1
|
Blázquez Ávila V, Borrego Rivas S, Jiménez Palacios M, Baldi Borelli JS, Álvarez Fernández C. Right-side diverticulitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38685897 DOI: 10.17235/reed.2024.10418/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Colonic diverticula develop at specific weak spots, where the vasa recta enter the colonic circular smooth muscle layer.1 They are usually seen in the left colon. Their most common complication is diverticulitis, with mild cases resolving even without antibiotic therapy.2 Right-side diverticulitis develops in only 1.5% of cases, primarily on the anterior aspect of the cecum, proximal to the ileocecal valve (80%).4 Given its low incidence, location, and the fact that it involves younger patients, a differential diagnosis is needed to rule out abdominal inflammatory conditions such as appendicitis or ileitis, as well as gynecological disorders. Diverticulitis is diagnosed using imaging modalities. Computed tomography (CT) is the modality of choice,5 and confirmation is required after clinical remission, primarily using colonoscopy. We studied a series of 3 cases of patients initially diagnosed with acute, uncomplicated right-side diverticulitis who were admitted to the Gastroenterology Department, Hospital de León, from January to December 2023. Our goal was to confirm a presumptive diagnosis of right-side diverticulitis using delayed endoscopy or barium enema to ascertain the presence of right-side diverticulosis and rule out other conditions manifesting with abdominal pain in the right iliac fossa. Cases 1 and 3 were admitted with an accurate diagnosis of right-side diverticulitis. Case 1 was confirmed by ambulatory colonoscopy, and case 3 was confirmed by barium enema because of a history of previous colonoscopy without findings. All three patients required surgical assessment to rule out appendicular involvement. The imaging technique of choice was CT, using the WSES scale for severity grading. Case 2 was diagnosed with right-side diverticulitis by means of ultrasonography, and its origin was later confirmed to be in the sigmoid colon. The remaining clinical, laboratory, and diagnostic characteristics are listed in Table 1.
Collapse
|
2
|
Fabian E, Roskaric T, Pfeifer J, Wenzl H, Hammer HF, Lackner C, Rosanelli G, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 166: An 82-year-old woman with voluminous diarrhea and weight loss. Wien Klin Wochenschr 2023; 135:429-435. [PMID: 36534207 PMCID: PMC10444654 DOI: 10.1007/s00508-022-02112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Elisabeth Fabian
- Department of Internal Medicine II , University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems on the Danube, Austria
| | - Thomas Roskaric
- Department of Surgery, State Hospital Wolfsberg, Wolfsberg, Austria
| | - Johann Pfeifer
- Department of Surgery, Medical University of Graz, Graz, Austria
| | - Heimo Wenzl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Heinz F Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Carolin Lackner
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Georg Rosanelli
- Department of Surgery, Elisabethinen Hospital, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| |
Collapse
|
3
|
Sobrado LF, Caldas TG, Facanali CG, Bustamente-Lopez L, Sobrado CW. Case Series of Right Colon Diverticulitis in the West: A Neglected Disease? JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1757953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy.
Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment.
Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed.
Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period.
Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease.
Collapse
Affiliation(s)
- Lucas Faraco Sobrado
- Division of Colorectal Surgery, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Department of Oncology and Proctology, Instituto de Gastrocirurgia, Oncologia e Proctologia (IGOP), São Paulo, São Paulo, Brazil
| | - Tarsila Gomes Caldas
- Division of Colorectal Surgery, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carolina Graciolli Facanali
- Division of Colorectal Surgery, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Leonardo Bustamente-Lopez
- Division of Colorectal Surgery, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos Walter Sobrado
- Division of Colorectal Surgery, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Department of Oncology and Proctology, Instituto de Gastrocirurgia, Oncologia e Proctologia (IGOP), São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Short-term outcomes following resection of right colon diverticulitis: a comparison of open and minimally invasive approaches using the NSQIP database. Surg Endosc 2022; 36:4283-4289. [PMID: 34697680 DOI: 10.1007/s00464-021-08771-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Right colon diverticulitis is a rare disease process for which there are no established treatment guidelines, and outcomes following surgical management are underreported in the literature. We sought to describe the demographics of patients undergoing ileocecectomy for right colon diverticulitis and compare short-term postoperative outcomes between open and minimally invasive approaches. METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for patients with diverticulitis of the colon who underwent ileocecectomy between 2012 and 2019. Patients with ascites, disseminated cancer, ASA class 5, and patients requiring mechanical ventilation were excluded. Preoperative, intraoperative, and 30-day postoperative outcomes were compared between the groups using both univariable chi-square or t-tests and multivariable logistical regression models. RESULTS 484 patients met inclusion criteria, 150 (31%) of whom underwent open surgery and 334 (69%) who underwent minimally invasive surgery with an 18% conversion rate. 71% of patients were White, 11% of were Black, 7% were Hispanic, and 5% were Asian. The indication for surgery differed significantly by approach with acute diverticulitis representing 47% of indications for open cases and 25% for MIS cases (p < 0.0001). After adjusting for possible confounders, patients undergoing the open approach had a significantly higher chance of post-operative sepsis (p = 0.009) and ileus (p = 0.04) compared with MIS. Hospital length of stay was also significantly shorter after MIS compared to open (5.9 days vs. 11.5 days; p < 0.0001). Mean operative time was significantly longer in MIS than open (173 min vs. 198 min; p = 0.001). CONCLUSION Our analysis demonstrates that minimally invasive surgery is associated with equivalent or improved short-term morbidity and shorter hospital stay despite longer mean operative time. Interestingly, unlike other countries where the prevalence of right colon diverticulitis is higher, a minority of patients requiring operative therapy in our study of patients in the Western hemisphere were of Asian descent.
