Jesse Zuckerman1, Richard Garfinkle2, Carol-Ann Vasilevksy2, Gabriela Ghitulescu2, Julio Faria2, Nancy Morin2, Marylise Boutros3,4. 1. Division of General Surgery, University of Toronto, Toronto, ON, Canada. 2. Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada. 3. Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada. marylise.boutros@mcgill.ca. 4. Faculty of Medicine, McGill University, Montreal, Canada. marylise.boutros@mcgill.ca.
Abstract
BACKGROUND: Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center. METHODS: This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis. RESULTS: Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001). CONCLUSIONS: Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
BACKGROUND: Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center. METHODS: This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis. RESULTS: Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001). CONCLUSIONS: Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
Authors: G A Binda; A Arezzo; A Serventi; L Bonelli; M Facchini; M Prandi; P S Carraro; M C Reitano; G Clerico; L Garibotto; R Aloesio; A Sganzaroli; M Zanoni; G Zanandrea; F Pellegrini; S Mancini; A Amato; P Barisone; C Bottini; D F Altomare; G Milito Journal: Br J Surg Date: 2011-11-21 Impact factor: 6.939
Authors: Ryan Lamm; Steven N Mathews; Jie Yang; Lijuan Kang; Dana Telem; Aurora D Pryor; Mark Talamini; Jill Genua Journal: J Gastrointest Surg Date: 2016-07-25 Impact factor: 3.452