Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2022

Open Access 01-12-2022 | Antibiotic | Review

The outcomes of right-sided and left-sided colonic diverticulitis following non-operative management: a systematic review and meta-analysis

Authors: Sih-Shiang Huang, Chih-Wei Sung, Hsiu-Po Wang, Wan-Ching Lien

Published in: World Journal of Emergency Surgery | Issue 1/2022

Login to get access

Abstract

Background

There is no sufficient overview of outcomes in right-sided and left-sided colonic diverticulitis (CD) following non-operative management. This systematic review was conducted to evaluate the recurrence/treatment failure in right-sided and left-sided CD.

Methods

A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane Library from inception to Dec 2021 were searched. The study characteristics, recurrence/treatment failure, and risk factors for recurrence/treatment failure were extracted. Proportional meta-analyses were performed to calculate the pooled recurrent/treatment failure rate of right-sided and left-sided CD using the random effect model. Logistic regression was applied for the factors associated with the recurrence/treatment failure.

Results

Thirty-eight studies with 10,129 patients were included, and only two studies comprised both sides of CD. None of the studies had a high risk of bias although significant heterogeneity existed. The pooled recurrence rate was 10% (95% CI 8–13%, I2 = 86%, p < 0.01) in right-sided and 20% (95% CI 16–24%, I2 = 92%, p < 0.01) in left-sided CD. For the uncomplicated CD, the pooled recurrence rate was 9% (95% CI 6–13%, I2 = 77%, p < 0.01) in right-sided and 15% (95% CI 8–27%, I2 = 97%, p < 0.01) in the left-sided. Age and gender were not associated with the recurrence of both sides. The treatment failure rate was 5% (95% CI 2–10%, I2 = 84%, p < 0.01) in right-sided and 4% (95% CI 2–7%, I2 = 80%, p < 0.01) in left-sided CD. The risk factors for recurrence and treatment failure were limited.

