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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.
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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.
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Tsang JS, Chung Foo C, Yip J, Kwok Choi H, Lun Law W, Siu Hung Lo O. Emergency surgery comparison of right versus left acute colonic diverticulitis: A 10-year outcome analysis. Surgeon 2020; 19:150-155. [PMID: 32690462 DOI: 10.1016/j.surge.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The difference in outcome between right (RCD) and left colonic diverticulitis (LCD) is not well established. The aim of this study was to analyse the presentation and surgical outcome of RCD versus left-sided disease following emergency surgery. METHOD We conducted a retrospective review of patients presenting with acute diverticulitis over a 10-year period from 2004 to 2014 to a tertiary unit. Patient demographics, Hinchey classification, need for emergency surgery, perioperative outcome and recurrence were evaluated. RESULTS In total 360 patients presented with acute diverticulitis, 218 (61%) were right-sided and 142 (39%) were left-sided. The mean age (57 yrs vs 68 yrs) and median length of stay (4 days vs 5 days) were significantly less in RCD (p < 0.001). The need for emergency surgery was similar between RCD and LCD (30.7% vs 23.2%, p = 0.12). Sixty-seven (31%) patients with RCD required emergency surgery, 42 (62.7%) of these were based on a presumptive diagnosis of appendicitis and underwent laparoscopic appendicectomy only. Operative morbidity (10.4% vs 51.5%, p < 0.001) and mortality were significantly higher in LCD (1.5% v 15.2%, p = 0.007). Subgroup analysis of non-appendicectomy, RCD patients, showed LCD were more likely to require surgery (11.5% vs 23.2%, p = 0.003). There was no difference in recurrence (p = 0.6). CONCLUSION Right colonic diverticulitis patients are younger and disease course is more benign compared to LCD. Presentation can be confused with appendicitis without proper imaging. In the rare cases where emergency surgery is required, RCD is associated with a lower operative morbidity and mortality compared to left-sided disease.
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Affiliation(s)
- J S Tsang
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong.
| | - Chi Chung Foo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Jeremy Yip
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Hok Kwok Choi
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Wai Lun Law
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Oswens Siu Hung Lo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Koshy RM, Abusabeib A, Al-Mudares S, Khairat M, Toro A, Di Carlo I. Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated? World J Emerg Surg 2016; 11:1. [PMID: 26734068 PMCID: PMC4700755 DOI: 10.1186/s13017-015-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/30/2015] [Indexed: 12/30/2022] Open
Abstract
Aim To compare experience with solitary cecal diverticulum (SCD) with literature on the indication for appendectomy in cases of solitary cecal diverticulitis. Methods We retrospectively reviewed all cases of SCD in our institution from September 2011 to March 2013. Data on sex, age, ethnic origin, presence of pain in the right iliac fossa, duration of symptoms, diagnosis, management, intraoperative findings, histologic examination, hospital stay, complications, and follow-up were reviewed and analyzed. We compared this to related literature reported between 2000 and 2015. Results In the study period, 10 patients presented with an SCD. Male sex and Asian origin were predominant. All patients had pain in the right iliac fossa, with a duration of 2–5 days. In nine cases the diagnosis was made by clinical examination and laboratory testing. One patient who had undergone a previous appendectomy was diagnosed with SCD by computed tomography. This last patient was treated conservatively, four patients were treated with resection of the cecum “en bloc” with the last jejunal loop and appendix, and the other five patients were treated with appendectomies. Two patients had minor complications. All patients were followed up for a minimum of 12 to a maximum of 24 months. No recurrence was recorded in either the case treated conservatively or the cases treated by appendectomies. Conclusions In cases of operative but conservative treatment for SCD, appendectomy could be justified to avoid misdiagnosis in case of future episodes of solitary cecal diverticulitis.
