Annals of Coloproctology

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Original Article

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina: René M. Palacios Huatuco, Diana A. Pantoja Pachajoa, Julian E. Liaño, Héctor A. Picón Molina, Rafael Palencia, Alejandro M. Doniquian, Matías Parodi; Ann Coloproctol. 2023;39(2):123-130. Published online November 24, 2021; DOI: https://doi.org/10.3393/ac.2021.00402.0057

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Purpose
In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD).
Methods
In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed.
Results
Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34).
Conclusion
Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.

Citations

Citations to this article as recorded by

Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study
E. Karam, C. Sabbagh, L. Beyer-Bergeot, P. Zerbib, V. Bridoux, G. Manceau, Y. Panis, E. Buscail, A. Venara, I. Khaoudy, M. Gaillard, M. Viennet, A. Thobie, B. Menahem, C. Eveno, C. Bonnel, J.-Y. Mabrut, B. Badic, C. Godet, Y. Eid, E. Duchalais, Z. Lakkis,
Techniques in Coloproctology.2024;[Epub] CrossRef

Case Report

Benign bowel disease

A case report of a colouterine fistula treatment: when the patient chooses the steeplechase: Stefano Pontone, Pier Giorgio Nardis, Chiara Eberspacher, Domenico Mascagni; Ann Coloproctol. 2023;39(4):366-370. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00318.0045

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Abstract PDF: Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.

Review

Benign GI diease,Benign diesease & IBD,Epidemiology & etiology

The Epidemiology and Etiology of Right-Sided Colonic Diverticulosis: A Review: Greg A. Turner, Michael J. O’Grady, Rachel V. Purcell, Frank A. Frizelle; Ann Coloproctol. 2021;37(4):196-203. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00192.0027

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17 Citations

Abstract PDF

Diverticulosis of the colon is a common condition in Western countries and most patients will remain asymptomatic, but some will present with symptoms of acute diverticulitis or bleeding. Our understanding of diverticulosis is evolving but is mostly derived from diverticulosis affecting the left-sided colon. In contrast, right-sided colonic diverticulosis (RCD) is more commonly seen in Asian countries but is much less common overall. Based on the marked differences in epidemiology, it is commonly thought that these are 2 distinct disease processes. A review of the literature describing the epidemiology and etiology of RCD was performed, with a comparison to the current understanding of left-sided diverticulosis. RCD is becoming increasingly common. The epidemiology of RCD shows it to be a mostly acquired condition, and not congenital as previously thought. Many factors in the etiology of RCD are similar to that seen in left-sided diverticulosis, with a few variations. It is therefore likely that most cases of RCD represent the same disease process that is seen in the left colon.

