Date of Award

6-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

John Geibel

Abstract

Purpose: To evaluate clinical presentation and outcomes of patients with end-stage renal disease (ESRD) or renal transplantation and symptomatic colonic diverticular disease Methods: A retrospective review of all patients with the primary diagnosis of diverticulitis or diverticulosis and end-stage renal disease treated at Yale-New Haven Hospital from January 1, 1985 to December 31, 2005 was performed. Patient factors evaluated including age, gender, comorbidities, nature of ESRD, and immunosuppression if any, along with the diagnosis of diverticulosis or diverticulitis, complicated vs. uncomplicated and outcomes including morbidity, mortality and LOS. Patients were evaluated to determine predictors of poor outcome. Simple summary statistics were calculated. Chi-square analyses were used to compare categorical and binary data. ANOVA was used for continuous outcome variables including length of stay. Results: Mean age was 70+/-13 years. Thirty/77(39%) were male. Thirty-three/54(61%) presented with gastrointestinal hemorrhage. Twenty-three/33(70%) required transfusion. One/28(4%) required surgery; one/28(4%) required angiographic embolization. There were no deaths. Twenty-five/77(30%) developed symptomatic diverticulitis. Seventeen/25(68%) were uncomplicated. Fifteen/17(88%) were managed conservatively; 1/17(6%) required surgery. Eight/25(32%) presented with complicated diverticulitis; three/8(38%) with perforation and 2/8(25%) with abscess. Eight/8 (100%) with complicated disease required urgent/emergent surgery. Five/8 (55%) who underwent surgery developed a perioperative complication. Four/8 (50%) died following surgery. Risk-factors for death were female peritoneal dialysis, surgery, diabetes, and perforation (p<0.05). Overall mean LOS for diverticular disease was 14.5+/-26 days. Conclusions: The presentation of diverticular disease in ESRD patients differs from those with normal renal function. ESRD patients have higher rates of diverticular bleeding requiring transfusion. Patients with ESRD who develop diverticulitis frequently present with complicated disease, requiring surgery. Those that require surgery for diverticulitis have a high mortality. Those with uncomplicated disease can be successfully managed conservatively. ESRD may adversely effect treatment of symptomatic diverticular disease.

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