Most patients with uncomplicated diverticulitis recover following medical treatment and do not require surgical intervention.
Recurrent disease
Diverticular disease recurs in 5% to 11% of patients over 5 years following an episode of uncomplicated diverticulitis.[6]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206757
http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com
Risk factors for recurrence seem to be younger age at presentation, female sex, Asian ethnicity, obesity, tobacco smoking, previous episode of recurrent disease, and abscess formation or complicated disease at index diagnosis.[6]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206757
http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com
[103]Hupfeld L, Burcharth J, Pommergaard HC, et al. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017 May;32(5):611-22.
http://www.ncbi.nlm.nih.gov/pubmed/28110383?tool=bestpractice.com
[104]Kang G, Son S, Shin YM, et al. Recurrence of uncomplicated diverticulitis: a meta-analysis. Medicina (Kaunas). 2022 Jun 2;58(6):758.
https://www.mdpi.com/1648-9144/58/6/758
http://www.ncbi.nlm.nih.gov/pubmed/35744021?tool=bestpractice.com
Recurrent disease is associated with high mortality, and response to therapy is less favourable.
Post-surgery
Following elective surgical treatment, up to 25% of patients continue to have ongoing pain or recurrent diverticular disease.[12]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.
https://www.gastrojournal.org/article/S0016-5085(20)35512-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com
Younger age and persistence of symptoms post-operatively are risk factors for recurrent diverticular disease.[105]Andeweg C, Peters J, Bleichrodt R, et al. Incidence and risk factors of recurrence after surgery for pathology-proven diverticular disease. World J Surg. 2008 Jul;32(7):1501-6.
https://onlinelibrary.wiley.com/doi/10.1007/s00268-008-9530-z
http://www.ncbi.nlm.nih.gov/pubmed/18330623?tool=bestpractice.com
Persistent symptoms and bowel dysfunction are common after emergency surgery for perforated diverticular disease.[106]Azhar N, Johanssen A, Sundström T, et al. Laparoscopic lavage vs primary resection for acute perforated diverticulitis: long-term outcomes from the scandinavian diverticulitis (SCANDIV) randomized clinical trial. JAMA Surg. 2021 Feb 1;156(2):121-7.
https://jamanetwork.com/journals/jamasurgery/fullarticle/2774478
http://www.ncbi.nlm.nih.gov/pubmed/33355658?tool=bestpractice.com
[107]Samuelsson A, Bock D, Prytz M, et al. Functional outcomes of emergency surgery for perforated diverticulitis, Hinchey grade III. World J Surg. 2023 Jun;47(6):1570-82.
https://onlinelibrary.wiley.com/doi/10.1007/s00268-023-06961-2
http://www.ncbi.nlm.nih.gov/pubmed/36856835?tool=bestpractice.com