FEATURE IN YOUNG PATIENTS SURGICALLY TREATED FOR ACUTE DIVERTICULITIS

Introduzione There is lack of consensus whether to consider acute diverticulitis in younger patients a more aggressive disease than in other. While some authors considered diverticulitis in younger worst than in older patients, others suggested similar outcomes. In this study we evaluate differences between patients  45 years old and > 45 who underwent surgery for acute diverticulitis. Pazienti e metodi From September 2011 to May 2015 119 patients underwent emergency surgical intervention for acute diverticulitis in our unit. Pre-, intra- and postoperative findings were collected in a prospective database. 12 patients (Group A, 10,1%) were  45 years old. We compared clinical and pathological data between Group A patients and the remaining 145 (Group B 89.9) to find out any difference for characteristics of patients, clinical presentation, operative and short-term results. Uni- and multivaiate analysis were performed with SPSS v. 13.0 and satistical significance considered with p value < 0.05. Risultati Slight difference between Group A and Group B was found about presence of males (75.0% vs 43.9%; p=0.065). Significant differences were found for patients with one ore more comorbidities (16.7% vs 86.9%; p<0.001) and in particular for cardiovascular diseases (0% vs 67.3; p<0.001). Also ASA score was lower in younger patients with ASA 1-2 in 91.7% of patients versus 29.0% in group B patients (p<0.001). Localization of disease differed between two group with prevalence of right colonic side in 41.7% of Group A patients rspect to 10.3% of older patients (p=0.010). Group A patients treated in emergency were at first admission in 91.7% of cases respect to 83.2% of group B but this difference was not found to be statistically significant (p=0.688). In group A, laparoscopy was performed in 50% of patients while in group B only in 20.6% of cases (p=0.033) with no difference in conversion rate. The majority of Group A patients did not required an ostomy after surgical exploration respect to Group B patients (33.3% vs 74.8% p=0.006). No significant difference was found for the incidence of purulent or fecal generalized peritonitis (33.3% vs 57.9%; p=0.131). For postoperative results, morbidity rate according Clavien-Dindo classification was lower in Group A patients (8.3% vs 57.9%; p=0.001) and also the incidence of medical complications favoured younger patients (8.3% vs 44.9%; p=0.015). On the other hand the two groups did not differ for postoperative mortality (8.3% vs 17.8% p=0.688). Mean length of postoperative stay was shorter in Group A patients respect to Group B (6.32.0 vs 15.314.6; p=0.002). Multivariate analysis between Group A and B showed only a higher incidence of ostomy after surgery in group B (HR 4.0; 95%CI0.85-19.0) that did not reached statistical significance (p=0.08). Conclusioni Acute diverticulitis in young patients shows some peculiar issues, in particular for the localization of the disease, but does not seem to be more aggressive than in older people. For these reasons surgical intervention should be taken into account not considering age but the actual clinical, laboratoristic and instrumental findings.