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Jedidi L, Mabrouk A, Ghali H, Ben Dhaou A, Ben Lahouel S, Daldoul S, Said Latiri H, Ben Moussa M. Right-sided acute diverticulitis in a North African country: Presentation and management in one surgical center. World J Surg 2024; 48:1509-1514. [PMID: 38557977 DOI: 10.1002/wjs.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia. METHODS This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021. RESULTS Forty patients were included in our study. The mean age was 42 years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5 ± 3 days). Follow-up showed no recurrences. CONCLUSION Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.
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Affiliation(s)
- Laila Jedidi
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia
| | - Aymen Mabrouk
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
| | - Anis Ben Dhaou
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Sami Daldoul
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
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Huatuco RMP, Pachajoa DAP, Liaño JE, Molina HAP, Palencia R, Doniquian AM, Parodi M. Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina. Ann Coloproctol 2023; 39:123-130. [PMID: 34814235 PMCID: PMC10169559 DOI: 10.3393/ac.2021.00402.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD). METHODS In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed. RESULTS Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34). CONCLUSION Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.
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Affiliation(s)
- René M. Palacios Huatuco
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Diana A. Pantoja Pachajoa
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Julian E. Liaño
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Héctor A. Picón Molina
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Rafael Palencia
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Alejandro M. Doniquian
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Matías Parodi
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
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Uhe I, Meyer J, Viviano M, Naiken S, Toso C, Ris F, Buchs NC. Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature. Colorectal Dis 2021; 23:2515-2526. [PMID: 34272795 PMCID: PMC9292704 DOI: 10.1111/codi.15818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
AIM Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. METHODS This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. RESULTS Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi-colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). CONCLUSION CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.
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Affiliation(s)
- Isabelle Uhe
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Jeremy Meyer
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Manuela Viviano
- Division of Gynaecology and ObstetricsOspedale Regionale di LuganoLuganoSwitzerland
| | - Surrennaidoo Naiken
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
- Pôle santé Vallée de JouxLe ChenitSwitzerland
| | - Christian Toso
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Frédéric Ris
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Nicolas C. Buchs
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
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Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surg Endosc 2019; 34:2019-2027. [PMID: 31309310 DOI: 10.1007/s00464-019-06981-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD. METHODS A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications. RESULTS A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine. CONCLUSION Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern.
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Sasaki Y, Komatsu F, Kashima N, Sato T, Takemoto I, Kijima S, Maeda T, Ishii T, Miyazaki T, Honda Y, Shimada N, Urita Y. Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study. World J Clin Cases 2019; 7:1393-1402. [PMID: 31363467 PMCID: PMC6656680 DOI: 10.12998/wjcc.v7.i12.1393] [Citation(s) in RCA: 2] [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] [Received: 03/11/2019] [Revised: 04/13/2019] [Accepted: 05/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited.
AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model.
METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate analyses.
RESULTS In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011); median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001); median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002); and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In the logistic regression model, odds ratios (ORs) were significantly high in nausea/vomiting (OR: 3.89, 95%CI: 2.04-7.42) and anorexia (OR: 2.13, 95%CI: 1.06-4.28). ORs were significantly lower with a longer onset-to-visit interval (OR: 0.84, 95%CI: 0.72-0.97), RLQ pain (OR: 0.28, 95%CI: 0.11-0.71), history of diverticulitis (OR: 0.034, 95%CI: 0.005-0.20), and CRP level > 3.0 mg/dL (OR: 0.25, 95%CI: 0.14-0.43). The regression model showed good calibration, discrimination, and optimism.
CONCLUSION Clinical findings can differentiate AA and ARCD before imaging studies; nausea/vomiting and anorexia suggest AA, and longer onset-to-visit interval, RLQ pain, previous diverticulitis, and CRP level > 3.0 mg/dL suggest ARCD.