Conclusion

Non-operative management is effective with low rates of recurrence and treatment failure for both right-sided and left-sided CD although left-sided exhibits a higher recurrence. The recurrence rates did not differ between patients receiving antibiotics or not in uncomplicated CD. Age and sex were not associated with the recurrence although other risk factors were dispersing. Further risk factors for recurrence and treatment failure would be investigated for precise clinical decision-making and individualized strategy.
Literature
1.
Meltzer AC, Pines JM, Richards LM, Mullins P, Mazer-Amirshahi M. US emergency department visits for adults with abdominal and pelvic pain (2007–13): trends in demographics, resource utilization and medication usage. Am J Emerg Med. 2017;35(12):1966–9.PubMedCrossRef
2.
Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A, et al. Diverticular disease of the colon–on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003;17(9):1189–95.PubMedCrossRef
3.
Etzioni DA, Mack TM, Beart RW, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. 2009;249(2):210–7.PubMedCrossRef
4.
Theodoropoulos D. Current options for the emergency management of diverticular disease and options to reduce the need for colostomy. Clin Colon Rectal Surg. 2018;31(4):229–35.PubMedPubMedCentralCrossRef
5.
Hupfeld L, Burcharth J, Pommergaard H-C, Rosenberg J. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017;32(5):611–22.PubMedCrossRef
6.
Ho VP, Nash GM, Milsom JW, Lee SW. Identification of diverticulitis patients at high risk for recurrence and poor outcomes. J Trauma Acute Care Surg. 2015;78(1):112–9.PubMedCrossRef
7.
Tan K-K, Wong J, Yan Z, Chong C-S, Liu JZ, Sim R. Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg. 2014;84(3):181–4.PubMedCrossRef
8.
Kim Y-C, Chung J-W, Baek J-H, Lee W-S, Kim D, Park Y-H, et al. Risk factors for recurrence of right colonic diverticulitis. Dig Surg. 2019;36(6):509–13.PubMedCrossRef
9.
Park H-C, 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.PubMedCrossRef
10.
Hajibandeh S, Hajibandeh S, Smart NJ, Maw A. Meta-analysis of the demographic and prognostic significance of right-sided versus left-sided acute diverticulitis. Colorectal Dis. 2020;22(12):1908–23.PubMedCrossRef
11.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.PubMedPubMedCentralCrossRef
12.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.PubMedCrossRef
13.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.PubMedCrossRef
14.
DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28(2):105–14.PubMedCrossRef
15.
Jackson D, Law M, Rücker G, Schwarzer G. The Hartung-Knapp modification for random-effects meta-analysis: a useful refinement but are there any residual concerns? Stat Med. 2017;36(25):3923–34.PubMedPubMedCentralCrossRef
16.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
17.
Mizuki A, Tatemichi M, Nakazawa A, Tsukada N, Nagata H, Kanai T. Changes in the clinical features and long-term outcomes of colonic diverticulitis in japanese patients. Intern Med. 2017;56(22):2971–7.PubMedPubMedCentralCrossRef
18.
Lee KY, Lee J, Park YY, Kim Y, Oh ST. Difference in clinical features between right- and left-sided acute colonic diverticulitis. Sci Rep. 2020;10(1):3754.PubMedPubMedCentralCrossRef
19.
Park YY, Nam S, Han JH, Lee J, Cheong C. Predictive factors for conservative treatment failure of right colonic diverticulitis. Ann Surg Treat Res. 2021;100(6):347–55.PubMedPubMedCentralCrossRef
20.
Park SM, Kwon TS, Kim DJ, Lee YS, Cheung DY, Oh ST, et al. Prediction and management of recurrent right colon diverticulitis. Int J Colorectal Dis. 2014;29(11):1355–60.PubMedCrossRef
21.
Chen Z, Zhang B, Wu D, Jin Y. Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy. BMC Surg. 2020;20(1):202.PubMedPubMedCentralCrossRef
22.
Moon HJ, Park JK, Lee JI, Lee JH, Shin HJ, Kim WS, et al. Conservative treatment for patients with acute right colonic diverticulitis. Am Surg. 2007;73(12):1237–41.PubMedCrossRef
23.
Issa N, Paran H, Yasin M, Neufeld D. Conservative treatment of right-sided colonic diverticulitis. Eur J Gastroenterol Hepatol. 2012;24(11):1254–8.PubMed
24.
Ha GW, Lee MR, Kim JH. Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg. 2017;87(6):467–70.PubMedCrossRef
25.
26.
Kim TJ, Lee IK, Park JK, Lee YS, Si Y, Jung H, et al. Is conservative treatment with antibiotics the correct strategy for management of right colonic diverticulitis?: a prospective study. J Korean Soc Coloproctol. 2011;27(4):188–93.PubMedPubMedCentralCrossRef
27.
Park H-C, Kim BS, Lee BH. Management of right colonic uncomplicated diverticulitis: outpatient versus inpatient management. World J Surg. 2011;35(5):1118–22.PubMedCrossRef
28.
Kim JY, Park SG, Kang HJ, Lim YA, Pak KH, Yoo T, et al. Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Int J Colorectal Dis. 2019;34(8):1413–20.PubMedCrossRef
29.
Courtot L, Bridoux V, Lakkis Z, Piessen G, Manceau G, Mulliri A, 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.PubMedCrossRef
30.
Schneider LV, Millet I, Boulay-Coletta I, Taourel P, Loriau J, Zins M. Right colonic diverticulitis in caucasians: presentation and outcomes versus left-sided disease. Abdom Radiol (NY). 2017;42(3):810–7.CrossRef
31.
Destek S, Gul VO. Effectiveness of conservative approach in right colon diverticulitis. Ulus Travma Acil Cerrahi Derg. 2019;25(4):396–402.PubMed
32.
Matsushima K. Management of right-sided diverticulitis: a retrospective review from a hospital in Japan. Surg Today. 2010;40(4):321–5.PubMedCrossRef
33.
