Skip to main content
Top
Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Diverticulitis | Research

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Authors: Zhilong Ma, Weiwei Liu, Jia Zhou, Le Yao, Wangcheng Xie, Mingqi Su, Jin Yang, Jun Shao, Ji Chen

Published in: BMC Surgery | Issue 1/2022

Login to get access

Abstract

Background

Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD.

Methods

We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment.

Results

A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis.

Conclusions

Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.
Literature
1.
go back to reference Swanson SM, Strate LL. Acute colonic diverticulitis. Ann Intern Med. 2018;168(9):ITC65–80.CrossRef Swanson SM, Strate LL. Acute colonic diverticulitis. Ann Intern Med. 2018;168(9):ITC65–80.CrossRef
2.
go back to reference Sardi A, Gokli A, Singer JA. Diverticular disease of the cecum and ascending colon. A review of 881 cases. Am Surg. 1987;53(1):41–5.PubMed Sardi A, Gokli A, Singer JA. Diverticular disease of the cecum and ascending colon. A review of 881 cases. Am Surg. 1987;53(1):41–5.PubMed
3.
go back to reference Jacobs DO. Clinical practice diverticulitis. N Engl J Med. 2007;357(20):2057–66.CrossRef Jacobs DO. Clinical practice diverticulitis. N Engl J Med. 2007;357(20):2057–66.CrossRef
4.
go back to reference Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, Yamamoto T. Characteristics of colonic diverticulitis and factors associated with complications: a Japanese multicenter, retrospective, cross-sectional study. Dis Colon Rectum. 2015;58(12):1174–81.CrossRef Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, Yamamoto T. Characteristics of colonic diverticulitis and factors associated with complications: a Japanese multicenter, retrospective, cross-sectional study. Dis Colon Rectum. 2015;58(12):1174–81.CrossRef
5.
go back to reference Paik PS, Yun JA. Clinical features and factors associated with surgical treatment in patients with complicated colonic diverticulitis. Ann Coloproctol. 2017;33(5):178–83.CrossRef Paik PS, Yun JA. Clinical features and factors associated with surgical treatment in patients with complicated colonic diverticulitis. Ann Coloproctol. 2017;33(5):178–83.CrossRef
6.
go back to reference Lee YF, Tang DD, Patel SH, Battaglia MA, Shanker BA, Cleary RK. Recurrence of acute right colon diverticulitis following nonoperative management: a systematic review and meta-analysis. Dis Colon Rectum. 2020;63(10):1466–73.CrossRef Lee YF, Tang DD, Patel SH, Battaglia MA, Shanker BA, Cleary RK. Recurrence of acute right colon diverticulitis following nonoperative management: a systematic review and meta-analysis. Dis Colon Rectum. 2020;63(10):1466–73.CrossRef
7.
go back to reference Tanase I, Paun S, Stoica B, Negoi I, Gaspar B, Beuran M. Epidemiology of diverticular disease—systematic review of the literature. Chirurgia (Bucur). 2015;110(1):9–14. Tanase I, Paun S, Stoica B, Negoi I, Gaspar B, Beuran M. Epidemiology of diverticular disease—systematic review of the literature. Chirurgia (Bucur). 2015;110(1):9–14.
8.
go back to reference Tan KK, Wong J, Yan Z, Chong CS, Liu JZ, Sim R. Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg. 2014;84(3):181–4.CrossRef Tan KK, Wong J, Yan Z, Chong CS, Liu JZ, Sim R. Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg. 2014;84(3):181–4.CrossRef
9.
go back to reference Wagner DE, Zollinger RW. Diverticulitis of the cecum and ascending colon. Arch Surg. 1961;83:436–43.CrossRef Wagner DE, Zollinger RW. Diverticulitis of the cecum and ascending colon. Arch Surg. 1961;83:436–43.CrossRef
