Yusuf Emre ALTUNDAL, Süleyman BÜYÜKAŞIK
Comprehensive Medicine - 2026;18(3):287-295
Objective: Acute diverticulitis presents with a wide clinical spectrum ranging from mild inflammation to severe complications. Early assessment of disease severity is essential to guide decisions regarding outpatient management, hospitalization, and intervention, as well as to plan appropriate post-episode surveillance. This study evaluated clinical and computed tomography (CT)-based predictors of disease severity and hospitalization and examined follow-up and colonoscopy adherence after an episode of acute diverticulitis. Materials and Methods: This single-center retrospective observational study included 57 patients diagnosed with acute diverticulitis between June 2020 and June 2025. Demographic characteristics, laboratory parameters [C-reactive protein (CRP) and white blood cell count], CT findings, treatment approaches, and follow-up data were analyzed. CT images were re-evaluated using the modified Hinchey classification, and intraperitoneal free air was categorized as none, minimal pericolic, or diffuse. Independent predictors of hospitalization were assessed using multivariate logistic regression. Results: Thirty-three patients (57.9%) were hospitalized, and 24 (42.1%) were managed as outpatients. Higher CRP levels, advanced modified Hinchey stage, and the presence of free air on CT were associated with hospitalization, longer hospital stay, and the need for percutaneous drainage or surgery (p<0.05). In multivariate analysis, modified Hinchey stage >=1b was the only independent predictor of hospitalization (OR: 14.32; 95% CI: 1.21-169.80; p=0.035). Among the 32 patients with available follow-up data, colonoscopy completion was strongly associated with follow-up attendance (p<0.001). Conclusion: Modified Hinchey staging plays a key role in predicting hospitalization in acute diverticulitis. Structured follow-up strategies, including scheduled colonoscopy, may improve adherence and support the timely exclusion of underlying malignancy.
