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[Acute colonic diverticulitis : outcome according to general practice management prior to referral and criteria predictive of complications. A 10-year experience in a University Hospital].

INTRODUCTION
Ambulatory treatment of acute uncomplicated diverticulitis has been shown to be safe and effective by several recent studies. The aim of our study was to analyze the outcome of general practice management concerning the complications, the treatment modalities and the hospitalization duration during the first episode of acute diverticulitis.


MATERIEL AND METHODS
A total of 176 medical files of patient presenting between January 2000 and December 2010 at the emergency department with a first episode of acute diverticulitis confirmed by an abdominal CT scan were analyzed. Among the 160 patients fulfilling the inclusion criteria, 50 were referred by a general practitioner (GP). Data concerning admission modalities, clinical status, paraclinic investigations, complications, treatment and length of hospital stay were reviewed.


RESULTS
The patients referred by the GP were significantly older (p ⟨ 0.001) and were hospitalized significantly longer (p = 0.034) than the patients consulting directly the emergency department. There was a significant correlation between the 2 variables (R = 0.406). Complications and treatment modalities did not differ between the two groups. Complicated diverticulitis was associated with rebound (p = 0.049), tenderness (p = 0.005) and a time interval between initial symptoms onset and admission to the emergency department superior to 4 days (p = 0.027).


CONCLUSIONS
Ambulatory management of acute diverticulitis by the GP does not affect the outcome of the patients after their hospital admission in term of complications and treatment modalities. Ambulatory treatment of acute diverticulitis is safe but hospitalization is indicated in case of poor clinical tolerance, presence of rebound, tenderness and duration of symptoms for more than 4 days.