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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.
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Conventional-Dose CT Versus 2-mSv CT for Right Colonic Diverticulitis as an Alternate Diagnosis of Appendicitis: Secondary Analysis of Large Pragmatic Randomized Trial Data. AJR Am J Roentgenol 2021; 217:1113-1121. [PMID: 33825498 DOI: 10.2214/ajr.21.25584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND. Adoption of low-dose CT for the diagnosis of appendicitis has been slow in children and in adults, partly because of concern about missing alternative diagnoses including right colonic diverticulitis. OBJECTIVE. The purpose of our study was to retrospectively compare the diagnostic performance of IV contrast-enhanced 2-mSv and conventional-dose CT (CDCT) for the diagnosis of right colonic diverticulitis in adolescents and young adults with suspected appendicitis. METHODS. This posthoc analysis of a prospective randomized controlled trial included 3074 patients (1672 female patients and 1402 male patients) ranging in age from 15 to 44 years old (mean ± SD, 28 ± 9 years) from 20 hospitals. From December 2013 to August 2016, patients were randomized to either the 2-mSv CT group (n = 1535 patients) or the CDCT (median, 7 mSv) group (n = 1539 patients). A total of 161 radiologists prospectively issued CT reports in which they suggested alternative diagnoses for 976 (2-mSV CT) and 924 (CDCT) patients. Seven independent assessors adjudicated final diagnoses on the basis of clinical and CT findings. Endpoints of test-positives, test-negatives, sensitivity, and specificity for right colonic diverticulitis were compared using chi-square and Mann-Whitney U tests. Characteristics and disposition of patients with test-positive results were assessed. Four readers retrospectively reviewed CT images of 400 patients selected from the trial (113 and 108 patients with diverticulitis from 2-mSv CT and CDCT groups, respectively) to evaluate interobserver agreement for right colonic diverticulitis in terms of Gwet coefficients. RESULTS. Between-group differences were minute for most endpoints related to right colonic diverticulitis: test-positives (difference, 0.2% [95% CI, -1.8% to 2.1%]; 7.8% [119/1535 patients] vs 7.6% [117/1539 patients]; p = .93), test-negatives (0.5% [95% CI, -1.5% to 2.5%]; 91.7% [1407/1535] vs 91.2% [1403/1539]; p = .67), sensitivity (0% [95% CI, -6% to 6%]; 95% [110/116] vs 95% [105/111]; p > .99), and specificity (0.3% [95% CI, -0.5% to 0.9%]; 99.4% [1401/1410] vs 99.1% [1397/1409]; p = .66). The characteristics and disposition of test-positive patients were similar between the two groups. Gwet coefficients were high and comparable between the two groups (2-mSv CT vs CDCT, 0.849 vs 0.889; p = .20). CONCLUSION. Two-millisievert CT is comparable to conventional-dose CT for the diagnosis of right colonic diverticulitis. CLINICAL IMPACT. By mitigating concern about a missed diagnosis of right colonic diverticulitis, the results further support the use of low-dose CT in patients with suspected appendicitis. TRIAL REGISTRATION. ClinicalTrials.gov NCT01925014.
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Recurrence of Acute Right Colon Diverticulitis Following Nonoperative Management: A Systematic Review and Meta-analysis. Dis Colon Rectum 2020; 63:1466-1473. [PMID: 32969890 DOI: 10.1097/dcr.0000000000001787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis. OBJECTIVE The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management. DATA SOURCES PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019. STUDY SELECTION Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available. INTERVENTIONS Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered. MAIN OUTCOME MEASURES The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model. RESULTS There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%-15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%-15%)) or heterogeneity. Funnel plot assessment revealed no publication bias. LIMITATIONS There were no randomized controlled trials available. The statistical heterogeneity was moderate (I = 46%). CONCLUSIONS Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon. PROSPERO CRD42019131673.
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Clinical Difference between Acute Appendicitis and Acute Right-Sided Colonic Diverticulitis. Emerg Med Int 2020; 2020:4947192. [PMID: 32953179 PMCID: PMC7481953 DOI: 10.1155/2020/4947192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical presentations of acute appendicitis (AA) and acute right-sided colonic diverticulitis (ARCD) are similar. However, the usual treatment for each disease differs between surgical and conservative management. The aim of this study was to identify clinical differences between AA and ARCD. Method We performed a single-center retrospective study on adult patients, with uncomplicated AA and ARCD confirmed by computed tomography, who visited an emergency department between March 2018 and August 2019. Clinical variables including past medical history, presented symptoms and signs, and laboratory findings were compared between the two groups. A logistic regression analysis was subsequently performed to differentiate ARCD from AA based on results of univariate analyses. Results A total of 212 (79.1%) and 56 (20.9%) patients were enrolled in AA and ARSD groups, respectively. Logistic regression analysis revealed that a past history of diverticulitis [OR: 102.679 (95% CI: 9.964–1058.055), p < 0.001] was associated with ARCD, while ketonuria [OR: 2.907 (95% CI: 1.091–7.745), p=0.033], anorexia [OR: 21.544 (95% CI: 3.905–118.868), p < 0.001], and neutrophilia [OR: 3.406 (95% CI: 1.243–9.336), p=0.017] were associated with AA. Conclusion Anorexia, neutrophilia, and ketonuria were predictors of AA while a history of diverticulitis was a predictor of ARCD.
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Sharma P, Hegde R, Kulkarni A, Soin P, Kochar P, Rotem E. Imaging right lower quadrant pain: Not always appendicitis. Clin Imaging 2020; 63:65-82. [PMID: 32163846 DOI: 10.1016/j.clinimag.2020.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Although acute appendicitis (AA) is one of the commonest causes of right lower quadrant abdominal pain (RLQP), there are numerous other conditions in the abdomen and pelvis that can simulate the clinical presentation of AA for which imaging is essential in detection. We discuss the approach to evaluation of patients presenting with acute onset RLQP and the choice of various imaging modalities that can be utilized. Although CT remains the workhorse in evaluation, US and MRI, given lack of radiation, play an important ancillary role, particularly in the pediatric and pregnant patients. We present a spectrum of conditions presenting with RLQP which we have classified systematically ranging from conditions affecting the bowel, mesentery/omentum/peritoneum, vasculature, urinary and reproductive systems to give the reader a checklist of conditions to consider when evaluating a case of RLQP.
