times$ 109/L in the early elderly group and 11.24 $\pm$ 7.89 in the late elderly group. CRP was elevated in 29 (78.3\%) cases in early elderly and in 23 late elderly patients (67.6\%). A CT scan of the abdomen was performed in every case (100\%). Almost all patients were treated with bowel rest and antibiotics (95.7\%). Average length of stay was 7.74 $\pm$ 7.1 days (range 1-48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 $\pm$ 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6\%). New episodes of acute diverticulitis were reported in 20 patients (28.1\%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities.