Short‐ and Long‐Term Outcomes of Right‐Sided Diverticulitis: Over 15 Years of North American Experience

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.

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

“…Full texts of the remaining 10 articles were screened carefully. One study was excluded because it did not provide adequate information about its methodology and outcomes, leaving nine eligible comparative observational studies [10][11][12][13][14][15][16][17][18] enrolling a total of 2933 patients. In the included patients, 1611 had right-sided diverticulitis and 1322 had left-sided diverticulitis.…”

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

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

Conventional-Dose CT Versus 2-mSv CT for Right Colonic Diverticulitis as an Alternate Diagnosis of Appendicitis: Secondary Analysis of Large Pragmatic Randomized Trial Data

“…Importantly, the catchment area was confined to Korea, where the prevalence of right colonic diverticulitis is high and radiologists are familiar with the disease. Patients' age ranged from 15 to 44 years, slightly younger than the reported mean age of patients with right colonic diverticulitis (ranging between 41 and 51 years) [2,[4][5][6]14]. Large body habitus was also very rare in the catchment area.…”

“…The two conditions are similar in symptoms and physical findings [1,2] but very different in management. Surgery is rarely indicated for right colonic diverticulitis [3,4] because recurrence or complications including perforation or fistula are much rarer and milder than in left colonic diverticulitis [2,[5][6][7], with unclear underlying mechanism. The reported surgical rate for right colonic diverticulitis was only 4% in a large retrospective cohort study [5].…”