Recurrence Following Nonoperative Management of 1st Episode of Hinchey II Diverticulitis

Not Applicable

Completed

Brief Summary: Patients will agree to be randomized to either surgery or observation following nonoperative management of a first episode of Hinchey II diverticulitis. Information will be collected on recurrence rates and major complications in both groups.

Detailed Description: This study will randomize patients with first episode of acute diverticulitis of the colon with extraluminal air and/or abscess as defined by CT scan following nonoperative management (NPO, IV antibiotics, percutaneous drainage, and TPN followed by colonoscopy) to observation or elective resection. The primary endpoint is recurrent diverticulitis of the colon defined as an acute episode confirmed at CT scan and requiring hospitalization with IV antibiotics.

Recruitment & Eligibility

Inclusion Criteria

older than or equal to 18
history of resolved first episode of diverticulitis with abscess (Hinchey class II) who were successfully treated by our standard protocol
the diagnosis confirmed by colonoscopy
Signed informed consent

Exclusion Criteria

Prior episode of diverticulitis
Right sided diverticulitis
Failure of recovery from first episode, defined as recurrence within one month.
Cancer found at the site on screening colonoscopy
Comorbidities prohibiting surgery (as measured by colorectal POSSUM score)
Immunosuppressed patients
Hinchey I, III, or IV (diverticulitis with peritonitis and/or free air under the diaphragm)
Patients who are unable to sign the informed consent

Arm && Interventions

Group	Intervention	Description
Surgery	Colon resection	The surgery group will be offered colon resection.

Primary Outcome Measures

Name	Time	Method
Primary Study Endpoint	Minimum of 1 year after enrollment	The primary outcome measure is recurrent diverticulitis of the colon defined as an acute episode confirmed at CT scan and requiring hospitalization with IV antibiotics.

Secondary Outcome Measures

Name	Time	Method
Post Operative Complications	30 days	Data will be collected on percent and type of complications for the surgery arm.
Measure Length of Hospital Stay for Surgery vs Non Surgery Patients	4 years	Data collected will include length of hospital stay from the date of admission to discharge day for nonoperative management of the first episode of Hinchey II diverticulitis.
Recurrence and Treatment	2 years	Data will be collected on recurrence and treatment for recurrent diverticulitis
Mortality	4 years	Data will be collected on percent of patients who die during the follow-up period after enrollment.
Readmission	30 days	Data will be collected on percent of patients who are readmitted for recurrence or postoperative complications during the follow-up period after enrollment.