Alatout, Mayar H

Abstract The optimal management of diverticulitis in young and immunocompromised patients remains controversial, particularly regarding whether these groups warrant a lower threshold for surgery. Historically, young patients were often offered elective colectomy after the first episode of diverticulitis because of concerns regarding recurrence and more aggressive disease. However, contemporary evidence shows that although younger patients may experience higher recurrence rates, they are not at increased risk for complicated recurrence, emergency surgery, or mortality compared with older adults. Nonoperative management is successful in most cases, supporting an individualized rather than age-based surgical approach. Immunocompromised patients, including those with solid organ transplantation, malignancy, chemotherapy exposure, chronic steroid use, or autoimmune disease requiring immunosuppression, represent a higher-risk population. These patients more commonly present with complicated diverticulitis, perforation, sepsis, and atypical symptoms that may delay diagnosis. Although uncomplicated disease can often be managed nonoperatively, immunocompromised patients experience higher rates of emergent surgery, stoma creation, postoperative complications, and mortality, particularly when surgery is performed in a non-elective setting. Current evidence does not support lowering the surgical threshold solely on the basis of young age or immunosuppression status. Instead, management should remain individualized, incorporating disease severity, recurrence pattern, comorbidities, operative risk, and patient preferences. Further research is needed to better define optimal surgical timing and patient selection in these two populations.

Abstract Aim Rectal prolapse is a full‐thickness intussusception of the rectum beyond the anal canal. It is often mistaken for other anorectal pathologies, leading to inaccurate referrals to colorectal surgeons and inappropriate management. However, the frequency of misdiagnosis is not well characterized. We aimed to assess the diagnostic accuracy of rectal prolapse referrals to three tertiary medical centres. Methods This is a retrospective study of patients referred for rectal prolapse to colorectal surgeons at the Mayo Clinic in Rochester, Jacksonville, and Phoenix from 2020 to 2024. The primary outcome is the accuracy of rectal prolapse diagnosis. The secondary outcomes are factors that correlate with diagnostic accuracy. Results Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients. Among misdiagnosed patients, the correct diagnosis was haemorrhoids (68.0%, n = 134), pelvic floor dysfunction (24.3%, n = 48) and rectocele (18.7%, n = 37). A diagnosis of rectal cancer was found in 3 patients (1.5%). The most common presenting symptoms were protrusion (66.3%, n = 345) and bleeding (33.6%, n = 175). Among the referring physicians, only 50.5% ( n = 227) performed an anorectal examination. Overall, there was significant variability in diagnostic accuracy across different specialties, with the highest accuracy from colorectal practices (84.0%) and the lowest from urologists (50.0%). Internal medicine physicians had a lower diagnostic accuracy with anorectal examination than without, though it did not reach statistical significance (44.0% vs. 59.5%, p = 0.2). Conclusion Over one‐third of rectal prolapse referrals were incorrectly diagnosed. This study highlights the opportunity for further training of referring providers on anorectal pathologies to improve diagnostic accuracy which could reduce treatment delays and optimize clinical outcomes.