Collapse
|
5
|
Sebastián-Tomás JC, Gómez-Abril SA, Ripollés T, Manrique A, Torres-Sanchez T, Martínez-Pérez MJ. How to strengthen the management of acute diverticulitis: the utility of the WSES classification-a prospective single-center observational study. Eur J Trauma Emerg Surg 2022; 48:4283-4291. [PMID: 35165746 DOI: 10.1007/s00068-022-01911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to validate the World Society for Emergent Surgery (WSES) scale for the management of acute left-sided colonic diverticulitis (ALCD). METHODS An observational study based on a prospective database of patients with ultrasound (US) and computerized tomography (CT) confirmed ALCD was conducted at our center from April 2018 to May 2019. The primary outcome was the success rate of outpatient management. Secondary outcomes were the association between different WSES stages, clinical and analytical parameters, treatments modalities, and outcomes, and the accuracy of US for management decisions. RESULTS A total of 230 patients were included. Outpatient management was successful in 51/53 (96.23%) cases with ALCD stage 0 and 62/72 (86.11%) patients with stage 1A. There were no differences in age (p = 0.076) or the presence of pericolic air bubbles (p = 0.06) between patients who underwent admission or outpatient management. Clinical and analytical data, treatment decisions, and outcomes showed statistically significant differences between WSES stages. In 7/12 patients with stage 2A, percutaneous drainage or emergency surgery was required. All cases with stage 2B (distant air) underwent conservative management without the need for emergency or elective surgery. The accuracy of US WSES stages for management decisions, when compared with CT, was 96.96%. CONCLUSION The WSES classification for ALCD seemed to be valid helping clinicians in the decision-making process to select between admission or outpatient management. Differences in clinical and analytical data, elected treatments, and outcomes were found between WSES stages. The US WSES stages showed high accuracy for management decisions.
Collapse
Affiliation(s)
- Juan Carlos Sebastián-Tomás
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46007, Valencia, Spain.
| | - Segundo Angel Gómez-Abril
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46007, Valencia, Spain
| | - Tomás Ripollés
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Andrea Manrique
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Teresa Torres-Sanchez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46007, Valencia, Spain
| | | |
Collapse
|
6
|
Uhe I, Meyer J, Viviano M, Naiken S, Toso C, Ris F, Buchs NC. Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature. Colorectal Dis 2021; 23:2515-2526. [PMID: 34272795 PMCID: PMC9292704 DOI: 10.1111/codi.15818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
AIM Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. METHODS This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. RESULTS Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi-colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). CONCLUSION CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.
Collapse
Affiliation(s)
- Isabelle Uhe
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Jeremy Meyer
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Manuela Viviano
- Division of Gynaecology and ObstetricsOspedale Regionale di LuganoLuganoSwitzerland
| | - Surrennaidoo Naiken
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
- Pôle santé Vallée de JouxLe ChenitSwitzerland
| | - Christian Toso
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Frédéric Ris
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Nicolas C. Buchs
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| |
Collapse
|
7
|
Wood EH, Sigman MM, Hayden DM. Special Situations in the Management of Diverticular Disease. Clin Colon Rectal Surg 2021; 34:121-126. [PMID: 33642952 DOI: 10.1055/s-0040-1716704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.
Collapse
Affiliation(s)
- Elizabeth H Wood
- Division of Colon and Rectal Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Michael M Sigman
- Division of Colon and Rectal Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Dana M Hayden
- Division of Colon and Rectal Surgery, Loyola University Medical Center, Maywood, Illinois
| |
Collapse
|
8
|
Zuckerman J, Garfinkle R, Vasilevksy CA, Ghitulescu G, Faria J, Morin N, Boutros M. Short- and Long-Term Outcomes of Right-Sided Diverticulitis: Over 15 Years of North American Experience. World J Surg 2021; 44:1994-2001. [PMID: 32100064 DOI: 10.1007/s00268-020-05431-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center. METHODS This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis. RESULTS Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001). CONCLUSIONS Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
Collapse
Affiliation(s)
- Jesse Zuckerman
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada
| | - Carol-Ann Vasilevksy
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada
| | - Gabriela Ghitulescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada. .,Faculty of Medicine, McGill University, Montreal, Canada.
| |
Collapse
|
9
|
Abstract
This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.
Collapse
Affiliation(s)
- Sanjay Mohanty
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Shawn P Webb
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| |
Collapse
|
10
|
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. [PMID: 28627445 DOI: 10.1016/j.ijsu.2017.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Right sided diverticular disease is a rare condition in Western countries whereas is common amongst Asian population. The aim of this study is to evaluate options and outcomes for the treatment of right colonic diverticulitis. METHOD We included only patients undergoing surgery with right colon diverticulitis (RCD) proven at histological specimen examination from September 2011 to December 2016. RESULTS We performed 18 operations for RCD. Age was lower compared to left sided disease (49 ± 16 vs 67 ± 14; P < 0.001). Three patients were Asian (16.7%). RCD was diagnosed preoperatively in 8 cases (44.4%), whereas appendicitis was suspected in 9 cases (50%) and neoplasm in one (5.6%). We performed resection with anastomosis in 13 patients (72.2%) and in 5 cases we performed a diverticulectomy. Laparoscopy was performed in 14 cases (77.8%). Postoperative morbidity occurred in 3 patients (16.7%; grade 2 or 3a according to Clavien-Dindo) with no mortality. No postoperative events occured after diverticulectomy with shorter hospital stay (4 ± 1.5 vs 11 ± 13; P = 0.022), as no recurrence or need for elective surgery after a mean follow-up of 20 months. CONCLUSION RCD is a rare but not irrelevant condition. Minimally invasive surgery is often feasible and complication rate is low. In selected patients, diverticulectomy can be a valid alternative to treat this condition providing improved postoperative results.
Collapse
Affiliation(s)
- Francesco Monari
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Maurizio Cervellera
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Basilio Pirrera
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy.
| | - Umberto D'Errico
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Samuele Vaccari
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Laura Alberici
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Valeria Tonini
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| |
Collapse
|
11
|
Higher Mortality in Surgically Managed Diverticulitis is Associated with Asian Ethnicity and Right-Sided Disease. Dis Colon Rectum 2016; 59:216-23. [PMID: 26855396 DOI: 10.1097/dcr.0000000000000526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology. OBJECTIVE The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy. DESIGN Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients. PATIENTS Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy. MAIN OUTCOME MEASURES The primary outcomes were in-hospital mortality, hospital length of stay, and total costs. RESULTS Asian patients were younger (56.1 vs. 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs. 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs. 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs. Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs. Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs. Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant. LIMITATIONS The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database. CONCLUSIONS Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.