Citations

Citations to this article as recorded by

Colonic diverticular hemorrhage: Etiology, diagnostic challenges, and evolving therapeutic strategies
Yi-Qing Hui, Zhi-Xuan Wang, Chun-Xi Wang, Chuan Tong
World Journal of Gastroenterology.2026;[Epub] CrossRef
A rare disease presenting with acute abdominal pain in a girl: Solitary cecal diverticulum
Hakan Özcan, Mehmet Özer, Mete Kaya
The European Research Journal.2025; 11(5): 1023. CrossRef
Innovative utilization of argon plasma coagulation combined with endoclips for managing gastrointestinal bleeding attributed to colonic diverticular bleeding: a retrospective study
Zihan Huang, Xiaomeng Feng, Xin Yin, Tao Sun, Chongxi Fan, Hongyu Chen, Bairong Li, Shoubin Ning
PeerJ.2025; 13: e19910. CrossRef
Prevalence, colonoscopic features, and risk factors of colonic diverticulosis in Vietnamese adults undergoing colonoscopy: a cross-sectional study
Uyen Pham-Phuong Vo, Nhu Thi-Hanh Vu, Quang Dinh Le, Doan Thi-Nha Nguyen, Mai Ngoc Luu, Nhung Thi-Hong Ngo, Duc Trong Quach
MedPharmRes.2025; 9(4): 420. CrossRef
Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life
Sara Lauricella, Francesco Brucchi, Dario Palmisano, Gianandrea Baldazzi, Luca Bottero, Diletta Cassini, Giuseppe Faillace
World Journal of Surgery.2024; 48(2): 484. CrossRef
49-jährige Patientin mit Unterbauchschmerz rechts
Achim Jatkowski, Arne Dehling, Wolfram Zoller
Zeitschrift für Gastroenterologie.2024; 62(02): 171. CrossRef
Features of colonic diverticulitis in children and adolescents: A multicenter study
Ji-Won Han, Joonhyuk Son, Chaeyoun Oh
Asian Journal of Surgery.2024; 47(5): 2195. CrossRef
Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis
Rediet Tefera Atalay, Oluwapelumi Kolawole, Girma M Ayele, Abay A Gobezie, Angesom Kibreab, Miriam B Michael
Cureus.2024;[Epub] CrossRef
Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates
Emeka Ray-Offor, Stella-Maris Egboh, Rex F.O.A. Ijah, Sameh Hany Emile, Steven D. Wexner
Digestive Surgery.2024; 41(2): 63. CrossRef
Genetic, epigenetic and environmental factors in diverticular disease: systematic review
Hannah N Humphrey, Pauline Sibley, Eleanor T Walker, Deborah S Keller, Francesco Pata, Dale Vimalachandran, Ian R Daniels, Frank D McDermott
BJS Open.2024;[Epub] CrossRef
Beyond the Norm: Acute Multifocal Diverticulitis
Bianca Thakkar, Jasmine Tidwell, Minh Thu T. Nguyen, Gengsheng Yu, Neil Parikh
ACG Case Reports Journal.2024; 11(9): e01505. CrossRef
Right-Sided Diverticulitis: A Rare Cause of Right-Sided Abdominal Pain
Athanasios Papatriantafyllou, Paraskevi Dedopoulou, Konstantina Soukouli, Ioannis Karioris, Stylianos Tsochatzis
Cureus.2023;[Epub] CrossRef
Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends
Mohit Bhatia, Aastha Mattoo
Cureus.2023;[Epub] CrossRef
Diagnosis and Treatment of Colonic Diverticular Disease
You Sun Kim
The Korean Journal of Gastroenterology.2022; 79(6): 233. CrossRef
When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach
Antonio Tursi, Valerio Papa, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Antonio Gasbarrini, Alfredo Papa
Journal of Personalized Medicine.2022; 12(10): 1713. CrossRef
Right-sided colopleural fistula secondary to diverticular disease: a case report
Summer Hassan, Primal Singh
Journal of Medical Case Reports.2022;[Epub] CrossRef
Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?
Lucas Faraco Sobrado, Tarsila Gomes Caldas, Carolina Graciolli Facanali, Leonardo Bustamente-Lopez, Carlos Walter Sobrado
Journal of Coloproctology.2022; 42(04): 302. CrossRef

Case Report

Successful Conservative Management of Hepatic Portal Venous Gas due to Anastomosis Leakage After a Sigmoidectomy: Injae Hong, Seong Woo Hong, Yeo Gu Chang, Byungmo Lee, Woo Yong Lee, Haeng Jin Ohe, Young Ki Kim; Ann Coloproctol. 2019;35(5):282-284. Published online January 25, 2019; DOI: https://doi.org/10.3393/ac.2018.03.23.1

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Abstract PDF

In past decades, hepatic portal venous gas (HPVG) has rarely been reported, and the mortality rate has been very high. In most cases, surgical intervention was needed. Presently, abdominal computed tomography can be conveniently used to diagnose HPVG, which has various underlying causes and benign courses. We present the case of a patient with HPVG due to anastomosis leakage after a sigmoidectomy for diverticulitis; the patient was cured with conservative management.

Citations

Citations to this article as recorded by

Clinical features and management of 20 patients with hepatic portal venous gas
Yuan Zhang, Hai-Long Liu, Min Tang, Hui Wang, Hui-Hong Jiang, Mou-Bin Lin
Experimental and Therapeutic Medicine.2022;[Epub] CrossRef
Conservative treatment of hepatic portal venous gas resulting from non-occlusive mesenteric ischemia: a case report
Takuya Seike, Tusyoshi Suda, Naoki Oishi
Clinical Journal of Gastroenterology.2021; 14(5): 1404. CrossRef
Reply on “Successful Conservative Management of Hepatic Portal Venous Gas due to Anastomosis Leakage After a Sigmoidectomy”
Seongwoo Hong
Annals of Coloproctology.2020; 36(4): 212. CrossRef
Hepatic Portal Venous Gas and Anastomotic Leakage
Filippo Carannante, Gabriella Teresa Capolupo, Gianluca Mascianà, Marco Caricato
Annals of Coloproctology.2020; 36(4): 211. CrossRef

Original Articles

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?: Taeyoung Yoo, Keun Ho Yang, Jungbin Kim, Inseok Park, Hyunjin Cho, Geumhee Gwak, Byung Noe Bae, Ki Hwan Kim; Ann Coloproctol. 2018;34(1):23-28. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.23

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5 Web of Science
5 Citations

Abstract PDF

Purpose

The aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.

Methods

We retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).