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Affiliation(s)
- Pranav Sharma
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Rahul Hegde
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America.
| | - Ashwini Kulkarni
- Department of Radiology, University of Massachusetts, Worcester, MA, United States of America
| | - Priti Soin
- Department of Pathology, Penn State College of Medicine, Hershey, PA, United States of America
| | - Puneet Kochar
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Eran Rotem
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
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CT Predictors of Unfavorable Clinical Outcomes of Acute Right Colonic Diverticulitis. AJR Am J Roentgenol 2017; 209:1263-1271. [DOI: 10.2214/ajr.17.17869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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.
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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
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Chung BH, Ha GW, Lee MR, Kim JH. Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon. Ann Coloproctol 2016; 32:228-233. [PMID: 28119866 PMCID: PMC5256252 DOI: 10.3393/ac.2016.32.6.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/24/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis. Methods This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification. Results Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m2 vs. 25.8 ± 4.3 kg/m2, P = 0.021) than those with uncomplicated disease. Conclusion Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.
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Affiliation(s)
- Byeoung Hoon Chung
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong Hun Kim
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Ferrara F, Bollo J, Vanni LV, Targarona EM. Diagnosis and management of right colonic diverticular disease: A review. Cir Esp 2016; 94:553-559. [PMID: 27823760 DOI: 10.1016/j.ciresp.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
Abstract
The aim of this narrative review is to define the clinical-pathological characteristics and to clarify the management of right colonic diverticular disease. It is rare in Europe, USA and Australia and more common in Asia. In the recent years its incidence has increased in the West, with various distributions among populations. Many studies have reported that it is difficult to differentiate the presenting symptoms of this disease from those of appendicitis before surgery, because the signs and symptoms are similar, so misdiagnosis is not infrequent. With accurate imaging studies it is possible to reach a precise preoperative diagnosis, in order to assess an accurate treatment strategy. Currently the management of this disease is not well defined, no clear guidelines have been proposed and it is not known whether the guidelines for left colonic diverticular disease can also be applied for it. Several authors have stated that conservative management is the best approach, even in case of recurrence, and surgery should be indicated in selected cases.
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Affiliation(s)
- Francesco Ferrara
- Departamento de Medicina, Cirugía y Neurociencias, Universidad de Siena, Siena, Italia; Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Jesús Bollo
- Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Letizia V Vanni
- Departamento de Medicina, Cirugía y Neurociencias, Universidad de Siena, Siena, Italia
| | - Eduardo M Targarona
- Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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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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Ha GW, Lee MR, Kim JH. Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg 2015; 87:467-470. [PMID: 25786747 DOI: 10.1111/ans.13028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although right colonic diverticulitis is more common than sigmoid diverticulitis, and its incidence has been increasing in Asian countries, there is no definitive treatment strategy for right colonic diverticulitis. This retrospective clinical study assessed the effect of conservative management in patients with right colonic diverticulitis. METHODS Of the 169 patients who were diagnosed with right colonic diverticulitis at Chonbuk National University Hospital, South Korea, from 2005 to 2012, 152 patients evaluated by abdominopelvic computed tomography (CT) and managed conservatively were included. CT findings were categorized by modified Hinchey classification, with stages Ib, II, III and IV, as well as fistula and obstruction defined as complicated diverticulitis. Factors associated with recurrence of diverticulitis were determined. RESULTS The mean age of 152 patients (87 males, 65 females) was 42.9 ± 13.8 years, median follow-up interval was 61 months (range, 17-113 months). At diagnosis, five patients (3.3%) had complicated diverticulitis. After treatment of first attack, 15 patients (9.9%) experienced recurrence of right colonic diverticulitis, including 10 (6.6%) within 12 months. Fourteen of these patients were successfully treated conservatively, whereas one failed conservative management and required surgical resection. Statistical analysis found no variables related to recurrence of right colonic diverticulitis. CONCLUSION Right colonic diverticulitis has a low rate of complicated diverticulitis at first attack and a low recurrence rate, with most recurrences being uncomplicated. Therefore, conservative management is effective in patients with right colonic diverticulitis. Close follow-up of patients for 12 months is required because most recurrences may occur within 12 months.
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Affiliation(s)
- Gi Won Ha
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Jeonbuk, South Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Jeonbuk, South Korea
| | - Jong Hun Kim
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Jeonbuk, South Korea
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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.
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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
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Bilic Komarica E, Zvizdic Z. Right-sided perforated ascending colonic diverticulum mimicking acute appendicitis. Acta Inform Med 2013; 20:269-70. [PMID: 23378699 PMCID: PMC3558287 DOI: 10.5455/aim.2012.20.269-270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 11/30/2012] [Indexed: 11/03/2022] Open
Abstract
Perforation of the colonic diverticulum is a common reason for emergency laparotomy, especially in older people but is rare in the younger population. While perforation of the sigmoid diverticulum is very common, perforation of the ascending colonic diverticulum is a very rare event. For this reason, the divereticulitis is usually discovered unexpectedly at surgery for suspected appendicitis.