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Affiliation(s)
- Renol M Koshy
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | | | - Saif Al-Mudares
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | - Mohamed Khairat
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | - Adriana Toro
- Department of Surgery, Patti Hospital, Patti (ME), Italy
| | - Isidoro Di Carlo
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar ; Department of Surgical Sciences and Advanced Technologies, "G.F. Ingrassia" University of Catania, Catania, Italy
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Lee Y, Francone T. Special Situations in the Management of Colonic Diverticular Disease. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tan KK, Liu JZ, Shen SF, Sim R. Emergency surgery in colonic diverticulitis in an Asian population. Int J Colorectal Dis 2011; 26:1045-50. [PMID: 21360277 DOI: 10.1007/s00384-011-1160-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2011] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Diverticulitis in Asians differs significantly from their Western counterparts in various aspects. This study was performed to highlight our institution's surgical experiences in patients with diverticulitis. The secondary aim was to compare the patients who underwent surgery for right- and left-sided diverticulitis. METHODS A retrospective review of all patients who underwent emergency surgery in patients with acute diverticulitis from July 2003 to April 2008 was performed. Right-sided pathology was regarded if it was located from the caecum till the transverse colon. Left-sided disease was regarded if it commenced from the splenic flexure. RESULTS The study group comprised of 104 patients, 68 (65.4%) of whom had right-sided diverticulitis. Caecum was the commonest site of disease, and the majority had only mild disease. In the 36 (34.6%) patients with left-sided diverticulitis, majority (63.8%) had an ASA score of three or four, with the sigmoid colon being the most common site of involvement. Most (91.7%) had worse peritoneal contamination with Hartmann's procedure being performed in 22 (61.1%) patients. Worse peri-operative outcome was also seen in this group. After multivariate analysis, the independent factors for right-sided disease were younger age, lower ASA score and no necessity for stoma. CONCLUSIONS In an Asian population, surgery in right-sided diverticulitis is more commonly performed and is associated with lower morbidity and mortality. Patients who underwent surgery for right-sided diverticulitis were younger, with lower ASA score and less likely to have stoma created.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
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Park HC, Chang MY, Lee BH. Nonoperative management of right colonic diverticulitis using radiologic evaluation. Colorectal Dis 2010; 12:105-8. [PMID: 19016818 DOI: 10.1111/j.1463-1318.2008.01734.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although a few reviews have been conducted, nonoperative management may be the mainstay of therapy for uncomplicated right colonic diverticulitis. With increasing use of radiological evaluation for diverticulitis, the status of the disease is becoming more accessible. In this study, clinical outcomes of nonoperative management for right colonic diverticulitis were assessed according to disease status using radiological evaluation. METHOD From April 2000 to March 2007, 296 patients were admitted for acute right colonic diverticulitis upon first attack and were treated with nonoperative management. The status of diverticulitis was classified using ultrasonography and/or computed tomography as inflamed diverticulum or phlegmon in 276 patients or pericolic abscess in 20 patients. Uncomplicated diverticulitis was defined as inflamed diverticulum or phlegmon. Length of hospital stay, antibiotic use, failure of initial therapy and the incidence of recurrence after nonoperative management were assessed. RESULTS The mean length of hospital stay and antibiotic use were 6 and 4.7 days respectively. All patients were successfully treated with the initial medical therapy and their hospital stays were uneventful. Of the 276 patients with an uncomplicated diverticulitis, two patients (1%) had a recurrence during follow-up that could be managed nonoperatively. Of the 20 patients with pericolic abscesses, four patients (20%) had a recurrence. One patient underwent laparoscopic ileocolic resection and the other patients were treated nonoperatively. CONCLUSION Nonoperative management may be the treatment of choice for right colonic diverticulitis with inflamed diverticulum or phlegmon. Diverticulitis with pericolic abscess should be treated with additional care.
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Affiliation(s)
- H-C Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
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Li JC, Ng SS, Lee JF, Yiu RY, Hon SS, Leung WW, Leung KL. Emergency Laparoscopic-Assisted Versus Open Right Hemicolectomy for Complicated Cecal Diverticulitis: A Comparative Study. J Laparoendosc Adv Surg Tech A 2009; 19:479-83. [DOI: 10.1089/lap.2008.0220] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jimmy C.M. Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon S.M. Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Janet F.Y. Lee
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Y.C. Yiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Sophie S.F. Hon
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Wa Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Lau Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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