10.
go back to reference Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284–94.CrossRef Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284–94.CrossRef
11.
go back to reference Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, Augustin G, Ben-Ishay O, Biffl WL, Bouliaris K, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020;15(1):32.CrossRef Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, Augustin G, Ben-Ishay O, Biffl WL, Bouliaris K, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020;15(1):32.CrossRef
12.
go back to reference Courtot L, Bridoux V, Lakkis Z, Piessen G, Manceau G, Mulliri A, Meurette G, Bouayed A, Venara A, Blanc B, et al. Long-term outcome and management of right colonic diverticulitis in western countries: Multicentric Retrospective Study. J Visc Surg. 2019;156(4):296–304.CrossRef Courtot L, Bridoux V, Lakkis Z, Piessen G, Manceau G, Mulliri A, Meurette G, Bouayed A, Venara A, Blanc B, et al. Long-term outcome and management of right colonic diverticulitis in western countries: Multicentric Retrospective Study. J Visc Surg. 2019;156(4):296–304.CrossRef
13.
go back to reference Luu LH, Vuong NL, Yen VTH, Phuong DTT, Vu BK, Thanh NV, Khanh NT, Van Hai N. Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surg Endosc. 2020;34(5):2019–27.CrossRef Luu LH, Vuong NL, Yen VTH, Phuong DTT, Vu BK, Thanh NV, Khanh NT, Van Hai N. Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surg Endosc. 2020;34(5):2019–27.CrossRef
14.
go back to reference Destek S, Gul VO. Effectiveness of conservative approach in right colon diverticulitis. Ulus Travma Acil Cerrahi Derg. 2019;25(4):396–402.PubMed Destek S, Gul VO. Effectiveness of conservative approach in right colon diverticulitis. Ulus Travma Acil Cerrahi Derg. 2019;25(4):396–402.PubMed
15.
go back to reference Kim JY, Park SG, Kang HJ, Lim YA, Pak KH, Yoo T, Cho WT, Shin DW, Kim JW. Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Int J Colorectal Dis. 2019;34(8):1413–20.CrossRef Kim JY, Park SG, Kang HJ, Lim YA, Pak KH, Yoo T, Cho WT, Shin DW, Kim JW. Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Int J Colorectal Dis. 2019;34(8):1413–20.CrossRef
16.
go back to reference Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004;187(2):233–7.CrossRef Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004;187(2):233–7.CrossRef
17.
go back to reference Park HC, Kim BS, Lee K, Kim MJ, Lee BH. Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack. Int J Colorectal Dis. 2014;29(10):1217–22.CrossRef Park HC, Kim BS, Lee K, Kim MJ, Lee BH. Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack. Int J Colorectal Dis. 2014;29(10):1217–22.CrossRef
18.
go back to reference Lee KY, Lee J, Park YY, Oh ST. Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis. BMC Gastroenterol. 2021;21(1):91.CrossRef Lee KY, Lee J, Park YY, Oh ST. Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis. BMC Gastroenterol. 2021;21(1):91.CrossRef
19.
go back to reference Hall J, Hammerich K, Roberts P. New paradigms in the management of diverticular disease. Curr Probl Surg. 2010;47(9):680–735.CrossRef Hall J, Hammerich K, Roberts P. New paradigms in the management of diverticular disease. Curr Probl Surg. 2010;47(9):680–735.CrossRef
20.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef
21.
go back to reference van Dijk ST, Rottier SJ, van Geloven AAW, Boermeester MA. Conservative treatment of acute colonic diverticulitis. Curr Infect Dis Rep. 2017;19(11):44.CrossRef van Dijk ST, Rottier SJ, van Geloven AAW, Boermeester MA. Conservative treatment of acute colonic diverticulitis. Curr Infect Dis Rep. 2017;19(11):44.CrossRef
