Abstract

Objective: This study aimed to determine whether acute diverticulitis can still be regarded solely as a disease of the elderly and to compare colonic localization, disease severity, and inflammatory indices between patients younger than 50 years and patients aged 50 years and older.

Materials and Methods: This retrospective cross-sectional study included 132 patients older than 18 years who were diagnosed with acute diverticulitis confirmed by contrast-enhanced abdominal computed tomography (CT) at Istanbul Haseki Training and Research Hospital between January 2017 and December 2021. Patients were divided into two groups: those younger than 50 years (n=64) and those aged 50 years and older (n=68). Diverticulitis localization was classified as distal (rectosigmoid/sigmoid/descending colon) or proximal (cecum/ascending colon/hepatic flexure). Disease severity was assessed according to the Hinchey classification, and Hinchey stage 1B or higher was defined as complicated diverticulitis. Demographic characteristics, comorbidities, laboratory parameters, and hemogram-derived inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and C-reactive protein (CRP)-to-albumin ratio were analyzed. Groups were compared using the Chi-square test, Fisher’s exact test, and Mann–Whitney U test.

Results: The overall mean age was 49.8±14.7 years. Male sex predominated among patients younger than 50 years (64.1%), whereas female sex predominated among patients aged 50 years and older (67.6%). Distal colonic involvement was similar in both groups (81.2% vs 82.4%; p=1.0). Overall, 82.6% of patients had Hinchey 1A disease. Although complicated diverticulitis appeared more frequent in younger patients, the difference was not statistically significant (20.3% vs 14.7%; p=0.536). Hypertension, cardiac disease, and previous abdominal surgery were significantly more common in patients aged 50 years and older. CRP levels and NLR showed a tendency to be higher in the older group, whereas the CRP-to-albumin ratio was significantly higher (1.14 [0.44–2.67] vs 1.78 [1.13–3.19]; p=0.045). PLR, SII, LMR, and length of hospital stay were similar between groups. Most patients were managed conservatively, consistent with the predominance of uncomplicated disease in the cohort.

Conclusion: Colonic localization of acute diverticulitis was similar in younger and older patients. Although complicated diverticulitis appeared numerically more frequent in younger patients, systemic inflammatory burden, particularly the CRP-to-albumin ratio, was more pronounced in patients aged 50 years and older. The comparable number of younger and older patients in the same center suggests that acute diverticulitis should no longer be regarded solely as a disease of the elderly. Larger prospective studies are needed to confirm these findings and to further clarify age-related differences in treatment and outcomes.

Keywords: acute diverticulitis, Hinchey classification, inflammatory indices, colonic diverticular disease

License

Copyright (c) 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to Cite

1.
Bezir N, Hut A, Canbay Torun B, Özden SÇ, Topgül OH. Has acute diverticulitis ceased to be a disease of the elderly?. J Trends Med Invest. 2026;2(1):1-7. https://doi.org/10.64512/JTMI.2026.21

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