Results

In the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).

Conclusion

We suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

Citations

Citations to this article as recorded by

Epidemiology, Management, and Outcomes of Acute Diverticulitis in King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
Hanan M Bamanie, Nadim Malibary, Nada A Algarni, Jumana O Badawi, Lujain M AlNasser, Khadijah A Almalki, Renad F Alnemari
Cureus.2022;[Epub] CrossRef
Development of a prediction model for clinically important outcomes of acute diverticulitis
Stephen Gyung Won Lee, Sang Do Shin, Hui Jai Lee, Gil Joon Suh, Do Joong Park
The American Journal of Emergency Medicine.2021; 50: 27. CrossRef
Diverticulitis: An Update From the Age Old Paradigm
Alexander T. Hawkins, Paul E. Wise, Tiffany Chan, Janet T. Lee, Tamara Glyn, Verity Wood, Timothy Eglinton, Frank Frizelle, Adil Khan, Jason Hall, M.I. Mohammed Ilyas, Maria Michailidou, Valentine N. Nfonsam, Michelle L. Cowan, Jennifer Williams, Scott R.
Current Problems in Surgery.2020; 57(10): 100862. CrossRef
Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis
R. Cirocchi, J. J. Randolph, G. A. Binda, S. Gioia, B. M. Henry, K. A. Tomaszewski, M. Allegritti, A. Arezzo, R. Marzaioli, P. Ruscelli
Techniques in Coloproctology.2019; 23(2): 87. CrossRef
Clinical presentation and outcomes of acute diverticulitis in a Middle Eastern population
Jasim Alabbad, Fawaz Abdul Raheem, Saba Al-Saddah, Abdulaziz Al-Mubarak
Arab Journal of Gastroenterology.2019; 20(2): 99. CrossRef

Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis: Pill Sun Paik, Jung-A Yun; Ann Coloproctol. 2017;33(5):178-183. Published online October 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.5.178

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6 Web of Science
6 Citations

Abstract PDF Supplementary Material

Purpose

Colonic diverticulitis is uncommon in Korea, but the incidence is rapidly increasing nowadays. The clinical features and the factors associated with complications of diverticulitis are important for properly treating the disease.

Methods

A retrospective review of the medical records of 225 patients that were prospectively collected between October 2007 and September 2016 was conducted.

Results

Diverticulitis was detected mainly in men and women aged 30 to 50 years. Diverticulitis more frequently affected the right colon (n = 194, 86.2%), but age was higher in case of left colonic involvement (42 years vs. 57 years, P < 0.001). Percentages of comorbidities (65.6% vs. 23.8%, P < 0.001), complications (65.6% vs. 6.2%, P < 0.001), and surgical treatment (50.0% vs. 4.1%, P < 0.001) were significantly higher in patients with left colonic diverticulitis. In the multivariate analysis, a risk factor for complicated diverticulitis was left colonic involvement (P < 0.001; relative risk [RR], 47.108; 95% confidence interval [CI], 12.651–175.413). In complicated diverticulitis, age over 50 was the only significant risk factor for surgical treatment (P = 0.024; RR, 19.350; 95% CI, 1.474–254.023).

Conclusion

In patients over 50 years of age with left colonic diverticulitis, a preventive colectomy should be reconsidered as one of the options for treatment.

Citations

Citations to this article as recorded by

Platelet to lymphocyte ratio is a risk factor for failure of non-operative treatment of colonic diverticulitis
Jong Ho Kim, Sang Hyup Han, Jin-Won Lee, Haesung Kim, Jeonghee Han
Scientific Reports.2023;[Epub] CrossRef
Diagnosis and management of acute colonic diverticulitis: results of a survey among Korean gastroenterologists
Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim
The Korean Journal of Internal Medicine.2023; 38(5): 672. CrossRef
Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence
Zhilong Ma, Weiwei Liu, Jia Zhou, Le Yao, Wangcheng Xie, Mingqi Su, Jin Yang, Jun Shao, Ji Chen
BMC Surgery.2022;[Epub] CrossRef
Predictive factors for conservative treatment failure of right colonic diverticulitis
Youn Young Park, Soomin Nam, Jeong Hee Han, Jaeim Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2021; 100(6): 347. CrossRef
Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis
Le Huy Luu, Nguyen Lam Vuong, Vo Thi Hong Yen, Do Thi Thu Phuong, Bui Khac Vu, Nguyen Viet Thanh, Nguyen Thien Khanh, Nguyen Van Hai
Surgical Endoscopy.2020; 34(5): 2019. CrossRef
Meta‐analysis of the demographic and prognostic significance of right‐sided versus left‐sided acute diverticulitis
S. Hajibandeh, S. Hajibandeh, N. J. Smart, A. Maw
Colorectal Disease.2020; 22(12): 1908. CrossRef

Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon: Byeoung Hoon Chung, Gi Won Ha, Min Ro Lee, Jong Hun Kim; Ann Coloproctol. 2016;32(6):228-233. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.228

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24 Web of Science
24 Citations

Abstract PDF

Purpose

This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis.

