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International Journal of Colorectal Disease

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01-06-2013 | Original Article

Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients

Authors: Ker-Kan Tan, Jiayi Wong, Richard Sim

Published in: International Journal of Colorectal Disease | Issue 6/2013

Abstract

Introduction

Data highlighting the long-term outcome following an initial episode of right-sided colonic diverticulitis is lacking. This study aims to evaluate and follow up on all patients with right-sided colonic diverticulitis.

Methods

A retrospective review of all patients who were discharged with a diagnosis of right-sided colonic diverticulitis from January 2003 to April 2008 was performed.

Results

A total of 226 patients, with a median age of 49 (range, 16–93) years, were admitted for acute right-sided colonic diverticulitis. The majority of the patients (n = 198, 87.6 %) had mild diverticulitis (Hinchey Ia and Ib). Seventy-three (32.3 %) patients underwent emergency surgery. The indications of surgery were predominantly suspected appendicitis (n = 50, 22.1 %) and perforated diverticulitis (n = 16, 7.1 %). Right hemicolectomy was performed in 32 (43.8 %) patients, while appendectomy, with or without diverticulectomy, was performed in the rest (n = 41, 56.2 %). There were seven patients who underwent elective right hemicolectomy after their acute admissions.Over a median duration of 64 (12–95) months, there were only nine patients who were readmitted 12 times for recurrent diverticulitis at a median duration of 17 (1–48) months from the index admission. The freedom from failure (recurrent attacks or definitive surgery (right hemicolectomy)) at 60 months was 92.0 % (95 % Confidence interval 86.1 %–97.9 %).

Conclusion

Right-sided diverticulitis is commonly encountered in the Asian population and often gets misdiagnosed as acute appendicitis. If successfully managed conservatively, the long-term outcome is excellent.

Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54(6):663–671PubMedCrossRef

Klarenbeek BR, Samuels M, van der Wal MA, van der Peet DL, Meijerink WJ, Cuesta MA (2010) Indications for elective sigmoid resection in diverticular disease. Ann Surg 251(4):670–674PubMedCrossRef

Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92(2):133–142PubMedCrossRef

Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45(7):962–966PubMedCrossRef

Mueller MH, Glatzle J, Kasparek MS et al (2005) Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 17(6):649–654PubMedCrossRef

Hall JF, Roberts PL, Ricciardi R et al (2011) Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum 54(3):283–288PubMedCrossRef

Carloni A, Sage E, Roudié J et al (2010) Right colonic diverticulitis: an uncommon disease in western countries. Acta Chir Belg 110(1):57–59PubMed

Lee YS (1986) Diverticular disease of the large bowel in Singapore. An autopsy survey. Dis Colon Rectum 29(5):330–335PubMedCrossRef

Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T (1984) Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum 27(8):531–537PubMedCrossRef

10.

Tan KK, Zhang J, Liu JZ, Shen SF, Earnest A, Sim R (2009) Right colonic perforation in an Asian population: predictors of morbidity and mortality. J Gastrointest Surg 13(12):2252–2259PubMedCrossRef

11.

Lee IK, Jung SE, Gorden DL et al (2008) The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Colorectal Dis 23(12):1151–1157PubMedCrossRef

12.

Jhaveri KS, Harisinghani MG, Wittenberg J, Saini S, Mueller PR (2002) Right-sided colonic diverticulitis: CT findings. J Comput Assist Tomogr 26(1):84–89PubMedCrossRef

13.

Tan KK, Liu JZ, Shen SF, Sim R (2011) Emergency surgery in colonic diverticulitis in an Asian population. Int J Colorectal Dis 26(8):1045–1050PubMedCrossRef

14.

Moon HJ, Park JK, Lee JI et al (2007) Conservative treatment for patients with acute right colonic diverticulitis. Am Surg 73(12):1237–1241PubMed

15.

Komuta K, Yamanaka S, Okada K et al (2004) Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg 187(2):233–237PubMedCrossRef

16.

Park HC, Kim BS, Lee BH (2011) Management of right colonic uncomplicated diverticulitis: outpatient versus inpatient management. World J Surg 35(5):1118–1122PubMedCrossRef

17.