Park HC, Chang MY, Lee BH. Nonoperative management of right colonic diverticulitis using radiologic evaluation. Colorectal Dis. 2010;12(2):105–8.PubMedCrossRef
34.
Park JH, Park HC, Lee BH. One-day versus four-day antibiotic treatment for acute right colonic uncomplicated diverticulitis: a randomized clinical trial. Turk J Gastroenterol. 2019;30(7):605–10.PubMedCrossRef
35.
Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, et al. Management of right colon diverticulitis: a 10-year experience. World J Surg. 2006;30(10):1929–34.PubMedCrossRef
36.
Reisman Y, Ziv Y, Kravrovitc D, Negri M, Wolloch Y, Halevy A. Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis. 1999;14(4–5):250–4.PubMedCrossRef
37.
Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104(1):52–61.PubMedCrossRef
38.
Pisanu A, Vacca V, Reccia I, Podda M, Uccheddu A. Acute diverticulitis in the young: the same disease in a different patient. Gastroenterol Res Pract. 2013;2013: 867961.PubMedPubMedCentralCrossRef
39.
Santos A, Mentula P, Pinta T, Ismail S, Rautio T, Juusela R, et al. Comparing laparoscopic elective sigmoid resection with conservative treatment in improving quality of life of patients with diverticulitis: the laparoscopic elective sigmoid resection following diverticulitis (LASER) randomized clinical trial. JAMA Surg. 2021;156(2):129–36.PubMedCrossRef
40.
Holmer C, Lehmann KS, Engelmann S, Gröne J, Buhr HJ, Ritz J-P. Long-term outcome after conservative and surgical treatment of acute sigmoid diverticulitis. Langenbecks Arch Surg. 2011;396(6):825–32.PubMedCrossRef
41.
Mizrahi I, Al-Kurd A, Chapchay K, Ag-Rejuan Y, Simanovsky N, Eid A, et al. Long-term outcomes of sigmoid diverticulitis: a single-center experience. J Surg Res. 2018;221:8–14.PubMedCrossRef
42.
Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K, Group AS. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99(4):532–9.CrossRef
43.
Mueller MH, Glatzle J, Kasparek MS, Becker HD, Jehle EC, Zittel TT, et al. Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol. 2005;17(6):649–54.PubMedCrossRef
44.
Frileux P, Dubrez J, Burdy G, Roullet-Audy JC, Dalban-Sillas B, Bonnaventure F, et al. Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years. Colorectal Dis. 2010;12(7):674–80.PubMedCrossRef
45.
Lopez-Borao J, Kreisler E, Millan M, Trenti L, Jaurrieta E, Rodriguez-Moranta F, et al. Impact of age on recurrence and severity of left colonic diverticulitis. Colorectal Dis. 2012;14(7):e407–12.PubMedCrossRef
46.
Binda GA, Arezzo A, Serventi A, Bonelli L. Italian study group on complicated D, Facchini M, et al multicentre observational study of the natural history of left-sided acute diverticulitis. Br J Surg. 2012;99(2):276–85.PubMedCrossRef
47.
Biondo S, Borao JL, Kreisler E, Golda T, Millan M, Frago R, et al. Recurrence and virulence of colonic diverticulitis in immunocompromised patients. Am J Surg. 2012;204(2):172–9.PubMedCrossRef
48.
Unlu C, van de Wall BJ, Gerhards MF, Wiezer M, Draaisma WA, Consten EC, et al. Influence of age on clinical outcome of acute diverticulitis. J Gastrointest Surg. 2013;17(9):1651–6.PubMedCrossRef
49.
Buchs NC, Konrad-Mugnier B, Jannot AS, Poletti PA, Ambrosetti P, Gervaz P. Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg. 2013;100(7):976–9.PubMedCrossRef
50.
Trenti L, Kreisler E, Galvez A, Golda T, Frago R, Biondo S. Long-term evolution of acute colonic diverticulitis after successful medical treatment. World J Surg. 2015;39(1):266–74.PubMedCrossRef
51.
Brochmann ND, Schultz JK, Jakobsen GS, Oresland T. Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study. Colorectal Dis. 2016;18(11):1101–7.PubMedCrossRef
52.
Meyer J, Caruso A, Roos E, Balaphas A, Toso C, Poletti PA, et al. The clinical significance of extraluminal air in Hinchey 1a diverticulitis: results from a retrospective cohort study with 10-year follow-up. Int J Colorectal Dis. 2019;34(12):2053–8.PubMedCrossRef
53.
Balk EM, Adam GP, Bhuma MR, Konnyu KJ, Saldanha IJ, Beland MD, et al. Diagnostic imaging and medical management of acute left-sided colonic diverticulitis: a systematic review. Ann Intern Med. 2022;175(3):379–87.PubMedCrossRef
54.
Desai M, Fathallah J, Nutalapati V, Saligram S. Antibiotics versus no antibiotics for acute uncomplicated diverticulitis: a systematic review and meta-analysis. Dis Colon Rectum. 2019;62(8):1005–12.PubMedCrossRef
Metadata
Title
The outcomes of right-sided and left-sided colonic diverticulitis following non-operative management: a systematic review and meta-analysis
Authors
Sih-Shiang Huang
Chih-Wei Sung
Hsiu-Po Wang
Wan-Ching Lien
Publication date
01-12-2022
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2022
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-022-00463-7

Other articles of this Issue 1/2022

World Journal of Emergency Surgery 1/2022 Go to the issue

Research

In-hospital mortality associated with necrotizing soft tissue infection due to Vibrio vulnificus: a matched-pair cohort study

Research

Differentiating necrotizing soft tissue infections from cellulitis by soft tissue infectious fluid analysis: a pilot study

Research

Knowledge, attitude, and practice of artificial intelligence in emergency and trauma surgery, the ARIES project: an international web-based survey

Research

Reduction of motorcycle-related deaths over 15 years in a developing country

Research

Periappendiceal fluid collection on preoperative computed tomography can be an indication for interval appendectomy: a retrospective study

Review

Delayed laparoscopic peritoneal washout in non-operative management of blunt abdominal trauma: a scoping review