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Affiliation(s)
- Yosuke Sasaki
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Fumiya Komatsu
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Naoyasu Kashima
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Takahiro Sato
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Ikutaka Takemoto
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Sho Kijima
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Tadashi Maeda
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Takamasa Ishii
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Taito Miyazaki
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshiko Honda
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Nagato Shimada
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshihisa Urita
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
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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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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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Park HC, Kim BS, Lee K, Kim MJ, Lee BH. Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack. Int J Colorectal Dis 2014; 29:1217-22. [PMID: 24980689 DOI: 10.1007/s00384-014-1941-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Most patients with acute right colonic uncomplicated diverticulitis can be managed conservatively. The aim of this study was to assess the clinical and radiologic risk factors for recurrence in patients with right colonic uncomplicated diverticulitis. METHODS The present survey included 469 patients who were successfully managed conservatively for the first episode of right colonic uncomplicated diverticulitis between 2002 and 2012 in a referral center, and records were reviewed from collected data. Patients were divided into two groups: a nonrecurrent and a recurrent group. The clinical and radiologic features of all patients were analyzed to identify possible risk factors for recurrence. The Kaplan-Meier method and Cox regression were used. RESULTS Seventy-four (15.8 %) patients had recurrence, and 15 (3.2 %) received surgery at recurrence within a median follow-up of 59 months. The mean recurrence interval after the first attack was 29 months. In univariate and multivariate analyses, risk factors for recurrence were confirmed multiple diverticula (relative risk [RR], 2.62; 95 % confidence interval [CI], 1.56-4.40) and intraperitoneally located diverticulitis (RR, 3.73; 95 % CI, 2.13-6.52). Of 66 patients with two risk factors, 36 (54.5 %) had recurrence and 10 (15.2 %) received surgery at recurrence. CONCLUSIONS In patients with right colonic uncomplicated diverticulitis who have multiple diverticula and intraperitoneally located diverticulitis, the possibility of recurrence and surgical rate are high. Poor outcome may be cautioned in these patients.
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Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 431-070, Republic of Korea
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Oh HK, Han EC, Ha HK, Choe EK, Moon SH, Ryoo SB, Jeong SY, Park KJ. Surgical management of colonic diverticular disease: Discrepancy between right- and left-sided diseases. World J Gastroenterol 2014; 20:10115-10120. [PMID: 25110438 PMCID: PMC4123340 DOI: 10.3748/wjg.v20.i29.10115] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/04/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.
METHODS: The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients.
RESULTS: The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05).
CONCLUSION: Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Colectomy/adverse effects
- Colectomy/mortality
- Colon/pathology
- Colon/surgery
- Diverticulitis, Colonic/diagnosis
- Diverticulitis, Colonic/mortality
- Diverticulitis, Colonic/surgery
- Diverticulosis, Colonic/diagnosis
- Diverticulosis, Colonic/mortality
- Diverticulosis, Colonic/surgery
- Diverticulum, Colon/diagnosis
- Diverticulum, Colon/mortality
- Diverticulum, Colon/surgery
- Female
- Hospital Mortality
- Humans
- Incidence
- Length of Stay
- Male
- Middle Aged
- Postoperative Complications/mortality
- Postoperative Complications/therapy
- Republic of Korea/epidemiology
- Retrospective Studies
- Risk Factors
- Tertiary Care Centers
- Time Factors
- Treatment Outcome
- Young Adult
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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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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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Lee IK, Lee YS, Kim SJ, Gorden DL, Won DY, Kim HJ, Cho HM, Jeon HM, Kim JG, Oh ST. Laparoscopic and Open Surgery for Right Colonic Diverticulitis. Am Surg 2010. [DOI: 10.1177/000313481007600515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this study is to evaluate the safety and effectiveness of laparoscopic surgery by comparing laparoscopic and conventional surgery of right colonic diverticulitis (RCD). Among 124 patients who were treated for RCD from January 1997 to July 2007, we enrolled 54 patients who received resection therapy of RCD. Patients were divided into two groups: laparoscopic (LAP; n = 19) and conventional (CON; n = 35) surgery groups according to the respective surgical modality. The diverticulectomy (DIV; n = 46) and right colectomy (COL; n = 8) groups were also compared according to operative methods. There were significant differences between preoperative diagnosis and selection of the operative method and between RCD type and selection of operative method. However, there were no significant differences between preoperative diagnosis and selection of laparoscopic surgery and between RCD type and selection of laparoscopic surgery. The Kaplan-Meier estimated recurrence risk for all patients also showed no significant differences between LAP and CON and DIV and COL ( P = 0.413). The Kaplan-Meier-estimated RCD-free period after surgery was 92.7 months (limited to 100 months). Laparoscopic surgery of RCD is an effective and safety method as a result of no differences in clinical data between conventional and laparoscopic surgery.
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Affiliation(s)
- In Kyu Lee
- 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
| | - Sung Jip Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - D. Lee Gorden
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Dae Youn Won
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeung Jin Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeun Min Cho
- 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
| | - Seong Taek Oh
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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