Can diverticulitis occur in a 28-year-old patient?

Diverticulitis in Young Adults (28 Years Old)

Yes, diverticulitis can definitely occur in a 28-year-old patient, although it is less common than in older populations. 1, 2

Epidemiology in Young Adults

• While diverticular disease is traditionally associated with older adults, there has been a dramatic rise in incidence among younger age groups in recent years 1
• Up to one-fifth of patients with acute diverticulitis in Western populations are under 50 years of age 1
• The annual incidence of diverticulitis in the US is approximately 180 per 100,000 people 2

Clinical Presentation in Young Adults

• Young patients with diverticulitis present with similar symptoms as older patients:
  • Abdominal pain (most commonly left lower quadrant, but can be right lower quadrant in some cases)
  • Nausea and vomiting (present in 86% of young patients)
  • Fever (present in 71% of young patients)
  • Leukocytosis (present in 90% of young patients) 3

Diagnostic Considerations

• Contrast-enhanced abdominal and pelvic CT scan is the recommended diagnostic test with 98-99% sensitivity and 99-100% specificity 2
• Diverticulitis in young patients may be misdiagnosed as appendicitis, especially when presenting with right lower quadrant pain 3

Treatment Approach

• Young patients with diverticulitis have been shown to respond well to conservative treatment:
  • 90.1% of patients ≤50 years can be successfully managed with conservative treatment compared to 76% of older patients 4
  • Young patients require emergency surgery less frequently than older patients (5.6% vs 20.5%) 4

Management Guidelines

• For uncomplicated diverticulitis (85% of cases):

  • Observation with pain management (typically acetaminophen)
  • Dietary modification with clear liquid diet
  • Antibiotics should be reserved for patients with:
    • Persistent fever or chills
    • Increasing leukocytosis
    • Immunocompromised status
    • Chronic medical conditions
    • Pregnancy 2

• For complicated diverticulitis:

  • Intravenous antibiotics (ceftriaxone plus metronidazole or piperacillin-tazobactam)
  • Percutaneous drainage for abscesses
  • Surgical intervention for perforation or peritonitis 2

Recurrence Risk

• Elderly patients have a lower risk of recurrence after the first episode of diverticulitis compared to younger patients 1
• The risk of requiring urgent surgery for recurrence is also lower among older patients (4.3% in patients >50 years vs 7.3% in patients <50 years) 1

Cautions and Pitfalls

• Delay in diagnosis may occur in young patients due to the misconception that diverticulitis primarily affects older individuals 3
• Diverticulitis in young patients should be considered in the differential diagnosis of acute abdominal pain, especially with fever, nausea, and leukocytosis 3
• Changes in dietary habits from traditional Mediterranean diet to Western diet may contribute to the increasing incidence in younger populations 5

While diverticulitis was once considered rare and potentially more aggressive in young patients, recent evidence suggests that young patients generally respond better to conservative management and have lower rates of emergency surgery than older patients 4. However, prompt diagnosis is essential to avoid complications.