Collapse
|
12
|
Tsai MS, Lee HM, Hsin MC, Lin CL, Hsu CY, Liu YT, Kao CH. Increased Risk of Pyogenic Liver Abscess Among Patients With Colonic Diverticular Diseases: A Nationwide Cohort Study. Medicine (Baltimore) 2015; 94:e2210. [PMID: 26656355 PMCID: PMC5008500 DOI: 10.1097/md.0000000000002210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Whether patients with diverticular diseases exhibit a higher risk of developing pyogenic liver abscess (PLA) remains inconclusive.From the inpatient claims in Taiwan's National Health Insurance Research Database, we identified 54,147 patients diagnosed with diverticulosis in the 1998 to 2010 period and 216,588 controls without the disorder. The 2 cohorts were matched by age, sex, and admission year, and were followed up until the end of 2010 to estimate the risk of PLA.Overall, the incidence of PLA was 2.44-fold higher in the diverticular-disease group than in the controls (11.5 vs 4.65 per 10,000 person-year). The adjusted hazard ratio (aHR) of PLA was 2.11 (95% confidence interval [CI], 1.81-2.44) for the diverticular-disease group, according to a multivariate Cox proportional hazards regression model. The age-specific data showed that the aHR for the diverticular-disease group, compared with the controls, was the highest inpatients younger than 50 years old (aHR, 4.03; 95% CI, 2.77-5.85). Further analysis showed that the diverticular-disease group exhibited an elevated risk of PLA regardless of whether patients had diverticulitis.The patients with diverticular diseases exhibited a higher risk of PLA.
Collapse
Affiliation(s)
- Ming-Shian Tsai
- From the Department of General Surgery, E-Da Hospital and I-Shou University, Kaohsiung (M-ST, H-ML, M-CH), School of Medicine, China Medical University, Taichung (C-LL), Management Office for Health Data, China Medical University Hospital (C-LL), Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung (C-YH, C-HK), Family Medicine Department, Changhua Christian Hospital, Changhua City (Y-TL), Master of Public Health Degree Program, National Taiwan University, Taipei City (Y-TL), and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
| | | | | | | | | | | | | |
Collapse
|
13
|
Lin JN, Lin CL, Yang CH, Lin MC, Lai CH, Lin HH, Kao CH. Increased Risk of Acute Coronary Syndrome in Patients With Diverticular Disease: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e2020. [PMID: 26559302 PMCID: PMC4912296 DOI: 10.1097/md.0000000000002020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diverticular disease and acute coronary syndrome (ACS) are common disorders that share several risk factors. Few researchers have evaluated the association between diverticular disease and ACS. We aimed to assess the risk of ACS in patients with diverticular disease. A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. All patients aged ≥20 years with a diagnosis of diverticular disease from January 1, 2000, to December 31, 2011, were included in this study. For comparison, patients without diverticular disease were randomly selected and matched with the study cohort at a 4:1 ratio according to age, sex, and the year of the diagnosis of diverticular disease. Patients with incomplete age or sex information and a history of cardiovascular diseases were excluded from the study. All patients were followed until an ACS event, withdrawal from the insurance program, or December 31, 2011. In this study, 52,681 patients with diverticular disease and 210,724 patients without diverticular disease were included. Men accounted for 56.1% of patients and 57.8% of patients were ≥50 years old. The overall incidence density of ACS in patients with diverticular disease (45.5 per 10,000 person-years) was significantly higher than in those without diverticular disease (30.3 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.23 (95% confidence interval [CI], 1.14-1.32) after adjustment for age, sex, and comorbidities. The cumulative incidence of ACS in patients with diverticular disease was significantly higher than that in the control cohort (log-rank test, P < 0.001). The adjusted HRs for the development of ACS were 1.25 (95% CI, 1.15-1.37) and 1.19 (95% CI, 1.07-1.32) in patients with diverticulitis and diverticulosis, respectively. The adjusted HRs of ACS in patients with diverticular disease additionally increased from 1.97 (95% CI, 1.73-2.23) in patients with 1 comorbidity to 5.51 (95% CI, 3.88-7.84) in those with ≥5 comorbidities. This large population-based retrospective study revealed an association between diverticular disease and ACS. Further research is warranted to determine the exact mechanism of the link between these diseases.
Collapse
Affiliation(s)
- Jiun-Nong Lin
- From the Department of Critical Care Medicine (JNL), Division of Infectious Diseases, Department of Internal Medicine (JNL, CHL, HHL), Department of Nuclear Medicine (MCL), E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan (JNL), Management Office for Health Data (CLL), Department of Nuclear Medicine and PET Center (CHK), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine (CHK), College of Medicine, China Medical University, Taichung, Taiwan (CLL); and General Education Center, Meiho University, Pingtung, Taiwan (CHY)
| | | | | | | | | | | | | |
Collapse
|
14
|
Cristaudo A, Pillay P, Naidu S. Caecal diverticulitis: Presentation and management. Ann Med Surg (Lond) 2015; 4:72-5. [PMID: 25830021 PMCID: PMC4355451 DOI: 10.1016/j.amsu.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/06/2015] [Accepted: 02/12/2015] [Indexed: 12/24/2022] Open
Abstract
Introduction While left sided colonic diverticular disease is common in Western countries, right sided colonic diverticular disease is rare. With increasing migration from Asia, many western countries including Australia, are now seeing more right sided diverticular disease, of which caecal diverticulitis is the commonest. This study aims to determine the incidence of caecal diverticulitis in patients presenting with colonic diverticulitis, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. Methods Data was collected using the Queen Elizabeth II Hospital medical records database identifying patients diagnosed with colonic diverticulitis and, more specifically, those with caecal diverticulitis from January 2007 to December 2013. Only those patients who had confirmed caecal diverticulitis on imaging studies or at laparoscopy on their first admission were included in this study. Results A total of 632 patients with colonic diverticulitis were admitted to our institution over a seven-year period, of which 13 patients had caecal diverticulitis (2.06%). Of the 13 patients, twelve were of Asian background and ten were considered young (≤50 years of age). The main complaints were right sided abdominal pain (n = 11, 84.6%) and diarrhoea (n = 5, 38.5%). Nine were diagnosed using computed tomography (n = 9/10, 90%), three on laparoscopy and one using ultrasound (n = 1/2, 50%). Ten patients were treated successfully by conservative means. Discussion A high index of suspicion in Asian patients with atypical symptoms of appendicitis, especially diarrhoea, may provide the diagnosis of caecal diverticulitis. CD occurs mostly in young Asians, presenting with atypical symptoms of appendicitis. With increasing migration, more patients are presenting in Western countries with CD. If imaging confirms uncomplicated CD, conservative treatment is recommended. In our limited study, diagnosis of CD was superior with computed tomography.
