Table 2.

Pearls of recurrent diverticulitis

Diverticulitis occurs in 4% of patients with diverticulosis	22
Recurrent diverticulitis Rate after primary attack treated conservatively: 11–35%	[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 13]
Readmission rate for recurrent diverticulitis 9–25%	[6, 8, 11, 12, 38]
Recurrent diverticulitis after surgery 7–16%	[3, 38]
36% have ongoing abdominal symptoms after the first episode of diverticulitis	[11, 12, 13]
Persistence of post-operative symptoms is a risk factor for recurrent diverticulitis	8
Severity of first episode is a risk factor for recurrent diverticulitis	8
CT scan evidence of gas pockets and abscess formation is a risk factor for recurrence	[1, 14]
Younger age is a risk factor for recurrence	[2, 4, 6, 7, 8, 14, 15]
Younger age is a risk factor for emergency colectomy/colostomy	[2, 6]
Diverticular disease in younger age is not more severe	15
Male gender is a risk for recurrent diverticulitis	15
Female gender is a risk for recurrent diverticulitis	[4, 6, 7]
Family history of diverticulitis is a risk factor for failure of non-operative management	7
Long segment of involved colon is a risk factor for failure of non-operative management	7
Presence of retroperitoneal abscess is a risk factor for failure of non-operative management	7
Complicated recurrence rate 3.9–5%	[5, 7]
Right-sided colonic diverticulitis not associated with recurrence	5
Surgery is recommended after 2 episodes of diverticulitis and after one episode in patients younger than 40 years	16
Emergency surgery for diverticulitis is 0.9–1.9%	[6, 8]
Elective colectomy for diverticulitis is 0.75–1.7%	[6, 8]
Likelihood of recurrent diverticulitis increases with number of recurrences
Recurrences do NOT infer higher risk of complications compared to the first episode	[9, 30, 39, 40]
Elective resection carries a lower risk of persisting symptoms compared to conservative management	[11, 13, 42]
Overlap between post-diverticulitis symptoms and irritable bowel syndrome	28
Risk of Hartmann's procedure after one diverticulitis attack is 1 in 2,000	30
18 elective colonic resections are needed to prevent one colostomy	30
92% of recurrent cases were treated as outpatient	41
2% of recurrent cases ultimately needed surgery	41
90% of chronic smoldering diverticulitis benefit from surgery	43
77% of chronic smoldering diverticulitis had complete resolution of symptoms after surgery	25
Comparable complication rate between Hartmann's and Primary anastomosis with stoma formation	[45, 46]
Stoma reversal with primary anastomosis was higher than Hartmann's procedure in grade III and IV Hinchey Diverticulitis	[45, 46]
Total sigmoidectomy is associated with lower recurrence	[3, 47]