Methods

This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification.

Results

Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m² vs. 25.8 ± 4.3 kg/m², P = 0.021) than those with uncomplicated disease.

Conclusion

Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.

Citations

Citations to this article as recorded by

The outcomes of right and left complicated colonic diverticulitis
Anh Tuan Nguyen, Quang Tien Pham, Hoi Van Tran, Hoang Viet Truong, Loc Huynh Tran
Surgery Open Science.2025; 27: 31. CrossRef
Right‐sided acute diverticulitis in a North African country: Presentation and management in one surgical center
Laila Jedidi, Aymen Mabrouk, Hela Ghali, Anis Ben Dhaou, Senda Ben Lahouel, Sami Daldoul, Houyem Said Latiri, Mounir Ben Moussa
World Journal of Surgery.2024; 48(6): 1509. CrossRef
Current diagnosis and management of acute colonic diverticulitis: What you need to know
Lisa M. Kodadek, Kimberly A. Davis
Journal of Trauma and Acute Care Surgery.2024; 97(1): 1. CrossRef
Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study
E. Karam, C. Sabbagh, L. Beyer-Bergeot, P. Zerbib, V. Bridoux, G. Manceau, Y. Panis, E. Buscail, A. Venara, I. Khaoudy, M. Gaillard, M. Viennet, A. Thobie, B. Menahem, C. Eveno, C. Bonnel, J.-Y. Mabrut, B. Badic, C. Godet, Y. Eid, E. Duchalais, Z. Lakkis,
Techniques in Coloproctology.2024;[Epub] CrossRef
Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines
Federico Coccolini, Massimo Sartelli, Robert Sawyer, Kemal Rasa, Bruno Viaggi, Fikri Abu-Zidan, Kjetil Soreide, Timothy Hardcastle, Deepak Gupta, Cino Bendinelli, Marco Ceresoli, Vishal G. Shelat, Richard ten Broek, Gian Luca Baiocchi, Ernest E. Moore, Ib
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Diagnosis and management of acute colonic diverticulitis: results of a survey among Korean gastroenterologists
Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim
The Korean Journal of Internal Medicine.2023; 38(5): 672. CrossRef
Right-sided diverticulitis in a Western population
Adi Rov, Anat Ben-Ari, Eyal Barlev, David Pelcman, Sergio Susmalian, Haim Paran
International Journal of Colorectal Disease.2022; 37(6): 1251. CrossRef
Emergency surgery comparison of right versus left acute colonic diverticulitis: A 10-year outcome analysis
JS Tsang, Chi Chung Foo, Jeremy Yip, Hok Kwok Choi, Wai Lun Law, Oswens Siu Hung Lo
The Surgeon.2021; 19(3): 150. CrossRef
Elective surgical management of diverticulitis
Jordan M. Rook, Jill Q. Dworsky, Thomas Curran, Sudeep Banerjee, Mary R. Kwaan
Current Problems in Surgery.2021; 58(5): 100876. CrossRef
Special Situations in the Management of Diverticular Disease
Elizabeth H. Wood, Michael M. Sigman, Dana M. Hayden
Clinics in Colon and Rectal Surgery.2021; 34(02): 121. CrossRef
Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis
Kil-yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh
BMC Gastroenterology.2021;[Epub] CrossRef
WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections
Massimo Sartelli, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu-Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, Abdulrashid Kayode Adesunkanmi, Boyko Atanasov, Goran Augustin, Miklosh Bala, Oussama Baraket, Suman Baral, Walter L. Biffl, Marja
World Journal of Emergency Surgery.2021;[Epub] CrossRef
Right sided diverticulitis in western countries: A review
Angelo Gabriele Epifani, Diletta Cassini, Roberto Cirocchi, Caterina Accardo, Francesca Di Candido, Massimiliano Ardu, Gianandrea Baldazzi
World Journal of Gastrointestinal Surgery.2021; 13(12): 1721. CrossRef
Difference in Clinical Features between Right- and Left-Sided Acute Colonic Diverticulitis
Kil-yong Lee, Jaeim Lee, Youn Young Park, Younglim Kim, Seong Taek Oh
Scientific Reports.2020;[Epub] CrossRef
2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting
Massimo Sartelli, Dieter G. Weber, Yoram Kluger, Luca Ansaloni, Federico Coccolini, Fikri Abu-Zidan, Goran Augustin, Offir Ben-Ishay, Walter L. Biffl, Konstantinos Bouliaris, Rodolfo Catena, Marco Ceresoli, Osvaldo Chiara, Massimo Chiarugi, Raul Coimbra,
World Journal of Emergency Surgery.2020;[Epub] CrossRef
Clinical Characteristics of Right Colonic Diverticulitis: A Comparison of Ileocecal Diverticulitis and Hepatic Flexure Diverticulitis
Yoshihisa Fujita, Fumihiko Ishikawa, Shigeyuki Kamata
Nippon Daicho Komonbyo Gakkai Zasshi.2020; 73(6): 244. CrossRef
Meta‐analysis of the demographic and prognostic significance of right‐sided versus left‐sided acute diverticulitis
S. Hajibandeh, S. Hajibandeh, N. J. Smart, A. Maw
Colorectal Disease.2020; 22(12): 1908. CrossRef
Long-term outcome and management of right colonic diverticulitis in western countries: Multicentric Retrospective Study
L. Courtot, V. Bridoux, Z. Lakkis, G. Piessen, G. Manceau, A. Mulliri, G. Meurette, A. Bouayed, A. Vénara, B. Blanc, N. Tabchouri, E. Salamé, M. Ouaïssi
Journal of Visceral Surgery.2019; 156(4): 296. CrossRef
Résultats à long terme et prise en charge des diverticulites du colon droit dans les pays occidentaux : étude rétrospective multicentrique
L. Courtot, V. Bridoux, Z. Lakkis, G. Piessen, G. Manceau, A. Mulliri, G. Meurette, A. Bouayed, A. Vénara, B. Blanc, N. Tabchouri, E. Salamé, M. Ouaïssi
Journal de Chirurgie Viscérale.2019; 156(4): 322. CrossRef
Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics
Jeong Yeon Kim, Sung Gil Park, Hee Joon Kang, Young Ah Lim, Kyung Ho Pak, Tae Yoo, Won Tae Cho, Dong Woo Shin, Jong Wan Kim
International Journal of Colorectal Disease.2019; 34(8): 1413. CrossRef
Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?
Taeyoung Yoo, Keun Ho Yang, Jungbin Kim, Inseok Park, Hyunjin Cho, Geumhee Gwak, Byung Noe Bae, Ki Hwan Kim
Annals of Coloproctology.2018; 34(1): 23. CrossRef
Perforated diverticulitis: is the right and left difference present here too?
Nicholas Yock Teck Soh, Nan Zun Teo, Carrie Jen Hsi Tan, Shivani Rajaraman, Marianne Tsang, Calvin Jian Ming Ong, Ramesh Wijaya
International Journal of Colorectal Disease.2018; 33(5): 525. CrossRef
Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis
Pill Sun Paik, Jung-A Yun
Annals of Coloproctology.2017; 33(5): 178. CrossRef
What is the Difference Between Right- and Left-Sided Colonic Diverticulitis?
Chang-Nam Kim
Annals of Coloproctology.2016; 32(6): 206. CrossRef