Collapse
Affiliation(s)
- Adam Cristaudo
- The Queen Elizabeth II Hospital, Coopers Plains, Queensland, Australia
| | - Praga Pillay
- The Queen Elizabeth II Hospital, Coopers Plains, Queensland, Australia ; University of Queensland, Brisbane, Queensland, Australia
| | - Sanjeev Naidu
- The Queen Elizabeth II Hospital, Coopers Plains, Queensland, Australia
| |
Collapse
|
15
|
Solitary cecal diverticulitis: an unusual cause of acute right iliac fossa pain-a case report and review of the literature. Case Rep Surg 2014; 2014:131452. [PMID: 25506025 PMCID: PMC4258334 DOI: 10.1155/2014/131452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Solitary cecal diverticulitis is a rare cause of acute abdominal pain in the Western world. Its clinical presentation, in most cases, mimics acute appendicitis. A 38-year-old Caucasian man presented with acute abdomen and clinical signs of acute appendicitis. Laparotomy was performed and revealed an inflammatory, solitary diverticulum of the cecum. A typical appendectomy was performed and a catheter was inserted for draining percutaneously the inflamed diverticulum of the cecum. The patient had an uneventful recovery and was discharged on the 4th postoperative day. This frequently misdiagnosed condition, in most cases, is being suspected and identified intraoperatively as acute appendicitis. The aim of this study is to review the available different surgical management options and to present an alternative therapeutic approach that may be valuable under specific circumstances.
Collapse
|
16
|
Huang WY, Lin CC, Jen YM, Chang YJ, Hsiao CW, Yang MH, Lin CS, Sung FC, Liang JA, Kao CH. Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study. Clin Gastroenterol Hepatol 2014; 12:1288-94. [PMID: 24361412 DOI: 10.1016/j.cgh.2013.11.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS We investigated whether a diagnosis of colonic diverticular disease is associated with an increased risk for subsequent development of colorectal cancer (CRC) in a nationwide population-based retrospective study. METHODS We identified 41,359 individuals diagnosed with colonic diverticular disease as inpatients from 2000 through 2009 from the Taiwan National Health Insurance Research Database (study cohort) and collected data for 165,436 randomly selected additional subjects, matched by sex, age, and baseline year (comparison cohort). Data were collected until individuals developed CRC or withdrew from the National Health Insurance system, or until December 31, 2010. Cumulative incidences and hazard ratios (HRs) of CRC development were determined. To assess for ascertainment bias, we conducted an analysis excluding the first 12 months of follow-up evaluation. RESULTS The risk of CRC was significantly higher in the study cohort than in the comparison cohort (HR adjusted for age, sex, and comorbidities, 4.54; 95% confidence interval, 4.19-4.91; P < .0001). In a sensitivity analysis, we excluded the first 12 months of follow-up evaluation after a diagnosis of colonic diverticular disease; subsequent incidence rates for CRC in the study and comparison cohorts were 15.13 and 15.74 per 10,000 person-years, respectively (adjusted HR, 0.96; 95% confidence interval, 0.83-1.11). CONCLUSIONS Colonic diverticular disease is not associated with an increased risk of subsequent CRC after the first year of diagnosis of colonic diverticular disease. An increased risk was observed in the first year, possibly owing to misclassification and screening effects.
Collapse
Affiliation(s)
- Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology-Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Shun Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University Hospital, Taichung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Nuclear Medicine and Positron Emission Tomography Center, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
17
|
Acute inflammation of the true cecal diverticulum--case report. POLISH JOURNAL OF SURGERY 2011; 83:461-4. [PMID: 22166721 DOI: 10.2478/v10035-011-0072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this case report, we describe a rare event: acute inflammation of the true cecal diverticulum. Emergency surgery enabled proper diagnosis and management of this condition. Diagnostic approaches and the management of this disease are described in detail and based on literature review. In conclusion, pathologies of cecal diverticula should be considered in differential diagnosis of pain in the right iliac fossa.
Collapse
|
18
|
Gonzales ER, Alavi K. Evaluation and Treatment of Uncomplicated Diverticular Disease. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Cirocchi R, Farinella E, Trastulli S, Boselli C, Montedori A, Gullà N, Noya G, Sciannameo F, Abraha I. Laparoscopic versus open surgery for colonic diverticulitis. Hippokratia 2011. [DOI: 10.1002/14651858.cd009277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberto Cirocchi
- University of Perugia; Department of General Surgery; Perugia Italy
| | | | | | - Carlo Boselli
- University of Perugia; Department of General Surgery; Perugia Italy
| | - Alessandro Montedori
- Regional Health Authority of Umbria; Health Planning Service; Via Mario Angeloni 61 Perugia Umbria Italy 06124
| | - Nino Gullà
- University of Perugia; Department of General Surgery; Perugia Italy
| | - Giuseppe Noya
- University of Perugia; Department of General Surgery; Perugia Italy
| | | | - Iosief Abraha
- Regional Health Authority of Umbria; Epidemiology Department; Via Mario Angeloni, 61 Perugia Italy 06124
| |
Collapse
|
20
|
Telem DA, Buch KE, Nguyen SQ, Chin EH, Weber KJ, Divino CM. Current recommendations on diagnosis and management of right-sided diverticulitis. Gastroenterol Res Pract 2009; 2009:359485. [PMID: 19325923 PMCID: PMC2659845 DOI: 10.1155/2009/359485] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 01/18/2009] [Indexed: 01/17/2023] Open
Abstract
We present the case of a 52-year-old female with recurrent symptomatic ascending colon diverticulitis who ultimately underwent elective laparoscopic right hemicolectomy. The following is a case report and literature review pertaining to right colonic diverticular disease.