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Affiliation(s)
- Edina Bilic Komarica
- Clinic of Anaestesiology, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Issa N, Paran H, Yasin M, Neufeld D. Conservative treatment of right-sided colonic diverticulitis. Eur J Gastroenterol Hepatol 2012; 24:1254-8. [PMID: 22872077 DOI: 10.1097/meg.0b013e328357e672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diverticulosis of the right colon occurs in a small percentage of patients in Western countries. Clinical presentation of right-sided colon diverticulitis is indistinguishable from that of acute appendicitis, and the majority of patients undergo surgical intervention for presumed appendicitis. The liberal use of diagnostic radiological modalities whenever appendicitis was suspected led to correct diagnosis and also to more preoperative diagnosis of right-sided diverticulitis, which consented conservative medical therapy in cases of uncomplicated right-sided diverticulitis. The aim of the study was to report the outcome in patients with right-sided diverticulitis diagnosed nonoperatively using computed tomography scanning and treated conservatively. METHODS Patients with clinical and radiological diagnosis of cecal or right colon diverticulitis treated conservatively between January 2005 and December 2007 were included. The demographic and clinical data were retrospectively analyzed. RESULTS Fifteen patients were included in this study. The median age was 52 years (range, 34-72 years) and the duration of symptoms was 4 days (range, 1-9 days) before the diagnosis. The median hospital stay was 5 days (range, 1-9 days). All patients were successfully treated with medical therapy. During a median follow-up of 32 months (range, 24-52 months) only one patient (6.6%) had a recurrent attack, and he was successfully treated again with medical therapy. CONCLUSION The routine use of the computed tomography scan for abdominal pain in the right lower quadrant, and whenever right-sided diverticulitis is suspected, improves diagnosis and reduces surgical interventions. The current study provides additional data in support of conservative therapy as the initial treatment in acute right-sided diverticulitis, even in cases of recurrence.
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Affiliation(s)
- Nidal Issa
- Hasharon Hospital Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Petah-Tikva, Israel.
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Kim SY, Oh TH, Seo JY, Jeon TJ, Seo DD, Shin WC, Choi WC, Jeong MJ. The clinical factors for predicting severe diverticulitis in Korea: a comparison with Western countries. Gut Liver 2012; 6:78-85. [PMID: 22375175 PMCID: PMC3286743 DOI: 10.5009/gnl.2012.6.1.78] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/20/2011] [Accepted: 07/31/2011] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIMS It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. METHODS A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. RESULTS Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38℃, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. CONCLUSIONS This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.
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Affiliation(s)
- Sun Young Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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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.
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Kim TJ, Lee IK, Park JK, Lee YS, Si Y, Jung H, Kim HJ, Lee SC, Cheung DY, Gorden LD, Oh ST. Is conservative treatment with antibiotics the correct strategy for management of right colonic diverticulitis?: a prospective study. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:188-93. [PMID: 21980589 PMCID: PMC3180599 DOI: 10.3393/jksc.2011.27.4.188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/16/2011] [Indexed: 11/19/2022]
Abstract
Purpose The goals of this study were to identify whether conservative treatment with antibiotics in right colonic diverticulitis (RCD) patients, our empirical method used until now, is adequate and to determine how the natural history of RCD is affected by conservative treatment. Methods This study was designed as a case-control study. Group I was comprised of 12 patients who were managed conservatively, and clinical data were retrospectively collected. In group II, a total of 49 patients, diagnosed by using diagnostic criteria for RCD and managed conservatively, were prospectively included. Results The period of fasting was 2.7 days, and the hospital stay was 4.6 days in all patients. The intravenous and the oral antibiotic periods were 3.8 days and 9.8 days, respectively. There were no statistically significant differences in treatment results between the two groups except the duration of fasting and the hospitalization, and there were no complications under conservative treatment. Eight patients (13.1%) had recurrent diverticulitis during the follow-up period. The recurrence risk showed no significant difference between the groups. The RCD-free period after management was 60.1 months, and patients with recurrent RCD were treated by conservative treatment or laparoscopic surgery. Conclusion Conservative treatment with antibiotics is the optimal treatment of choice for RCD and shows no increase in complications.
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Affiliation(s)
- Tae Jung Kim
- Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
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Kim MR, Kye BH, Kim HJ, Cho HM, Oh ST, Kim JG. Treatment of right colonic diverticulitis: the role of nonoperative treatment. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:402-6. [PMID: 21221240 PMCID: PMC3017975 DOI: 10.3393/jksc.2010.26.6.402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 10/26/2010] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis. Methods One hundred fifty-eight patients with right-sided colonic diverticulitis were evaluated. Clinical history, physical and radiologic findings, and treatments were reviewed retrospectively. Also, additional episodes and treatment modalities were checked. Results Our patients were classified according to treatment modality; 135 patients (85.4%) underwent conservative treatment, including antibiotics and bowel rest, and 23 patients (14.6%) underwent surgery. The mean follow-up length was 37.3 months, and 17 patients (17.5%) underwent recurrent right-sided colonic diverticulitis. Based on treatment modality, including surgery and antibiotics, no significant differences in the clinical features and the recurrence rates were noted between the two groups. Conclusion Conservative management with bowel rest and antibiotics could be considered as a safe and effective option for treating right-sided colonic diverticulitis. This treatment option for right-sided colonic diverticulitis, even if the disease is complicated, may be the treatment of choice.
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Affiliation(s)
- Ma Ru Kim
- Department of Surgery, St. Vincent Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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20
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Park HC, Lee BH. Suspected uncomplicated cecal diverticulitis diagnosed by imaging: Initial antibiotics vs laparoscopic treatment. World J Gastroenterol 2010; 16:4854-7. [PMID: 20939115 PMCID: PMC2955256 DOI: 10.3748/wjg.v16.i38.4854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the recurrence rate following initial antibiotic management to that following laparoscopic treatment for suspected uncomplicated cecal diverticulitis.
METHODS: We examined the records of 132 patients who were diagnosed with uncomplicated cecal diverticulitis and a first attack during an 8-year period. The diagnosis of uncomplicated diverticulitis was made based on imaging findings, such as inflamed diverticulum or a phlegmon with cecal wall thickening. Concurrent appendiceal dilatation from 8 to 12 mm was observed in 36 patients (27%). One hundred and two patients were treated initially with antibiotics only, whereas 30 underwent laparoscopic treatment, including partial cecectomy (n = 8) or appendectomy with diverticulectomy (n = 9) or appendectomy alone (n = 13). We compared clinical outcomes in both groups over a median follow-up period of 46 mo.
