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A Complicated Problem in the Immunocompromised Patient

Edward S. Tyau, MD; Jay B. Prystowsky, MD; Raymond J. Joehl, MD; David L. Nahrwold, MD

Arch Surg. 1991;126(7):855-859.

Abstract
• 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.

(Arch Surg. 1991;126:855-859)

Author Affiliations
From the Department of Surgery, Northwestern University Medical School, Chicago, Ill.

Footnotes
Accepted for publication March 9, 1991.

Read before the 98th Annual Meeting of the Western Surgical Association, Scottsdale, Ariz, November 13, 1990.

Reprint requests to Department of Surgery, 250 E Superior St, Wesley, Suite 201, Chicago, IL 60611 (Dr Prystowsky).

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