Collapse
Affiliation(s)
- Dana A. Telem
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Kerri E. Buch
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Scott Q. Nguyen
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Edward H. Chin
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Kaare J. Weber
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Celia M. Divino
- Department of Surgery, The Mount Sinai School of Medicine, Box 1259, 1 Gustave L. Levy Place, New York, NY 10029, USA
| |
Collapse
|
21
|
Patkar NM, Curtis JR, Teng GG, Allison JJ, Saag M, Martin C, Saag KG. Administrative codes combined with medical records based criteria accurately identified bacterial infections among rheumatoid arthritis patients. J Clin Epidemiol 2009; 62:321-7, 327.e1-7. [PMID: 18834713 PMCID: PMC2736855 DOI: 10.1016/j.jclinepi.2008.06.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 05/29/2008] [Accepted: 06/04/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate diagnostic properties of International Classification of Diseases, Version 9 (ICD-9) diagnosis codes and infection criteria to identify bacterial infections among rheumatoid arthritis (RA) patients. STUDY DESIGN AND SETTING We performed a cross-sectional study of RA patients with and without ICD-9 codes for bacterial infections. Sixteen bacterial infection criteria were developed. Diagnostic properties of comprehensive and restrictive sets of ICD-9 codes and the infection criteria were tested against an adjudicated review of medical records. RESULTS Records on 162 RA patients with and 50 without purported bacterial infections were reviewed. Positive and negative predictive values of ICD-9 codes ranged from 54%-85% and 84%-100%, respectively. Positive predictive values of the medical records based criteria were 84% and 89% for "definite" and "definite or empirically treated" infections, respectively. Positive predictive value of infection criteria increased by 50% as disease prevalence increased using ICD-9 codes to enhance infection likelihood. CONCLUSION ICD-9 codes alone may misclassify bacterial infections in hospitalized RA patients. Misclassification varies with the specificity of the codes used and strength of evidence required to confirm infections. Combining ICD-9 codes with infection criteria identified infections with greatest accuracy. Novel infection criteria may limit the requirement to review medical records.
Collapse
Affiliation(s)
- Nivedita M Patkar
- Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Lee IK, Jung SE, Gorden DL, Lee YS, Jung DY, Oh ST, Kim JG, Jeon HM, Chang SK. The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Colorectal Dis 2008; 23:1151-7. [PMID: 18704462 DOI: 10.1007/s00384-008-0512-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In this study, we evaluate prospective diagnostic criteria and propose a clinical scoring system for the evaluation of patients suspected to have right colonic diverticulitis (RCD) prospectively. PATIENTS AND METHODS One hundred adult patients, who were clinically suspected to have appendicitis or RCD, and in whom we were not able to preoperatively rule out appendicitis, were examined prospectively. Patients were scored upon clinical presentation based on major diagnostic criteria included (1) no migration pain to the right lower quadrant; (2) a leukocyte count <10,000/mm(3); (3) lateralized abdominal pain, and (4) a history of right colonic diverticulum (two points each). Minor diagnostic criteria (one point each) included (1) a history of right lower quadrant abdominal pain; (2) no symptoms of nausea or vomiting; (3) symptoms of constipation or diarrhea, and (4) abdominal pain for at least seven days. For patients in whom the diagnostic score exceeded two points, a contrast enhanced computed tomography (CT) scan of the abdomen was performed. RESULTS Thirteen patients had a final diagnosis of RCD. These diagnostic criteria demonstrated a sensitivity of 85%, a specificity of 68%, a positive predictive value of 28%, a negative predictive value of 97%, and a diagnostic accuracy of 70%. Among the 38 patients examined with CT, diagnoses for acute diverticulitis included nine true positives, 26 true negatives, two false positives, and one false negative. CONCLUSION Performing CT scans after application of these diagnostic criteria gave a superior preoperative diagnostic rate for patients with RCD.
Collapse
Affiliation(s)
- In Kyu Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
This review examines the role of colonoscopy in the evaluation of asymptomatic diverticulosis, segmental diverticular disease-associated colitis and acute diverticulitis. Asymptomatic acute diverticulitis, discovered during screening colonoscopy, is also discussed. In addition, the use of colonoscopy, both diagnostic and therapeutic, is compared to standard radiology studies for the management of acute diverticular bleeding.
Collapse
|
24
|
Karatepe O, Gulcicek OB, Adas G, Battal M, Ozdenkaya Y, Kurtulus I, Altiok M, Karahan S. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases. World J Emerg Surg 2008; 3:16. [PMID: 18426572 PMCID: PMC2365938 DOI: 10.1186/1749-7922-3-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 04/21/2008] [Indexed: 11/14/2022] Open
Abstract
Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.
Collapse
Affiliation(s)
- Oguzhan Karatepe
- Department of General Surgery, Okmeydaný Training and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
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; 30:1929-34. [PMID: 16983473 DOI: 10.1007/s00268-005-0746-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Controversies abound as regards the optimal treatment for patients with diverticulitis of the right colon. METHODS This is a retrospective review of 113 patients with a diagnosis of right colonic diverticulitis who received treatment at the China Medical University Hospital from July 1994 to June 2004. RESULTS Medical therapy was undertaken in 56 patients diagnosed preoperatively with uncomplicated diverticulitis. All but one patient was successfully treated with bowel rest and antibiotics. Of the 51 patients with a preoperative diagnosis of acute appendicitis, 32 received appendectomy along with postoperative antibiotic therapy, 8 received diverticulectomy in addition to appendectomy, and 11 received colectomy. In all, 17 patients required right hemicolectomy or ileocecal resection due to diverticulitis-related complications or suspected malignancy. Of the 87 (56-1+32) patients who responded to conservative treatment, 11 developed recurrent diverticulitis. All 11 patients were successfully treated with medical therapy, and 2 subsequently received elective right hemicolectomy. Of the 9 patients who received medical treatment alone at the second attack, 2 suffered a third attack. Both were successfully managed with medical therapy. CONCLUSIONS For uncomplicated diverticulitis of the right colon diagnosed preoperatively, antibiotic therapy with bowel rest is an effective treatment. Once it is encountered during surgery for presumed acute appendicitis, a conservative approach involving prophylactic appendectomy and postoperative antibiotics is recommended. For patients with recurrent diseases, medical treatment is still safe and efficient. Colectomy is indicated when complications occur or when malignancy is strongly suspected.