RESULTS: All patients were successfully treated with initial therapy. Of the 102 patients who initially received only antibiotic treatment, 6 (6%) had a recurrence (3 in the cecum and 3 in the ascending colon or transverse colon) during the follow-up period. Five of these patients were managed with repeated antibiotic treatment and 1 underwent ileocolic resection for perforation. Of the 30 patients treated by the laparoscopic approach, 2 (7%) had a recurrence (ascending colon) which was treated with antibiotics.
CONCLUSION: Initial antibiotic management for suspected uncomplicated cecal diverticulitis showed comparable efficacy to laparoscopic treatment in the prevention of recurrence.
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Lee IK. Right colonic diverticulitis. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:241-5. [PMID: 21152224 PMCID: PMC2998007 DOI: 10.3393/jksc.2010.26.4.241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/27/2010] [Indexed: 02/07/2023]
Abstract
Although right colonic diverticultis (RCD) has been reported to be a rare disease in Western countries, RCD is a common diagnosis, with an incidence per 2.9-17 case of appendicitis, in Korea. Many Western studies have reported that it is difficult to differentiate the presenting symptoms of RCD from those of appendicitis before surgery because the signs and symptoms are similar. However, performing a computed tomography scan after the application of the diagnostic criteria for RCD has increased the preoperative RCD diagnostic rate. Treatment strategies have been difficult to define for this condition due to its low preoperative diagnosis rate. However, recent reports have shown that conservative medical treatment of uncomplicated RCD can be recommended and that such treatment is effective due to the benign and self-limited natural history of RCD. Therefore, in this review, we discuss the controversies surrounding RCD management.
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Affiliation(s)
- In Kyu Lee
- Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
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Abstract
Diverticulitis is a common problem, and although most cases will respond to conservative measures, surgeons will frequently need to treat patients requiring emergency surgery. Surgical management has progressed over the past 30 years, with a change in practice from routine drainage and proximal diversion (necessitating two further major procedures) to primary resection and anastomosis in selected cases. In 2004, surgeons must use clinical judgment to determine which approach will optimize outcomes both in terms of morbidity and mortality and in terms of quality of life for their patients.
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Affiliation(s)
- Nancy N Baxter
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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Management of right-sided diverticulitis: A retrospective review from a hospital in Japan. Surg Today 2010; 40:321-5. [PMID: 20339986 DOI: 10.1007/s00595-008-4055-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 10/02/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE Right-sided diverticulitis is a rare clinical entity in Western countries; however, in some Asian countries diverticulitis affects the right side of the colon more often than the left side. This study aims to establish some guidelines for patients with right-sided diverticulitis because at present, there are only guidelines for those with acute left-sided diverticulitis. METHODS A review was conducted of the medical records of patients with acute right-sided diverticulitis admitted to Okinawa Prefectural Chubu Hospital, a teaching hospital in Japan, between 1994 and 2005. RESULTS Right-sided diverticulitis was identified in 110 patients. The mean age of these patients was significantly lower than that of those with left-sided diverticulitis (43.4 +/- 14.8 years vs 54.8 +/- 17.4 years, respectively). Emergency laparotomy was performed for suspected acute appendicitis in 10 patients. Initial conservative therapy did not fail in any of the remaining 100 patients, although 5 underwent subsequent elective surgery, and 8 (8.4%) of the remaining 95 suffered recurrent right-sided diverticulitis, which was treated successfully with conservative therapy. CONCLUSION Patients with acute right-sided diverticulitis seldom require emergency surgery unless acute appendicitis is misdiagnosed preoperatively. Most cases of uncomplicated right-sided diverticulitis, even if it is recurrent, can be treated conservatively.
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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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25
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Park SJ, Choi SI, Lee SH, Lee KY. Image-guided conservative management of right colonic diverticulitis. World J Gastroenterol 2009; 15:5838-42. [PMID: 19998506 PMCID: PMC2791278 DOI: 10.3748/wjg.15.5838] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 10/29/2009] [Accepted: 11/05/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ia, 23 patients (12.2%) in stage Ib, and 1 patient (0.5%) in stage III. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ib required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.
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Valentino M, Serra C, Ansaloni L, Mantovani G, Pavlica P, Barozzi L. Sonographic features of acute colonic diverticulitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:457-463. [PMID: 19655391 DOI: 10.1002/jcu.20619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. Sonography is frequently used as the initial imaging modality because of its ready availability. This pictorial essay aims to provide an overview of the sonographic features of acute colonic diverticulitis and of the more common differential diagnosis.
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Affiliation(s)
- Massimo Valentino
- Urgency/Emergency, General Surgery and Transplantation Department, Radiology Unit, S. Orsola-Malpighi, University Hospital, Bologna, Italy
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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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Moon HJ, Park JK, Lee JI, Lee JH, Shin HJ, Kim WS, Kim MS, Jeong JH. Conservative Treatment for Patients with Acute Right Colonic Diverticulitis. Am Surg 2007. [DOI: 10.1177/000313480707301208] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Little is known about the natural history of right colonic diverticulitis treated with conservative management. The purpose of this study was to analyze the short-term outcome of a conservative approach to the treatment of patients with acute right colonic diverticulitis. A retrospective review of the clinical and radiological findings of 62 patients with acute right colonic diverticulitis was carried out. Conservative treatment was provided to 47 patients and surgical treatment to 15 patients with the diagnosis of acute right colonic diverticulitis. An initial ultrasound was performed in 45 of 62 patients (73%) and a CT was performed in 16 of 62 patients (26%). Diverticulitis was confirmed pretreatment diagnosis in 56 of 61 (91.8%) patients who had radiological evaluation. There were seven (11.3%) pericolic abscesses identified as a complication of the diverticulitis. All 47 patients who received conservative management were successfully treated and had improvement of symptoms with no sign of clinical deterioration. For the fifteen patients who had surgery: 5 had right hemicolectomies, 8 had appendectomies without diverticulectomy, 1 had an appendectomy with diverticulectomy, and 1 had diverticulectomy alone. During a median follow-up of 23.9 months, two of 55 (3.6%) patients who did not have surgical resection for inflamed diverticulum had recurrences one and ten months after the initial treatment; they were successfully treated again with bowel rest and antibiotics without complication. Conservative treatment should be considered as a safe and effective option for acute right colonic diverticulitis. In addition, a less aggressive approach may be more suitable for recurrent diverticulitis than extended surgical resection.
