Case Report: A 31-Year-Old Man with Relapsing Complicated Diverticulitis after Initial Conservative Treatment

Abstract

BACKGROUND: There is controversy regarding the surgical approach for severe complications of diverticular disease. The classical approach has been a Hartmann’s procedure, but laparoscopic lavage and drainage has been suggested as an alternative. We present a patient who initially responded to conservative management of complicated diverticulitis, but had a recurrence that was managed surgically.

CASE PRESENTATION: A 31-year-old man presented with Hinchey Stage I diverticulitis and was discharged from the hospital after medical management. Six days later, he returned to the hospital with radiographic evidence of a pericolonic abscess. The patient was taken to the operating room for laparoscopic drainage with placement of a drain in the abscess cavity. He required reoperation with sigmoid colon resection, primary anastomosis, and diverting ileostomy.

DISCUSSION: Despite requiring reoperation, the authors believe that initial conservative management possibly prevented progression to generalized feculent peritonitis. If this had occurred, the patient may have required Hartmann’s procedure, which is associated with more complications than primary anastomosis with protective ileostomy.

CONCLUSION: The patient had recurrence of complicated diverticular disease that was initially managed conservatively and then with laparoscopic drainage, followed by primary anastomosis with protective ileostomy. Given individual patient factors, the authors believe that he was managed optimally. There is currently controversy between the use of laparoscopic lavage and drainage versus Hartmann’s procedure for the management of complicated colonic diverticular disease and more investigation is required on the subject.