Collapse
Affiliation(s)
- Horng-Ren Yang
- Department of Surgery, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 404, Taiwan
| | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Chedid AD, Domingues LA, Chedid MF, Villwock MDM, Mondelo AR. [Solitary diverticulum of the cecum: experience of a Brazilian general hospital]. ARQUIVOS DE GASTROENTEROLOGIA 2004; 40:216-9. [PMID: 15264042 DOI: 10.1590/s0004-28032003000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cecal diverticulitis is a rare condition, specially in western people. Its importance concerns of being part of the differential diagnosis of acute appendicitis and ulcerated cecal carcinoma. AIM To present the experience of southern Brazilian general hospital in the treatment of cecal diverticulitis. MATERIAL AND METHODS We present four cases of single inflamed cecal diverticulum. One was diagnosed by pre-operatively computer tomography and was treated medically without complications. The other three cases were diagnosed during operation and treated by right hemicolectomy and ileotransverse anastomosis. RESULTS There were no deaths or complications. When cecal diverticulitis is pre-operatively diagnosed it may be treated medically. We preclude laparotomy when the diagnosis is uncertain. CONCLUSION We recommend radical surgical management when the diagnosis is made during operation.
Collapse
|
28
|
Abstract
Diverticulitis involving the right colon is uncommon in the Occident; only one case for every 300 cases of appendicitis occurs in Western countries compared to a ratio of 1/40-1/180 in Asia. The preferential localization of diverticula in the right colon among Asiatics is probably due to genetic factors. In Asia as in the West, a right colon diverticulum is more likely to cause hemorrhage than diverticulitis. The peak age of symptoms is 40-45 years and the sex ratio is 1:1. The patient most commonly presents with symptoms suggestive of acute appendicitis, acute localized peritonitis, or, more rarely, a psoas abscess. Clinical exam reveals an inflammatory mass in the right lower quadrant in 30% of cases; diffuse peritonitis, large abscesses, and fistulae are rare. Helical CT scan is the best tool for establishing the diagnosis and also helps to rule out other possible etiologies in the differential diagnosis-particularly a perforated right colon cancer. In noncomplicated cases with convincing evidence for the diagnosis by CT scan, a conservative (non-surgical) treatment with antibiotics is possible; a later stage colonoscopy will rule out other colonic lesions. More commonly, the correct diagnosis is only made after embarking on an appendectomy via a McBurney incision; the surgical strategy thereafter depends on the level of suspicion regarding the diagnosis and the extent and complexity of the diverticulitis. Therapeutic options may be conservative (appendectomy), limited (diverticulectomy, or extensive (ileocecal resection or right hemicolectomy). For complicated disease (abscess, localized perforation), an aggressive surgical approach is warranted. Surgical strategies need to be validated, particularly in the light of the increasing use of the laparoscopic approach for suspected appendicitis.
Collapse
Affiliation(s)
- P Lê
- Service de Chirurgie Générale, Centre Hospitalier de l'Agglomération Montargoise - Montargis.
| | | | | |
Collapse
|
29
|
Abstract
AIM: To evaluate systematically our nine-year experience in treating right-sided diverticulitis of the colon, and to explore its clinical and radiological relationship.
METHODS: The clinical and radiological data of 40 patients with colonic diverticulitis treated in Mackay Memorial Hospital, Taipei, from 1993 through 2002 were reviewed retrospectively.
RESULTS: The average age of the patients with right-sided diverticulitis was 53.1 years, which was 11.6 years younger than that of the patients with left-sided diverticulitis. The preoperative diagnosis of appendicitis was made in 8 of 13 right-sided diverticulitis patients. Nine (69%) had right lower quadrant abdominal pain for more than 48 hours, and ten patients (77%) presented with fever. CT findings suggesting acute right-sided diverticulitis including thickening of the intestinal wall and pericolonic inflammation were present in five patients.
CONCLUSION: Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than that in left-sided diverticulitis. Barium enema and CT are helpful for the early diagnosis of right-sided diverticulitis. While clearly not required in the majority of patients with right lower quadrant abdominal pain, barium enema and CT may be helpful in making the decision with a clinical history or physical examinations atypical of acute appendicitis.
Collapse
Affiliation(s)
- Li-Rung Shyung
- Division of Gastroen-terology, Department of Internal, Medicine, Mackay Memorial Hospital, 92, Section 2, Chungshan North Road, Taipei, Taiwan, China.
| | | | | | | | | |
Collapse
|
30
|
Tubía Landaberea J, Palomar de Luis M, Partearroyo N, Uriarte Zaldúa C, López de Heredia Armentia E, Gil Sánchez Sainz de la Maza J, Galarraga Ibarrolaburu I, Farnández Val J. Diverticulitis solitaria de ciego. Presentación de 2 casos. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71769-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
31
|
Affiliation(s)
- T M Young-Fadok
- Division of Colon and Rectal Surgery, Mayo Medical School, Rochester, Minnesota, USA
| | | | | | | |
Collapse
|
32
|
Jasper DR, Weinstock LB, Balfe DM, Heiken J, Lyss CA, Silvermintz SD. Transverse colon diverticulitis: successful nonoperative management in four patients. Report of four cases. Dis Colon Rectum 1999; 42:955-8. [PMID: 10411445 DOI: 10.1007/bf02237109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Diverticulitis of the transverse colon is a rare disorder and is often confused with other conditions. Previously reported cases of transverse colon diverticulitis were diagnosed and treated by surgical exploration. Four cases are presented that were successfully managed with a nonsurgical approach. METHODS AND RESULTS Review of the literature in English disclosed 31 cases of transverse colon diverticulitis. The clinical characteristics and management of these patients are reviewed and compared with the current series of patients. The utility of computerized tomography in the diagnosis of diverticulitis is discussed. CONCLUSIONS Medical therapy with bowel rest and antibiotics is appropriate for transverse colon diverticulitis when free perforation and peritoneal signs are absent and the inflammation is contained, as shown by computerized tomography. Operative exploration should be reserved for patients with diffuse peritonitis or those where perforated colon cancer cannot be excluded.
