Acute diverticulitis. A complicated problem in the immunocompromised patient
E. S. Tyau, J. B. Prystowsky, R. J. Joehl and D. L. Nahrwold
Department of Surgery, Northwestern University Medical School, Chicago.
We reviewed the records of 209 patients with acute diverticulitis treated
from 1984 through 1989 to determine if immunocompromised patients have a
worse prognosis than nonimmunocompromised patients. Forty immunocompromised
patients and 169 nonimmunocompromised patients with acute diverticulitis
were identified. Free perforation into the peritoneal cavity occurred in
43% (17/40) of immunocompromised patients and 14% (24/169) of
nonimmunocompromised patients. Operations were performed in 58% (23/40) of
immunocompromised patients and 33% (55/169) of nonimmunocompromised
patients. Postoperative morbidity was 65% (15/23) in immunocompromised
patients and 24% (13/55) in nonimmunocompromised patients; postoperative
mortality was 39% (9/23) and 2% (1/55), respectively. We conclude that
acute diverticulitis in the immunocompromised patient is a complicated
problem; there is a greater risk of free perforation and need for surgery
than in the nonimmunocompromised patient. Furthermore, the prognosis for
immunocompromised patients who undergo surgery is worse than that for
nonimmunocompromised patients.
