Abstract
<title>Abstract</title> <p>Purpose Colonic diverticulosis is frequently detected incidentally at colonoscopy. Although the incidence of diverticular disease is rising fastest among young adults, natural-history data derive almost exclusively from older Western cohorts. We aimed to determine the risk of complications in young patients with incidentally detected, previously uncomplicated diverticulosis. Methods We conducted a retrospective longitudinal cohort study of patients aged 40 years or younger with colonoscopy-confirmed colonic diverticulosis at the Ambulatory Care Centre, Hamad Medical Corporation, Qatar (January 2015–December 2021). Patients with any diverticular complication at or before the index colonoscopy were excluded. Cumulative incidence of a first episode of acute diverticulitis or diverticular bleeding was estimated by Kaplan–Meier analysis; incidence rates were expressed per 1000 person-years. Results Of 144 patients identified, 98 were eligible, contributing 527 person-years (median follow-up 5.6 years). Median age was 36.2 years; 62.2% were male and 50.0% obese. Diverticula were right-sided in 32.7%, left-sided in 29.6%, and bilateral in 21.4%. Six patients (6.1%) developed a first complication (four diverticulitis, two bleeding), an incidence of 11.38 per 1000 person-years (95% CI 4.18–24.77). The 5-year cumulative incidence was 3.9% (95% CI 1.3–11.6) for any complication, 2.5% for diverticulitis, and 1.4% for bleeding. No event occurred within two years. All diverticulitis episodes were uncomplicated and medically managed, both bleeds were self-limited, and no patient required surgery. Conclusion Incidentally detected diverticulosis in young patients carried a low 5-year complication risk with a benign course, arguing against the historically quoted risk. Small event numbers warrant cautious interpretation.</p>