Ashraf Imam1, Elad Steiner2, Riham Imam1, Loai Omari2, Guy Lin2, Harbi Khalayleh2, Guy Pines3

1Department of Surgery, Hadassah Medical Center, Faculty of Medicine Hebrew University of Jerusalem, Israel
2Department of Surgery, Kaplan Medical Center, Faculty of Medicine Hebrew University of Jerusalem, Rehovot, Israel
3Department of Thoracic Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel


Objective: Discriminating simple from complicated diverticulitis solely on clinical bases is challenging. The aim of this study was to identify clinical predictive factor for the need for invasive treatment for patients presenting with acute diverticulitis in the emergency room.

Material and Methods: The records of all patients, who were discharged from a university hospital between January 2010 and March 2018 with “diverticulitis” diagnosis, were reviewed. Data collected included clinical features, whether this was a first or recurrent episode, WBC, and Hinchey score. Patients were divided into conservative and invasive treatment groups. Groups were compared by age, sex, BMI, fever, WBC and CT findings. Hinchey score groups were also compared by age, sex, BMI, fever, WBC.

Results: A total of 809 patients were included. Mean age was 60.6 years, with 10% below 40 years. Most patients were treated conservatively (95.9%) while only 4.1% were treated invasively. WBC at presentation was significantly higher in those who required invasive treatment in comparison with the conservative group (13.72 vs. 11.46K/uL, p= 0.024). A statistically significant higher WBC was found among patients with a higher Hinchey score (13.16 vs 11.69, p< 0.005). No difference between the groups was found in terms of age, sex, fever or BMI.

Conclusion: This study showed that patients who present with acute diverticulitis and an elevated WBC are prone to a more severe disease and a higher Hinchey score. Prudence should be taken with these patients, and CT scan is warranted as there is a greater chance that invasive treatment will be required.

Keywords: Diverticulitis, invasive treatment, Hinchey score

Cite this article as: İmam A, Steiner E, İmam R, Omari L, Lin G, Khalayleh H, et al. Identifying patients with complicated diverticulitis, is it that complicated? Turk J Surg 2022; 38 (2): 169-174.


Ethics Committee Approval

This study was approved by the Ethics Committee of the hospital (0058-18-KMC) in 26.06.2018 before the study was started and has been conducted in accordance with the principles set forth in the Helsinki Declaration.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - H.K., A.I., G.P.; Design - H.K., A.I., E.S.; Supervision - H.K., A.I., G.P.; Materials - H.K., A.I., G.P., G.I.; Data Collection and/or Processing - All of authors; Analysis and/or Interpretation - H.K., A.I., G.P., E.S.; Literature Search - H.K., A.I., G.P.; Writing Manuscript - All of authors; Critical Reviews -All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.