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Affiliation(s)
- Hyoun Jong Moon
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Jea Kun Park
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Jong In Lee
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Jong Hoon Lee
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Hyuk Jai Shin
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Wan Sung Kim
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
| | - Mi Sung Kim
- Radiology, Myoungji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Jin Ho Jeong
- Departments of Surgery, Kwandong University College of Medicine, Goyang, Korea
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Shin JH, Son BH, Kim H. Clinically distinguishing between appendicitis and right-sided colonic diverticulitis at initial presentation. Yonsei Med J 2007; 48:511-6. [PMID: 17594161 PMCID: PMC2628084 DOI: 10.3349/ymj.2007.48.3.511] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Most patients diagnosed with right-sided colonic diverticulitis complain of right lower quadrant pain, which is frequently confused for appendicitis and therefore may result in unnecessary emergency surgery. In this paper we intend to differentiate between right-sided colonic diverticulitis and appendicitis by initial presentation in the emergency department. MATERIALS AND METHODS We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among these patients, 92 with right-sided colonic diverticulitis were classified as group I; 268 patients with simple appendicitis were classified as group II; and 90 patients with perforated appendicitis were classified as group III. RESULTS Prodromal symptoms were less common in group I (p < 0.05) than in the other groups. In comparing the location of maximal tenderness among groups, 19.6% of group I patients complained of maximal tenderness at a point lateral to McBurney's point, a greater percentage than those in groups II and III (p=0.002). Group I experienced less leukocytosis (10,913.8/mm(3)) than did groups II (13,238.3/mm(3)) and III (15,589.3/mm(3)). The percentage of segmented forms in the differential counts was also smaller in group I (73.6%) than in groups II (79.1%) and III (81.8%). In addition, the proportion of lymphocytes was larger in group I (17.7%) than in groups II (13.9%) and III (9.3%). CONCLUSION Among patients complaining of right lower quadrant pain in an emergency setting, right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations: lack of prodromal symptoms, tenderness at a point lateral to McBurney's point, and absent or mild leukocytosis with a low fraction of segmented forms and a high fraction of lymphocytes in the CBC.
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Affiliation(s)
- Jun-Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul 110-746, Korea
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Leung WW, Lee JFY, Liu SYW, Mou JWC, Ng SSM, Yiu RYC, Li JCM. Critical appraisal on the role and outcome of emergency colectomy for uncomplicated right-sided colonic diverticulitis. World J Surg 2007; 31:383-7. [PMID: 17219286 DOI: 10.1007/s00268-006-0236-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Emergency colectomy is well accepted for treating complicated right-sided colonic diverticulitis. However, the role of colectomy for uncomplicated diverticulitis is not well defined. The aim of this study was to evaluate the short-term and long-term surgical outcome of uncomplicated right-sided diverticulitis in our locality. PATIENTS AND METHODS Retrospective chart review of patients operated for right-sided diverticulitis over a 20-year period was conducted. Recurrent attacks of right-sided diverticulitis, re-operation rate and re-hospitalisation rate were the long-term parameters of interest. An updated telephone interview was carried out for all surviving patients. RESULTS Seventy-four patients (35 males and 39 females), median age 35.5 (range 16-70) years, were operated for uncomplicated diverticulitis. Thirty patients underwent colectomy, whereas the others underwent appendectomy with diverticulectomy (n = 8) or appendectomy alone (n = 36). All short-term parameters were less favourable for the colectomy group, including higher complication rate, slower return of gastrointestinal function, higher requirement of parenteral analgesic and longer hospital stay. Without colectomy, only 2 patients developed recurrent diverticulitis necessitating hospitalisation, both of whom resolved on conservative treatment. On the other hand, 1 patient required re-operation after colectomy because of intestinal obstruction. The overall re-hospitalisation rate was comparable between the colectomy and the non-colectomy group (16.7% vs. 13.6%). CONCLUSIONS Emergency colectomy can eradicate suspicious lesions and eliminate risk of recurrent diverticulitis but at the expense of higher morbidity rates. As the natural course of uncomplicated right-sided colonic diverticulitis is usually benign, conservative treatment with minimal surgery may be a better therapeutic option.
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Affiliation(s)
- Wing-Wa Leung
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China
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Lee IK, Kim SH, Lee YS, Kim HJ, Lee SK, Kang WK, Ahn CH, Oh ST, Jeon HM, Kim JG, Kim EK, Chang SK. Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2007. [DOI: 10.3393/jksc.2007.23.4.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- In Kyu Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Hong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Jin Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Kuon Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyung Kang
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hyeok Ahn
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Taek Oh
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Myung Jeon
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Gi Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eung Kook Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Kyun Chang
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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.
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Affiliation(s)
- Horng-Ren Yang
- Department of Surgery, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 404, Taiwan
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Abstract
Synchronous colonic events are rare. Diverticulitis is the most common and lethal cause of colonic perforation. The first case in the literature of a synchronous diverticular perforation is presented. The patient was admitted with peritonitis. An exploratory laparotomy showed cecal and sigmoid perforations. Resection and primary anastomosis with a protective loop ileostomy was performed. Microscopic evaluation confirmed the presence of cecal and sigmoid perforated diverticuli. Diverticular disease is present in up to two-thirds of patients 80 years of age and older. Right-sided free colonic perforation is rare. Resection and primary anastomosis is feasible in the treatment of perforated diverticular disease. In this report, we emphasize the importance of a thorough abdominal exploration at the time of surgery.