Collapse
Affiliation(s)
- D R Jasper
- Department of Medicine, Barnes-Jewish Hospital, Mallinkrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri, USA
| | | | | | | | | | | |
Collapse
|
33
|
Lane JS, Sarkar R, Schmit PJ, Chandler CF, Thompson JE. Surgical approach to cecal diverticulitis. J Am Coll Surg 1999; 188:629-34; discussion 634-5. [PMID: 10359355 DOI: 10.1016/s1072-7515(99)00043-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cecal diverticulitis is a rare condition in the Western world, with a higher incidence in people of Asian descent. The treatment for cecal diverticulitis has ranged from expectant medical management, which is similar to uncomplicated left-sided diverticulitis, to right hemicolectomy. STUDY DESIGN A retrospective chart review was conducted of the 49 patients treated for cecal diverticulitis at Olive View-UCLA Medical Center from 1976 to 1998. This was the largest-ever single-institution review of cecal diverticulitis reported in the mainland US. RESULTS The clinical presentation was similar to that of acute appendicitis, with abdominal pain, low-grade fever, nausea/vomiting, abdominal tenderness, and leukocytosis. Operations performed included right hemicolectomy in 39 patients (80%), diverticulectomy in 7 patients (14%), and appendectomy with drainage of intraabdominal abscess in 3 patients (6%). Of the 7 patients who had diverticulectomy, 1 required right hemicolectomy at 6 months followup for continued symptoms. Of the three patients who underwent appendectomy with drainage, all required subsequent hemicolectomy for continued inflammation. Of the 39 patients who received immediate hemicolectomies, there were complications in 7 (18%), with no mortality. CONCLUSIONS We endorse an aggressive operative approach to the management of cecal diverticulitis, with the resection of all clinically apparent disease at the time of the initial operation. In cases of a solitary diverticulum, we recommend the use of diverticulectomy when it is technically feasible. When confronted with multiple diverticuli and cecal phlegmon, or when neoplastic disease cannot be excluded, we advocate immediate right hemicolectomy. This procedure can be safely performed in the unprepared colon with few complications. Excisional treatment for cecal diverticulitis prevents the recurrence of symptoms, which may be more common in the Western population.
Collapse
Affiliation(s)
- J S Lane
- Department of Surgery, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | | | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Acute diverticulitis of the right colon is a rare condition with a higher incidence in Oriental populations than in Occidental populations. PATIENTS AND METHODS A retrospective review was conducted between 1982 and 1993 on 22 surgically treated Chinese patients (14 men, 8 women; mean age 47 years) with documented right colon diverticulitis. RESULTS Most patients presented with right lower quadrant pain and local peritoneal signs. Acute appendicitis was the preoperative diagnosis in 82% (18/22) of the patients. Only one diagnosis subsequently proved correct. The pathology was easily recognized in 4 patients during surgery, while examination of the resected specimen confirmed the intraoperative suspicion in 13 patients. The right colon was resected and an ileocolonic anastomosis performed in 21 patients; the remaining patient underwent diverticulectomy and drainage of a pericolic abscess. There was no postoperative mortality, and 4 patients developed wound infection. CONCLUSIONS Our results showed that acute diverticulitis of the right colon was encountered once in 180 cases of acute appendicitis. Local resection or colectomy with primary anastomosis without bowel preparation is the procedure of choice.
Collapse
Affiliation(s)
- C Y Lo
- Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong
| | | |
Collapse
|
35
|
Abstract
Ninety surgical cases of cecal diverticulitis at the University of Hawaii hospitals were reviewed from 1980 to 1991. Seventy-eight percent of the study group were of Asian descent, with a mean age of 41.7 years. Right lower quadrant pain and tenderness were the only constant findings, occurring in 86 and 87 of the 90 patients, respectively. The most common preoperative diagnosis was acute appendicitis, occurring in 73% of patients. A right colectomy or cecectomy was performed in 49 patients, an appendectomy in 29, and a diverticulectomy in 10. Seventeen complications occurred, only 1 of which was in the appendectomy group. Follow-up of up to 10 years was successful in 27 of 29 appendectomy patients, only 4 of whom had recurrent pain. There were no instances of a missed cecal carcinoma. We concluded that in those patients in whom carcinoma can be ruled out and in whom there is no evidence of abscess formation, appendectomy combined with postoperative antibiotics is a safe and effective method for the treatment of cecal diverticulitis.
Collapse
Affiliation(s)
- R N Harada
- Department of Surgery, University of Hawaii, Honolulu
| | | |
Collapse
|
36
|
Abstract
The surgical treatment of acute, complicated diverticulitis remains controversial. No randomized studies have been performed to clarify which operative procedure best fits each situation. As a result, the surgeon must use accumulated knowledge and judgment to make the correct decisions for an individual patient. The morbidity and mortality of patients with complicated diverticular disease in 1993 depend, not so much on the operative procedure, but on the severity of the disease and the associated comorbid conditions, namely the presence of fecal or purulent peritonitis, past medical problems, immune status, and nutritional status. However, adherence to the several principles detailed in this report will minimize morbidity and mortality. The surgeon should always attempt to convert the patient from an emergency to an urgent or elective operative status. In the absence of free perforation, this goal usually can be achieved. Rushing into surgery in patients with a normal immune system is generally ill advised. It is far preferable to stabilize the patient, percutaneously drain abscesses if possible, prepare the bowel before exploration, and thus keep the option of primary anastomosis open. A primary anastomosis done first thing in the morning is far preferable to an end-stoma created in the middle of the night in an emergency situation. The algorithm displayed in Figure 1 provides a useful guideline for treating patients with complicated diverticulitis.