Kotzampassakis N, Pittet O, Schmidt S, Denys A, Demartines N, Calmes JM (2010) Presentation and treatment outcome of diverticulitis in younger adults: a different disease than in older patients? Dis Colon Rectum 53(3):333–338PubMedCrossRef

18.

Wasvary H, Turfah F, Kadro O et al (1999) Same hospitalization resection for acute diverticulitis. Am Surg 65:632–635PubMed

19.

Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917PubMedCrossRef

20.

Ngoi SS, Chia J, Goh MY, Sim E, Rauff A (1992) Surgical management of right colon diverticulitis. Dis Colon Rectum 35(8):799–802PubMedCrossRef

21.

Law WL, Lo CY, Chu KW (2001) Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions. Int J Colorectal Dis 16(5):280–284PubMedCrossRef

22.

Kim SH, Byun CG, Cha JW, Choi SH, Kho YT, Seo DY (2010) Comparative study of the clinical features and treatment for right and left colonic diverticulitis. J Korean Soc Coloproctol 26(6):407–412PubMedCrossRef

23.

Masoomi H, Buchberg BS, Magno C, Mills SD, Stamos MJ (2011) Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg 146(4):400–406PubMedCrossRef

24.

Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003) Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 186(6):696–701PubMedCrossRef

25.

Greason KL, Rappold JF, Liberman MA (1998) Incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain. Its time has come. Surg Endosc 12(3):223–225PubMedCrossRef

26.

van den Broek WT, Bijnen AB, de Ruiter P, Gouma DJ (2001) A normal appendix found during diagnostic laparoscopy should not be removed. Br J Surg 88(2):251–254PubMedCrossRef

27.

Lee JH, Park YS, Choi JS (2010) The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol 20(2):97–105PubMedCrossRef

28.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132(5):910–925PubMed

29.

Liljegren G, Chabok A, Wickbom M, Smedh K, Nilsson K (2007) Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis 9(6):480–488PubMedCrossRef

30.

Sarma D, Longo WE (2008) Diagnostic imaging for diverticulitis. J Clin Gastroenterol 42(10):1139–1141PubMedCrossRef

31.

Chou YH, Chiou HJ, Tiu CM et al (2001) Sonography of acute right side colonic diverticulitis. Am J Surg 181(2):122–127PubMedCrossRef

32.

Cobben LP, Groot I, Blickman JG, Puylaert JB (2003) Right colonic diverticulitis: MR appearance. Abdom Imaging 28(6):794–798PubMedCrossRef

33.

Heverhagen JT, Sitter H, Zielke A, Klose KJ (2008) Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum 51(12):1810–1815PubMedCrossRef

34.

Schwerk WB, Schwarz S, Rothmund M (1992) Sonography in acute colonic diverticulitis. A prospective study. Dis Colon Rectum 35(11):1077–1084PubMedCrossRef

35.

Saini S, Mueller PR, Wittenberg J, Butch RJ, Rodkey GV, Welch CE (1986) Percutaneous drainage of diverticular abscess: an adjunct to surgical therapy. Arch Surg 121:475–478PubMedCrossRef

36.

Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F (2005) Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum 48:787–791PubMedCrossRef

37.

Kim MR, Kye BH, Kim HJ, Cho HM, Oh ST, Kim JG (2010) Treatment of right colonic diverticulitis: the role of nonoperative treatment. J Korean Soc Coloproctol 26(6):402–406PubMedCrossRef

38.

Tan KK, Liu JZ, Yeow Y, Gunasekaran S, Tan JJ (2011) Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution’s experience of 207 cases over 6 years. Int J Colorectal Dis 26(9):1157–1161PubMedCrossRef

39.

Etzioni DA, Chiu VY, Cannom RR, Burchette RJ, Haigh PI, Abbas MA (2010) Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum 53(6):861–865PubMedCrossRef

Title: Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients
Authors: Ker-Kan Tan
Jiayi Wong
Richard Sim
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1595-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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