DIVERTICULAR DISEASES-ASSOCIATED COLECTOMY IN URBAN AFRICAN AMERICAN PATIENTS: A HOSPITAL BASED STUDY. S. Ghavimi, H. Brim, H, Ashkorab. Dept. of Medicine and Cancer Center, Howard University Hospital, Washington, DC. Diverticular Diseases (DD) are generally benign and are primarily detected as incidental finding during routine colonoscopies. However, in certain cases, DD might lead to colectomy. Method: We reviewed 2400 patients’ files that correspond to DD patients seen at Howard University Hospital from1996 to 2014. Clinical and pathological features of patients that ended up having colectomy were analyzed in details. Results: Among the 2400 DD cases, there were 59.8% females and 40.2%males, of which 2020 (60%) had diverticulosis while 380 (40%) had diverticulitis. Colectomy was performed in 174 (7.3%) patients of which 112 (64%) had Diverticulosis and 62 (36%) had Diverticulitis. Of the Diverticulosis/Colectomy patients, 92 (82%) had hemorrhage, of which 34 (40%) had massive GI bleeding. Of the Diverticulitis/Colectomy patients, only 14 (23%) had hemorrhage. From the 48 patients without hemorrhage, 31(65%) had recurrent diverticulitis and the remaining 17 (35%) fit the Hinechey Criteria with 5 cases at stage 1, 3 at stage 2, 5 at stage 3 and 4 at stage 4. Conclusion: This study reveals that a sizable portion of African Americans with DD undergo colectomy due primarily to hemorrhage in diverticulosis patients. Such patients will benefit from periodical FOBT to catch potential massive bleeding at early stages. This applies to diverticulitis patients as well, however, in these patients, recurrence of diverticulitis is the primary indicator for colectomy.

1. Diverticular Disease and
Colectomy
By: Shima Ghavimi, MD
PGY-2 Internal Medicine Resident
Howard University Hospital

2. Diverticular Disease
Is one of the most prevalent medical conditions in western
countries. Etiology
- occur at the site of vasa recta insertion
- associated with a Western diet—low fiber, high fat
Incidence:
- ~71% in those greater than 85.
- ~33% in those greater than 45.
Location:
~95% of diverticular disease occurs in the sigmoid colon

3. Number of Patients with Diverticular Disease
(1996-2014)
•2400 Patients with Diverticular Disease
-20 to 102 years old , Median age of 55
-1438 Female (59.8%)
-962 Male (40.2%)

4. Diverticolosis Diverticulitis
Male 820 (34%) 145 (6%)
Female 1200 (50%) 235 (10%)
total 2020 (60%) 380 (40%)

5. Number of Patients with DD and Colectomy
(1996-2014) – (2400 Patients with DD)
174 (7.3 %) patients who got colectomy
81 Male (3.4%)
93 Female (3.9%)

6. Diverticulosis Diverticulitis
Male 54/2400 (2.3) 27/2400 (1.1%)
Female 58/2400 (2.4) 35/2400 (1.5%)
Total 112/2400 (4.7%) 62/2400 (2.6%)

7. Patients with DD and Colectomy
(1996-2014)
Age : 25 to 101
Median age 54

8. Number Patients with Diverticulosis vs
patients with Diverticulitis
- 380 [16%] Diverticulitis
318/380 acute [84%]
62/380 [16%] complicated
Complicated ones all got colectomy
- 2020 [84%] Diverticulosis
( which 112/2020 [5.5%] got colectomy)

9. Table 4: Hinchey classification
Stage Description
I Pericolic abscess or phlegmon
II Pelvic, intraabdominal, or
retroperitoneal abscess
III Generalized purulent peritonitis
IV Generalized fecal peritonitis

10. Complicated Diverticulitis who got Colectomy
- 14/62 [23%] had hemorrhage
( 2 stage 1 , 2 stage 2, 6 state 3, 4 stage 4 )
- 48/62 [77%] without hemorrhage
( 5 stage 1, 3 stage 2, 5 stage 3 , 4 stage 4).
35/48 [72.9%] had recurrent Diverticulitis

11. Patients with Diverticulosis who got Colectomy
- 112 Diverticulosis
Which
- 44/112 had hemorrhage (40%)
-68/112 without hemorrhage (60%)
(5.3%) 6 patients with Colorectal Cancer,
(0.9%) 1 tubolovilus adenoma without high grade dysplasia
(5.8%) 4 multiple Polyps that lead to perforation
(0.9%) 1 Adenocarcinoma
56 patients had colectomy without mention of hemorrhage but there is not hx or any electronic
medical records from them!!!

12. Diverticulitis without hemorrhage
• Diverticulitis and immunosuppression : 1/62 (1.6%)
• Recurrent diverticulitis:35/62 (56.7%)
• Perforated diverticulitis : 6/62 (9.6%)
• Intussusception 2/62 (3.2%)
• Peridiverticular abscess : 1/62(1.6%)
• Colovesicular fistula: 2/62 (3.2%)
• Large bowel obstruction secondary to diverticulitis: 1/62 (1.6%)

13. Figure 1: Management of Rectal Bleeding
Rectal Bleeding
Resuscitate
Stable Unstable
Angiography
or
Red Blood Cell count
Surgery
Colonoscopy
Observe
Endoscopic
Therapy
Bleeding stopped
Active
bleeding
Bleeding stopped
Bleeding
continues

14. Table 5. Type of Surgery for the 174 patients

15. Wheat et al, (2015)
100000 patients
- diverticular bleeding decreased over the 10-year period from 32.5 to 27.1%
- hospitalizations for diverticulitis peaked in 2008
- The prevalence of diverticulitis was higher in women than in men.
- The prevalence of diverticular bleeding was highest in African Americans
(34.4%)
- prevalence of diverticulitis was highest in whites (75.5%)

16. Masoumi et al, (2011)
Did a research on 1,073,397 patients admitted with diverticulitis
(emergent: 78.3%, elective: 21.7%) during 2002 to 2007
The emergent admission rate increased by 9.5% over the study period.

17. Stamos et al, (2014)
- “The frequency of elective surgical resection for diverticulitis has
dramatically increased by 38%
- which is nearly 9 times greater than the relative increase in urgent
surgical resection.
- This may reflect the influence of the American Society of Colon and
Rectal Surgeons guidelines from 2000.”

18. Etzioni et al, (2007)
Did a research on 267,000
- Rates of admission increased more rapidly within patients aged 18 to
44 years (82%) 45 to 74 years (36%).
- rapid increase (73%) in rates of surgery for individuals aged 18 to 44
years.

19. Thank you