Perforated diverticulitis: is the right and left difference present here too?

Aim The aim of this work was to compare demographic factors, outcomes and prognosis for right-sided versus left-sided acute colonic diverticulitis. Method We searched MEDLINE, CINAHL, EMBASE, CENTRAL, Scopus and unpublished literature to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis (PROSPERO registration number CRD42020180075). We used the QUIPS tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data.

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“…Nine studies [10][11][12][13][14][15][16][17][18] including 2933 patients provided data on complicated diverticulitis (Fig. 2l).…”

Section: Complicated Diverticulitismentioning

confidence: 99%

“…Five studies [10][11][12][13]16] including 2393 patients provided data on modified Hinchey III disease (Fig. 2i).…”

Section: Modified Hinchey III Diseasementioning

confidence: 99%

Meta‐analysis of the demographic and prognostic significance of right‐sided versus left‐sided acute diverticulitis

2020

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“…Specifically, compared to left colon diverticulitis, right colon diverticulitis tends to occur at a younger age, with a lower Hinchey stage, and a lower rate of recurrence (3.1% versus 17.9% for left colon diverticulitis) [9]. Based on these facts, and considering the high diagnostic yield of CT imaging and the development of accurate pathological finding for colon cancer, the utility of routine colonoscopy in patients after treatment of acute right colon diverticulitis, in the absence of complications, such as perforation, abscess formation, and/or obstruction, has been questioned [10].…”

Section: Discussionmentioning

confidence: 99%

Routine colonoscopy may not be needed for uncomplicated acute right colonic diverticulitis

Lee

Lee²,

Park

et al. 2020

Preprint

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BACKGROUND Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography imaging, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, or aim in this study was to evaluate the incidence of colon cancer, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. METHODS Included were patients with uncomplicated right colon diverticulitis (modified Hinchey stage Ia) diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved, retrospectively, from patients’ medical records. RESULTS The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.3% (67/330 cases), with advanced adenoma identified in 9 of these cases (13.4%). CONCLUSION In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may not be necessary.

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“…Although this previous study investigated diverticulitis severities, it did not identify cases of recurrent diverticulitis over a follow-up period. Recently, Soh et al 10 compared RCD with LCD and showed that patients with RCD were younger, had less advanced Hinchey stages, and had a lower recurrence rate (3.1% versus 17.9%). However, their study was limited by the enrolment of only 99 patients.…”

Section: Discussionmentioning

confidence: 99%

Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis

Lee

Park

et al. 2020

Sci Rep

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Right colonic diverticulitis (RCD) and left colonic diverticulitis (LCD) may have different clinical features due to the different embryologic origins and anatomical locations of each colon. Therefore, we aimed to compare RCD and LCD in terms of the associated clinical features. We retrospectively collected clinical data from patients who were diagnosed with acute colonic diverticulitis based on computed tomography findings between 2011 and 2017. RCD was defined as colonic diverticulitis extending from the caecum to the transverse colon, and LCD was defined as extending from the splenic flexure to the sigmoid colon. These analyses included 667 patients with RCD and 58 patients with LCD. Relative to the patients with LCD, the patients with RCD were younger (P < 0.001), were more likely to be male (P = 0.033), were taller (P < 0.001), had lower body mass index values (P < 0.001), had less advanced modified Hinchey stages (P < 0.001), and had shorter hospital stays (P < 0.001). Having LCD rather than RCD was a predictor of recurrent colonic diverticulitis (P = 0.003). Relative to LCD, RCD occurs at younger ages, is expressed at less advanced modified Hinchey stages, and is associated with lower risks of recurrence. The clinical importance of colonic diverticulitis has been emphasised in the literature because the incidence of colonic diverticulitis has been increasing worldwide 1. Several studies have been conducted to evaluate left colonic diverticulitis (LCD) and identify the best treatment strategy because it is common in Western populations 2,3. In contrast, right colonic diverticulitis (RCD) is rare in Western populations but common in Asian populations 4,5. Despite its prevalence in Asian populations, few studies have investigated the clinical course of RCD or sought to identify the best treatment strategy. Recently, Strate et al. 6 introduced a management algorithm for colonic diverticulitis that was mainly based on LCD. As a result, the algorithm has limited applicability to patients with RCD. For example, the algorithm recommends that only patients with complicated diverticulitis undergo surgery. It further recommends that if surgery is performed, then second-stage surgery should also be performed depending on the patient's hemodynamic stability. However, the medical literature contains few cases of RCD in Asian patients for whom complicated diverticulitis was an indication for surgery 7. The left and right colons have different embryologic origins, with the left colon originating from the hindgut and the right colon originating from the midgut 8. Right diverticular disease and left diverticular disease differ in that diverticula from the left colon are more likely to be true diverticula 8. Therefore, the clinical characteristics of LCD and RCD may differ. Thus far, a few studies have compared RCD and LCD, but these studies have been severely limited by their small sample sizes 9,10. We therefore aimed to perform a similar study with a larger sample size. Methods This study was approved by the institutional...

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Perforated diverticulitis: is the right and left difference present here too?

Abstract: LPD is a more aggressive disease presenting with greater clinical severity in older patients and is associated with frequent disease recurrence when treated conservatively. Misdiagnosis of RPD as appendicitis is common and may lead to unnecessary surgery.

Cited by 11 publications

References 33 publications

Meta‐analysis of the demographic and prognostic significance of right‐sided versus left‐sided acute diverticulitis

Meta‐analysis of the demographic and prognostic significance of right‐sided versus left‐sided acute diverticulitis

Routine colonoscopy may not be needed for uncomplicated acute right colonic diverticulitis

Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis

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