Right sided diverticulitis in western countries: A review

Abstract

BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia. AIM To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries. METHODS MEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021. RESULTS A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases . CONCLUSION The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.

Right‐sided acute diverticulitis in a North African country: Presentation and management in one surgical center

“…9,10 According to various Asian and western studies, RSD mainly affects young adults with an age range between 30 and 45 years. [11][12][13] It could be difficult to distinguish RSD from acute appendicitis since they have similar clinical presentations. However, few studies have reported some differences in order to avoid unnecessary surgery for RSD patients.…”

“…These facts have been proclaimed in both Asian and Western series. 3,[35][36][37] Epifani et al 11 published a recent review describing RSD in western countries: only 16 patients out of 422 studied (3.8%) had a recurrence after a nonsurgical treatment with an average follow-up of 32.5 months. Even some of the authors did not report any recurrences in their studies.…”

“…The exact cause of acute diverticulitis is unknown, but risk factors such as aging, genetics, and unhealthy lifestyle choices have been associated with its development 9,10 . According to various Asian and western studies, RSD mainly affects young adults with an age range between 30 and 45 years 11–13 . It could be difficult to distinguish RSD from acute appendicitis since they have similar clinical presentations.…”

Right Iliac Fossa Pain other than Appendicitis

“…Right-sided diverticulitis is more common in oriental populations, where it typically occurs in younger patients and is often misdiagnosed initially as appendicitis. [ 10 ] Ultrasound findings are similar to left-sided diverticulitis with an outpouching of the bowel containing echogenic material, diverticular wall thickening, and surrounding echogenic fat at the point of maximal tenderness[ 11 ] [ Figure 3 and Video 2 ].…”

The role of PET/CT in oncogynecology (literature review)

“…Аппендицит и дивертикулит трудно отличить от ВЗОМТ в случае вовлечения придатков и образования абсцесса. Дивертикулез имеет высокую распространенность в общей популяции, а наличие дивертикулов в пораженных сегментах свидетельствует о дивертикулите [72].…”