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Affiliation(s)
- Eduardo Krajewski
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | | | - Eric G. Weiss
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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Kauvar DS, Aydelotte J, Harnisch M. Perforated solitary diverticulitis of the ascending colon. ACTA ACUST UNITED AC 2005; 62:338-40. [PMID: 15890220 DOI: 10.1016/j.cursur.2004.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- David S Kauvar
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA.
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Greenwald M, Nussbaum T. Right colon, sigmoid colon, and transverse colon diverticulitis in the same patient: report of a case. Dis Colon Rectum 2005; 48:162-6. [PMID: 15690675 DOI: 10.1007/s10350-004-0757-7-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although sigmoid colon diverticulitis is frequently seen, right colon and transverse colon diverticulitis remain rare forms of the disease. This case report examined the disease course of a 46-year-old female who first presented to our institution in 1990 with perforated right-sided diverticulitis. During the next 11 years, she developed sigmoid colon diverticulitis and then transverse colon diverticulitis. The right and sigmoid colon diverticulitis were treated with surgery and the transverse colon diverticulitis was managed conservatively. This is the first reported case of a single patient who had separate episodes of diverticulitis in the right, transverse, and sigmoid colon. The evaluation and management of this patient has mirrored a trend in the literature and clinical practice.
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Affiliation(s)
- Marc Greenwald
- Department of Surgery, Division of Colon and Rectal Surgery, North Shore University Hospital, Great Neck, New York 11023, USA.
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Abstract
Diverticular disease, and particularly diverticulitis, has increasing incidence in industrialised countries. Diverticular disease can be classified as symptomatic uncomplicated disease, recurrent symptomatic disease, and complicated disease. Conservative or medical management is usually indicated for acute uncomplicated diverticulitis. Indications for surgery include recurrent attacks and complications of the disease. Surgical treatment options have changed considerably over the years along with the inventions of new diagnostic tools and new surgical therapeutic approaches. Indications and timing for surgery of diverticular disease are determined mainly by the stage of the disease. In addition to this major factor, the individual risk factors of the patient along with the course of the disease after conservative or operative therapy do play a big role in decision-making and treatment of this disease. In this context, the purpose of this article is to review the surgical treatment of diverticulitis with regard to indications, timeliness of operative intervention, operative options and techniques, and special circumstances.
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Affiliation(s)
- H N Aydin
- Department of Colorectal Surgery, Cleveland Clinic Foundation, A30 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg 2004; 187:233-7. [PMID: 14769311 DOI: 10.1016/j.amjsurg.2003.11.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Revised: 03/07/2003] [Indexed: 12/30/2022]
Abstract
BACKGROUND At present, little information is available on the outcome of medical therapy for patients with acute right colonic diverticulitis, and this has meant a gap in constructing guidelines for its treatment. METHODS The records of patients with acute right colonic diverticulitis at Nagasaki University Graduate School and affiliated hospitals were reviewed and analyzed with the goal of establishing therapeutic guidelines. The time frame of the data analyzed was from 1984 to 2002. RESULTS Of the 81 patients included in the data, 80 patients who were suffering a first attack were successfully treated with bowel rest and antibiotics. Two of these 80 patients underwent an elective operation at the surgeon's discretion during the original hospitalization and 1 (1.2%) needed an urgent operation. Of the 78 patients who responded to medical therapy, 16 (20.5%) developed recurrent right colonic diverticulitis. All 16 patients who had a second attack were successfully treated with medical therapy. Three of the 16 patients underwent an elective operation during this rehospitalization period. Of the 13 patients who had had a second attack and had responded to medical therapy, there was a third attack in 2 patients (15.4%). Both of these patients were again successfully treated with medical therapy. There has been no morbidity and no mortality related to recurrence to date. The average time from the first attack to us contacting the patient was 35.2 months. CONCLUSIONS Unlike acute uncomplicated left colonic diverticulitis, our findings indicate that after two documented episodes, medical treatment alone rather than elective surgery may be considered as an effective guideline for the treatment of acute uncomplicated right colonic diverticulitis.
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Affiliation(s)
- Ko Komuta
- Division of Colon and Rectal Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Ngasaki 852-8102, Japan.
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39
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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.
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Affiliation(s)
- P Lê
- Service de Chirurgie Générale, Centre Hospitalier de l'Agglomération Montargoise - Montargis.
