2026 Volume 46 Issue 6 Pages 655-660
Conservative treatment is often selected for patients with colonic diverticulitis when imaging reveals localized inflammation, even in the presence of extraluminal air. However, some patients eventually require surgery because of treatment failure. We retrospectively analyzed the data of 75 patients with Hinchey stage Ⅰ or Ⅱ perforated colonic diverticulitis who were initially managed by conservative treatment. We then compared the clinical characteristics between patients in whom conservative management proved successful (success group) and those in whom the treatment failed (failure group). Conservative treatment was successful in 66 patients (88%), whereas it failed in the remaining 9 patients (12%) who were subsequently treated by surgery. The proportions of patients with left-sided disease and Hinchey stage II disease, with higher serum C-reactive protein levels at presentation, and with persistently elevated white blood cell counts during days 3–7 after treatment initiation were significantly higher in the failure group. No significant associations of the treatment outcomes were observed with the age, sex, presence of underlying diabetes mellitus, smoking history, positive blood cultures, or initial choice of antibiotic therapy. Thus, while conservative treatment is effective for most patients with localized perforated colonic diverticulitis, left-sided disease, Hinchey stage Ⅱ disease, and persistently elevated inflammatory marker levels may be predictive of treatment failure. Early identification of high-risk patients may facilitate timely surgical intervention and improve clinical outcomes.
