Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.313
Peer-review started: June 26, 2015
First decision: July 25, 2015
Revised: September 8, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 27, 2015
While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to population-based or retrospective studies. This comprehensive review aimed to evaluate the NH of simple sigmoid diverticulitis. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low, ranging from 13% to 47%, depending on the definition used by the authors. Among different risk factors for recurrence, patients with C-reactive protein > 240 mg/L are three times more likely to recur. Other risk factors include: Young age, a history of several episodes of acute diverticulitis, medical vs surgical management, male patients, radiological signs of complicated first episode, higher comorbidity index, family history of diverticulitis, and length of involved colon > 5 cm. The risk of developing a complicated second episode (and its corollary to require an emergency operation) is less than 2%-5%. In fact, the old rationale for elective surgery as a preventive treatment, based mainly on concerns that recurrence would result in a progressively increased risk of sepsis or the need for a colostomy, is not upheld by the current evidence.
Core tip: The natural history of sigmoid diverticulitis is poorly understood. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this comprehensive review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low. Several risk factors are found to be associated with recurrence.