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40
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Agramunt M, Ripollés T, Blanc E, Martínez MJ, Gómez-Abril S. Diverticulitis del colon derecho. Hallazgos en ecografía y tomografía computarizada. RADIOLOGIA 2004. [DOI: 10.1016/s0033-8338(04)77953-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Aggressive resection is indicated for cecal diverticulitis. Am J Surg 2003; 185:135-40. [PMID: 12559443 DOI: 10.1016/s0002-9610(02)01209-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of the difficulties in preoperative diagnosis and controversies in the management, cecal diverticulitis has received much discussion in the literature. There, however, are still many questions that remain unanswered. METHODS During a 5-year period, 112 patients with a clinical diagnosis of cecal diverticulitis were treated. Twenty-seven patients were excluded because of uncertainty in diagnosis or incomplete data collection, leaving 85 patients as the study group. The diagnosis of cecal diverticulitis was made by pathology, surgical findings, or image study. RESULTS Nonoperative management was applied to 18 patients initially. Three patients had recurrent diverticulitis during follow up. These patients responded satisfactorily to another course of medical treatment. Laparotomy was performed in 67 patients. Acute appendicitis was the preoperative diagnosis in 47 patients (70%). Of the other 20 patients, 6 received operation because of repeated attack of diverticulitis, 7 had preoperative computed tomography (CT) diagnosis of cecal diverticulitis with perforation, 5 had preoperative diagnosis of cecal tumor, and 2 had medical treatment failure. All these 20 patients received right hemicolectomy. In the 47 patients with a preoperative diagnosis of acute appendicitis, 24 received appendectomy, 9 received diverticulectomy, and 14 received right hemicolectomy. Overall, 34 patients received right hemicolectomy, 9 received diverticulectomy, and 24 received appendectomy only. In the right hemicolectomy group, there were 2 deaths with underlying diseases and 5 complications. In the appendectomy group, there was no postoperative mortality, but in 7 patients recurrent diverticulitis developed. Three of them required right hemicolectomy. CONCLUSIONS The natural history of cecal diverticulitis varies from benign and self-limiting to fulminant in the oriental population. Less than 40% (32 of 85) of patients were successfully treated with conservative methods initially and had no recurrence during the follow-up period. We recommend aggressive surgical resection for patients with a definite diagnosis. Adjuvant appendectomy without resection of the lesion should be considered only in uncomplicated patients whose diagnosis is in doubt.
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Affiliation(s)
- Jen-Feng Fang
- First Division of Trauma and Emergency Surgery, Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, 5 Fushing St., Kweishan, Taoyuan, Taiwan
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Jhaveri KS, Harisinghani MG, Wittenberg J, Saini S, Mueller PR. Right-sided colonic diverticulitis: CT findings. J Comput Assist Tomogr 2002; 26:84-9. [PMID: 11801908 DOI: 10.1097/00004728-200201000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Right-sided colonic diverticulitis is an uncommon but clinically significant condition as it closely mimics other common acute right-sided abdominal conditions like acute appendicitis and cholecystitis. CT can provide a rapid and accurate diagnosis of this condition and thereby prevent unnecessary laparotomy and surgical procedures since it is essentially a benign self-limiting condition requiring medical treatment. It is the aim of this pictorial essay to describe the CT findings and increase awareness among radiologists of this condition.
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Affiliation(s)
- Kartik S Jhaveri
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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43
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Chiu PW, Lam CY, Chow TL, Kwok SP. Conservative approach is feasible in the management of acute diverticulitis of the right colon. ANZ J Surg 2001; 71:634-6. [PMID: 11736820 DOI: 10.1046/j.1445-1433.2001.2226.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute diverticulitis of the caecum and ascending colon is uncommon. Controversies abound as regards the optimal surgical treatment, ranging from appendectomy, diverticulectomy to right hemicolectomy. The aim of the present paper was to review treatment strategy followed by a critical appraisal. METHODS The case notes of 30 patients with acute diverticulitis of the right colon who were treated at the United Christian Hospital, Hong Kong from 1992 to 1998 were systematically reviewed. The data were subjected to statistical analysis. RESULTS The median age was 34 years, with a male:female ratio of 1:1.15. All patients presented with acute right lower abdominal pain and localized rebound tenderness. All were diagnosed preoperatively as having appendicitis. The mean duration of symptoms was 2 days (range: 1-6 days). Two treatment groups were identified. Group A (n = 16; 53%) received appendicectomy alone, while group B (n = 14; 47%) underwent diverticulectomy in addition to appendicectomy, including one patient with perforated diverticulitis. Overall, there was no procedure-related morbidity or mortality. Both groups received a similar duration of broad-spectrum antibiotics. All the patients were interviewed by phone after operation to detect any recurrence of symptoms, with a median follow-up interval of 34 months (range: 11-78 months). There was no recurrence of symptoms in group A, which received appendicectomy and antibiotics. The only difference was operative time. CONCLUSION For non-perforated diverticulitis of the right colon, appendicectomy and intravenous antibiotics without diverticulectomy is the preferred treatment strategy.
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Affiliation(s)
- P W Chiu
- Department of Surgery, United Christian Hospital, Hong Kong
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44
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Lin OS, Soon MS, Wu SS, Chen YY, Hwang KL, Triadafilopoulos G. Dietary habits and right-sided colonic diverticulosis. Dis Colon Rectum 2000; 43:1412-8. [PMID: 11052519 DOI: 10.1007/bf02236638] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In Asian populations, there is a high prevalence of right-sided colonic diverticulosis, the cause of which is uncertain. It is suspected that dietary habits may interact with a congenital predilection to cause this condition. To evaluate the relationship between long-term dietary habits and the prevalence of right-sided diverticulosis in the general population, we performed a retrospective case-control study. METHODS We reviewed the records of 3,105 screening colonoscopies performed on healthy, asymptomatic adults. All cases of right-sided diverticulosis were selected, and a similar number of gender-matched and age-matched controls with negative colonoscopies were randomly sampled from the same cohort. All case and control subjects were interviewed by a single-blinded nurse to establish their dietary habits during the past decade, in addition to other demographic characteristics. Based on consumption frequency, they were assigned to one of three diet classes for each of three food categories of interest: meat, vegetable, and fruit products. Staple foods such as rice were not included. Odds ratios were then calculated using multivariate conditional logistic regression and tests for trend were performed. RESULTS A total of 86 cases of right-sided diverticulosis were included, whereas 106 controls were randomly selected. There was a marked association between meat consumption frequency and right-sided diverticulosis, with a trend P value of <0.01 and an odds ratio of 24.81 between the most and least frequent consumers of meat products. CONCLUSIONS The prevalence of right-sided diverticulosis is strongly positively associated with past meat consumption frequency. There is no association with vegetable or fruit consumption frequency, laxative use, supplemental fiber intake, smoking, or family history.