22.
go back to reference Bollom A, Austrie J, Hirsch W, Nee J, Friedlander D, Ellingson K, Cheng V, Lembo A. Emergency department burden of diverticulitis in the USA, 2006–2013. Dig Dis Sci. 2017;62(10):2694–703.CrossRef Bollom A, Austrie J, Hirsch W, Nee J, Friedlander D, Ellingson K, Cheng V, Lembo A. Emergency department burden of diverticulitis in the USA, 2006–2013. Dig Dis Sci. 2017;62(10):2694–703.CrossRef
23.
go back to reference Lim DR, Kuk JC, Shin EJ, Hur H, Min BS, Lee KY, Kim NK. Clinical outcome for management of colonic diverticulitis: characteristics and surgical factor based on two institution data at South Korea. Int J Colorectal Dis. 2020;35(9):1711–8.CrossRef Lim DR, Kuk JC, Shin EJ, Hur H, Min BS, Lee KY, Kim NK. Clinical outcome for management of colonic diverticulitis: characteristics and surgical factor based on two institution data at South Korea. Int J Colorectal Dis. 2020;35(9):1711–8.CrossRef
24.
go back to reference Lauro A, Pozzi E, Vaccari S, Cervellera M, Tonini V. Drains, germs, or steel: multidisciplinary management of acute colonic diverticulitis. Dig Dis Sci. 2020;65(12):3463–76.CrossRef Lauro A, Pozzi E, Vaccari S, Cervellera M, Tonini V. Drains, germs, or steel: multidisciplinary management of acute colonic diverticulitis. Dig Dis Sci. 2020;65(12):3463–76.CrossRef
25.
go back to reference Ha GW, Lee MR, Kim JH. Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg. 2017;87(6):467–70.CrossRef Ha GW, Lee MR, Kim JH. Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg. 2017;87(6):467–70.CrossRef
26.
go back to reference Hupfeld L, Burcharth J, Pommergaard HC, Rosenberg J. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017;32(5):611–22.CrossRef Hupfeld L, Burcharth J, Pommergaard HC, Rosenberg J. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017;32(5):611–22.CrossRef
27.
go back to reference Kim YC, Chung JW, Baek JH, Lee WS, Kim D, Park YH, Yang JY, Lee WK. Risk factors for recurrence of right colonic diverticulitis. Dig Surg. 2019;36(6):509–13.CrossRef Kim YC, Chung JW, Baek JH, Lee WS, Kim D, Park YH, Yang JY, Lee WK. Risk factors for recurrence of right colonic diverticulitis. Dig Surg. 2019;36(6):509–13.CrossRef
28.
go back to reference Monari F, Cervellera M, Pirrera B, D’Errico U, Vaccari S, Alberici L, Tonini V. Right-sided acute diverticulitis: a single Western center experience. Int J Surg. 2017;44:128–31.CrossRef Monari F, Cervellera M, Pirrera B, D’Errico U, Vaccari S, Alberici L, Tonini V. Right-sided acute diverticulitis: a single Western center experience. Int J Surg. 2017;44:128–31.CrossRef
29.
go back to reference Papaziogas B, Makris J, Koutelidakis I, Paraskevas G, Oikonomou B, Papadopoulos E, Atmatzidis K. Surgical management of cecal diverticulitis: is diverticulectomy enough? Int J Colorectal Dis. 2005;20(1):24–7.CrossRef Papaziogas B, Makris J, Koutelidakis I, Paraskevas G, Oikonomou B, Papadopoulos E, Atmatzidis K. Surgical management of cecal diverticulitis: is diverticulectomy enough? Int J Colorectal Dis. 2005;20(1):24–7.CrossRef
30.
go back to reference Hildebrand P, Kropp M, Stellmacher F, Roblick UJ, Bruch HP, Schwandner O. Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period. Langenbecks Arch Surg. 2007;392(2):143–7.CrossRef Hildebrand P, Kropp M, Stellmacher F, Roblick UJ, Bruch HP, Schwandner O. Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period. Langenbecks Arch Surg. 2007;392(2):143–7.CrossRef
31.