Collapse
|
37
|
|
38
|
Abstract
The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease. In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive. We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy. Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis. Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases). The inflammation invariably responded to antibiotic therapy. Only three patients had colonic resection since a malignant neoplasm could not be excluded. There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy. With this policy of management we encountered no mortality, and morbidity was acceptable.
Collapse
Affiliation(s)
- S S Ngoi
- Department of Surgery, National University Hospital, Singapore
| | | | | | | | | |
Collapse
|
39
|
Abstract
Diverticulitis affects the right side of the colon more commonly than the left side in the Far East. A consecutive series of 35 patients (mean age 44 years) with right sided diverticulitis seen at this hospital is presented. All had localised pain in the right iliac fossa but systemic upset was uncommon. All but one were thought to have acute appendicitis. Thirty one were explored through a right iliac fossa incision but in more than half this had to be closed and a full laparotomy performed. A correct diagnosis was then made at the time of surgery in 28 (80%). Five patients underwent simple diverticulectomy, the remainder having a right hemicolectomy. On histological analysis most (26) had a single false diverticulum. All patients made a satisfactory recovery from surgery.
Collapse
|
40
|
Abstract
Diverticulitis affects the right side of the colon more commonly than the left side in the Far East. A consecutive series of 35 patients (mean age 44 years) with right sided diverticulitis seen at this hospital is presented. All had localised pain in the right iliac fossa but systemic upset was uncommon. All but one were thought to have acute appendicitis. Thirty one were explored through a right iliac fossa incision but in more than half this had to be closed and a full laparotomy performed. A correct diagnosis was then made at the time of surgery in 28 (80%). Five patients underwent simple diverticulectomy, the remainder having a right hemicolectomy. On histological analysis most (26) had a single false diverticulum. All patients made a satisfactory recovery from surgery.
Collapse
Affiliation(s)
- N I Markham
- Prince of Wales Hospital, Chinese University of Hong Kong
| | | |
Collapse
|
41
|
Veidenheimer MC. Invited commentary. World J Surg 1991. [DOI: 10.1007/bf01658731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
42
|
Schmit PJ, Bennion RS, Thompson JE. Cecal diverticulitis: a continuing diagnostic dilemma. World J Surg 1991; 15:367-71. [PMID: 1844125 DOI: 10.1007/bf01658730] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cecal diverticulitis is a rare entity and remains a difficult diagnostic problem. A retrospective review was undertaken of 16 patients (11 men, 5 women; average age, 33.2 years) with a pathologic diagnosis of cecal or right colon diverticulosis who received treatment from 1979 to the present. Preoperative symptoms were difficult to distinguish from appendicitis. The majority complained of right lower quadrant pain and tenderness. Diagnostic studies were not helpful. Preoperative diagnosis was appendicitis in 88% (14 of 16) and correct in 1 patient (6%). At exploratory celiotomy, the surgeon was able to make the diagnosis of cecal diverticulitis in 9 (60%) of the 15 patients in whom the correct diagnosis had not been made preoperatively. Neoplasm was suspected in 5 patients, and an appendiceal abscess was suspected in 1. Treatment was colectomy in 9 and local excision in 4 patients. In 3 patients, the inflamed diverticulum was left in situ at initial exploration; all underwent later excision, one of these urgently for sepsis. No patient died; however, one anastomotic leak requiring reoperation occurred. On the basis of this experience, we recommend excisional therapy in all cases in which the intraoperative diagnosis is certain. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting.
Collapse
Affiliation(s)
- P J Schmit
- Department of Surgery, UCLA School of Medicine, Los Angeles County-Olive View Medical Center
| | | | | |
Collapse
|
43
|
Abstract
Ten cases of caecal diverticulitis are reviewed. Caecal diverticulitis is frequently diagnosed as appendicitis pre-operatively and is difficult to distinguish from carcinoma or inflammatory bowel disease intra-operatively. The average age of presentation is younger than that of left-sided colonic diverticulitis. Most of the diverticula are narrow-neck false diverticula. When diagnosed intra-operatively hemicolectomy can often be avoided.
Collapse
Affiliation(s)
- P M Randle
- Department of Pathology, Royal Perth Hospital, Western Australia
| | | |
Collapse
|
44
|
Abstract
Solitary colonic diverticula are rare. Most have been described in the cecum or ascending colon. Solitary diverticula of the transverse colon are extremely rare, and there are only a few reports in the English medical literature, all occurring in adulthood. This paper reports the case of a 13-year-old girl with a solitary, true diverticulum of the transverse colon, presenting as acute diverticulitis.
Collapse
|
45
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1987. A 61-year-old man with abdominal pain and a mass in the right side of the abdomen. N Engl J Med 1987; 317:1076-83. [PMID: 3657869 DOI: 10.1056/nejm198710223171707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
46
|
Abstract
The etiology of cecal diverticulitis remains unclear. The majority of diverticula are solitary and probably false and may be the result of the same degenerative process seen in the more common left-sided diverticulosis. A minority are true diverticula and may be of congenital origin. Cecal diverticulitis is clinically indistinguishable from acute appendicitis although patients with cecal diverticulitis tend to be older (average age, 40 years), have a longer duration of symptoms, and present less often with nausea and vomiting. In patients with previous appendectomy and in those with more indolent symptoms, barium enema may be helpful in making the diagnosis. If nonoperative treatment is chosen, careful follow-up with air contrast barium enema and colonoscopy should be carried out. The majority of patients require surgery and two types of cecal diverticulitis are encountered at laparotomy. The usual type, accounting for two thirds of cases, is easy to recognize, has an inflamed projection from the cecal wall, and is dealt with by a limited local diverticulectomy. Some authors advocate nonsurgical treatment for this first group of patients. Incidental appendectomy is advocated to avoid confusion should symptoms occur postoperatively. The hidden variant presents as a large, indurated phlegmon and is difficult to distinguish from a perforated cecal carcinoma. With the hidden variant, right hemicolectomy is the surgical treatment of choice and carries a 1.4 percent mortality.
Collapse
Affiliation(s)
- S M Graham
- Department of Surgery, Yale University School of Medicine
| | | |
Collapse
|