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Affiliation(s)
- O S Lin
- Division of Gastroenterology, ChangHua Christian Medical Center, Taiwan
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Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa TK. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum 2000; 43:1383-9. [PMID: 11052515 DOI: 10.1007/bf02236634] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Diverticulosis of the right colon has been increasing in the Far East; however, a considerable proportion of these patients includes cases of solitary right-sided diverticular disease. This study aimed to determine whether the incidence of such solitary diverticula (defined as 1 or 2 diverticula in this study) and multiple (3 or more) diverticula of the right colon is increasing in Japan. METHODS A total of 13,947 consecutive barium enema examinations, performed in the period from 1982 to 1997, were reviewed. Changes in the frequency (detection rate) and number of diverticula across time and with aging of three types of diverticula, right-sided, left-sided, and bilateral, were investigated, with special interest in those patients with one or two diverticula of the right colon. RESULTS Right-sided and bilateral diverticula have increased in frequency across time; however, left-sided diverticula have not. Patients with one or two diverticula in the right colon of right-sided disease, unexpectedly, have increased across time in both genders, and patients with three or more diverticula in the right colon of right-sided disease have shown an increase in males. The number of diverticula of the right colon showed no increase across time or with aging. CONCLUSIONS Diverticulosis of the right colon, both solitary and multiple, has been increasing steadily in Japan; therefore, diverticulitis and bleeding diverticula of the right colon may continue to increase. Diverticula of the right colon might be an acquired disease and self-limiting in development, because the frequency did not increase substantially in the elderly and because the number changed little across time and with aging.
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Affiliation(s)
- S Miura
- First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Kori T, Nemoto M, Maeda M, Tsuzuki Y, Ando T, Sekihara M, Uchida N, Mochida Y, Kogure K, Kuwano H. Sonographic features of acute colonic diverticulitis: the "dome sign". JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:340-346. [PMID: 10934333 DOI: 10.1002/1097-0096(200009)28:7<340::aid-jcu4>3.0.co;2-b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE This study was performed to clarify the sonographic features of acute colonic diverticulitis to enable its differentiation from appendicitis. METHODS Of 119 patients who were referred to our hospitals for lower abdominal pain between June 1997 and December 1998 and underwent sonography, 12 patients had a definitive diagnosis of acute colonic diverticulitis and 4 patients a tentative diagnosis. Seventy-eight patients were diagnosed as having acute appendicitis, confirmed by appendectomy. In the 16 patients with diagnoses of diverticulitis, the sonographic and clinical features of acute colonic diverticulitis were studied. RESULTS Among the 12 patients with definitive diagnoses of acute colonic diverticulitis, sonographic findings included localized thickening of the colonic wall (100%) and a hemispheric mass (the "dome sign") protruding at the thickened colonic wall (100%) and consisting of a hypoechoic wall (100%) and a central echogenic area (66%). The presence of diverticula was confirmed by barium-enema x-ray study in all 12 patients. The 4 patients with tentative diagnoses of acute colonic diverticulitis all had colonic wall thickening but no dome sign. Colonoscopy revealed colitis in 3 of these patients. All 16 patients recovered with conservative treatment, without laparotomy. CONCLUSIONS Sonography was useful for differentiating acute colonic diverticulitis from appendicitis. The sonographic finding of the dome sign seems to be specific for acute colonic diverticulitis.
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Affiliation(s)
- T Kori
- Department of Surgery, Hokumo Hospital, 233 Arima, Sibukawa 377-0005, Japan
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Affiliation(s)
- T M Young-Fadok
- Division of Colon and Rectal Surgery, Mayo Medical School, Rochester, Minnesota, USA
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Jang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol 2000; 174:1397-402. [PMID: 10789802 DOI: 10.2214/ajr.174.5.1741397] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the value of characteristic thin-section helical CT findings of acute diverticulitis involving the cecum and ascending colon in excluding colonic carcinoma. MATERIALS AND METHODS Thin-section helical CT scans (5-mm collimation) of 19 consecutive patients with proven diverticulitis and 21 consecutive patients with surgically proven carcinoma involving the cecum and ascending colon were reviewed retrospectively. Two radiologists independently analyzed these parameters: degree of pericolic infiltration, mesenteric fluid, vascular engorgement, arrowhead-shaped wall thickening, air-filled diverticula, inflamed diverticula, and preserved enhancement pattern of involved colonic wall. Inter-observer agreement was assessed with a kappa statistical analysis, and the features that most distinguished diverticulitis from colonic carcinoma were selected with a stepwise logistic-regression analysis. RESULTS The two CT findings of right-sided colonic diverticulitis that most distinguished it from colonic carcinoma were inflamed diverticula and the preservation of an enhancement pattern of the involved colonic wall. Excellent interobserver agreement (kappa > 0.60) was obtained for both findings. Inflamed diverticula (kappa = 0.80) had a mean sensitivity, specificity, and accuracy for diverticulitis of 86.8%, 92.9%, and 90.0%, respectively, in differentiating right-sided colonic diverticulitis from colonic carcinoma. Preserved wall enhancement pattern (kappa = 0.70) had a mean sensitivity, specificity, and accuracy of 89.5%, 95.3%, and 92.5%, respectively. CONCLUSION On thin-section helical CT, an inflamed diverticula and a preserved enhancement pattern of the thickened colonic wall were the two most statistically significant CT findings of acute diverticulitis involving the cecum and ascending colon that distinguished diverticulitis from colonic carcinoma.
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Affiliation(s)
- H J Jang
- Department of Radiology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea
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49
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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.
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Affiliation(s)
- J S Lane
- Department of Surgery, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
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50
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Abstract
Unenhanced helical CT is an accurate technique for the evaluation of patients with suspected acute appendicitis. This non-operator-dependent examination can be performed without the risk of intravenous contrast material or the delay associated with the use of oral and rectal contrast material. This article reviews the unenhanced helical CT findings of acute appendicitis and those entities that commonly mimic acute appendicitis clinically.
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Affiliation(s)
- M J Lane
- Department of Radiology, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, TX 78234-6200, USA
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