Surgical Intervention for Right-Side Diverticulitis: A Case-Matched Comparison with Left-Side Diverticulitis

Abstract

Right-side diverticulitis (RSD) is an uncommon disease in Western countries. We conducted a case-matched comparison of surgically managed right-side and left-side diverticulitis (LSD) from the Southern California Kaiser Permanente database (2007–2014). Of 995 patients undergoing emergent surgery for diverticulitis, 33 RSD (3.3%) met our inclusion criteria and were matched (1:1) to LSD based on age, gender, year of diagnosis, and Hinchey class. Mean age of the RSD group was 56 ± 13.9 years, and 24.2 per cent were Asian. RSD was classified as Hinchey class III or IV in 28.1 per cent and 9.4 per cent of cases, respectively. Right hemicolectomy was performed in 87.9 per cent and laparoscopy was used in 24.2 per cent of the cases. Surgically managed RSD patients were more likely to be Asian (25% vs 3.1%, P = 0.03) and have body mass index < 25 (31.3% vs 6.3%, P = 0.02) compared with LSD patients. Diverting stoma was less common in the RSD (6.3% vs 62.5%) ( P < 0.001). Hospital stay was shorter in RSD (7.6 ± 4.2 vs 12.8 ± 9.4 days, P = 0.006) and more common in the RSD group ( P < 0.01). Open surgery (90.6% vs 71.9%) and postoperative complications (37.5% vs 25%) were more common in the LSD group, but that was not statistically significant ( P > 0.05). Surgery for complicated RSD was associated with shorter hospital stay and decreased likelihood of diverting ostomy.

Congenital cecal diverticulitis in a pediatric patient

“…However, in another study the correct diagnosis of right sided diverticulitis or possible diverticulitis in adults was still made only 39.4% of the time prior to operation or other treatment. And this study was significantly better than most other studies it compared to, where misdiagnosis occurred over 90% of the time [ 7 ]. In regard to laboratory results, some studies have stated that there may be a mildly elevated WBC count with a higher percentage of lymphocytes in acute diverticulitis as compared to what is expected in appendicitis [ 8 ].…”

Right sided diverticulitis in western countries: A review

“…We therefore evaluated 130 full-text reviews and obtained 18 eligible studies. The entire process of screening is shown in Figure 1 [ 9 , 12 - 28 ].…”

“…We analysed 18 studies, for a total of 422 patients. A summary of results is shown in Table 1 , Table 2 , Table 3 , and Table 4 [ 9 , 12 - 28 ] and in Figure 2 . There were 212 females (50.2%) and 190 males (45%), however in 20 patients (4.7%) sex was not recorded.…”

“…By selecting the cases in this way it has not been possible to argue many of their results and we have not been able to do an adequate data extraction. Furthermore, lacking a specific code for coding ARCD, the low accuracy of this research method was also highlighted in another study in which the authors who had initially screened ARCD with ICD codes, found a high percentage of misdiagnosed cases (74%) when they subsequently analyzed every medical chart[ 9 ].…”

Essential updates 2018/2019: Colorectal (benign)

“…Patients with right side diverticulitis were more likely to be Asian and had a higher BMI than those with left side diverticulitis. Surgery for right side diverticulitis was associated with shorter hospital stay and less diverting stoma, but postoperative complications were not significantly different between right and left side disease …”