go back to reference Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, Chen RJ. Management of right colon diverticulitis: a 10-year experience. World J Surg. 2006;30(10):1929–34.CrossRef Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, Chen RJ. Management of right colon diverticulitis: a 10-year experience. World J Surg. 2006;30(10):1929–34.CrossRef
32.
go back to reference Kauff DW, Kloeckner R, Frogh S, Lang H. Management of cecal diverticulitis diagnosed by computed tomography scan. Int J Colorectal Dis. 2019;34(7):1333–6.CrossRef Kauff DW, Kloeckner R, Frogh S, Lang H. Management of cecal diverticulitis diagnosed by computed tomography scan. Int J Colorectal Dis. 2019;34(7):1333–6.CrossRef
33.
go back to reference Chiu TC, Chou YH, Tiu CM, Chiou HJ, Wang HK, Lai YC, Chiou YY. Right-sided colonic diverticulitis: clinical features, sonographic appearances, and management. J Med Ultrasound. 2017;25(1):33–9.CrossRef Chiu TC, Chou YH, Tiu CM, Chiou HJ, Wang HK, Lai YC, Chiou YY. Right-sided colonic diverticulitis: clinical features, sonographic appearances, and management. J Med Ultrasound. 2017;25(1):33–9.CrossRef
34.
go back to reference Shyung LR, Lin SC, Shih SC, Kao CR, Chou SY. Decision making in right-sided diverticulitis. World J Gastroenterol. 2003;9(3):606–8.CrossRef Shyung LR, Lin SC, Shih SC, Kao CR, Chou SY. Decision making in right-sided diverticulitis. World J Gastroenterol. 2003;9(3):606–8.CrossRef
35.
go back to reference Shin JH, Son BH, Kim H. Clinically distinguishing between appendicitis and right-sided colonic diverticulitis at initial presentation. Yonsei Med J. 2007;48(3):511–6.CrossRef Shin JH, Son BH, Kim H. Clinically distinguishing between appendicitis and right-sided colonic diverticulitis at initial presentation. Yonsei Med J. 2007;48(3):511–6.CrossRef
36.
go back to reference Cole M, Ayantunde AA, Payne J. Caecal diverticulitis presenting as acute appendicitis: a case report. World J Emerg Surg. 2009;4:29.CrossRef Cole M, Ayantunde AA, Payne J. Caecal diverticulitis presenting as acute appendicitis: a case report. World J Emerg Surg. 2009;4:29.CrossRef
37.
go back to reference Papapolychroniadis C, Kaimakis D, Fotiadis P, Karamanlis E, Stefopoulou M, Kouskouras K, Dimitriadis A, Harlaftis N. Perforated diverticulum of the caecum. A difficult preoperative diagnosis. Report of 2 cases and review of the literature. Tech Coloproctol. 2004;8(Suppl 1):s116-118.CrossRef Papapolychroniadis C, Kaimakis D, Fotiadis P, Karamanlis E, Stefopoulou M, Kouskouras K, Dimitriadis A, Harlaftis N. Perforated diverticulum of the caecum. A difficult preoperative diagnosis. Report of 2 cases and review of the literature. Tech Coloproctol. 2004;8(Suppl 1):s116-118.CrossRef
38.
go back to reference Hot S, Egin S, Gokcek B, Yesiltas M, Alemdar A, Akan A, Karahan SR. Solitary caecum diverticulitis mimicking acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2015;21(6):520–3.PubMed Hot S, Egin S, Gokcek B, Yesiltas M, Alemdar A, Akan A, Karahan SR. Solitary caecum diverticulitis mimicking acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2015;21(6):520–3.PubMed
39.
go back to reference Koshy RM, Abusabeib A, Al-Mudares S, Khairat M, Toro A, Di Carlo I. Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated? World J Emerg Surg. 2016;11:1.CrossRef Koshy RM, Abusabeib A, Al-Mudares S, Khairat M, Toro A, Di Carlo I. Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated? World J Emerg Surg. 2016;11:1.CrossRef
Metadata
Title
Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence
Authors
Zhilong Ma
Weiwei Liu
Jia Zhou
Le Yao
Wangcheng Xie
Mingqi Su
Jin Yang
Jun Shao
Ji Chen
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01578-z

Other articles of this Issue 1/2022

BMC Surgery 1/2022 Go to the issue