Colovesical Fistula: Should It Be Considered a Single Disease?: Qamar Hafeez Kiani, Mark L. George, Emin A. Carapeti, Alexis M. P. Schizas, Andrew B. Williams; Ann Coloproctol. 2015;31(2):57-62. Published online April 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.2.57

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Abstract PDF

Purpose

This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies.

Methods

Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies.

Results

A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001).

Conclusion

Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.

Citations

Citations to this article as recorded by

Laparoscopic management of colovesical fistula in different clinical scenarios
Davide Campobasso, Maurizio Zizzo, Federico Biolchini, Carolina Castro-Ruiz, Antonio Frattini, Alessandro Giunta
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Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment: Cosimo Riccardo Scarpa, Nicolas Christian Buchs, Antoine Poncet, Béatrice Konrad-Mugnier, Pascal Gervaz, Philippe Morel, Frédéric Ris; Ann Coloproctol. 2015;31(2):52-56. Published online April 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.2.52

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Abstract PDF

Purpose

This study included all patients treated at the University Hospital of Geneva for a first episode of uncomplicated diverticulitis. Risks of recurrence and treatment failure were evaluated by comparing the results between short-course and long-course intravenous (IV) antibiotic therapy groups.

Methods

The records of all patients hospitalized at our facility from January 2007 to February 2012 for a first episode of uncomplicated diverticulitis (Hinchey Ia), as confirmed by computed tomography, were prospectively collected. We published an auxiliary analysis from this registered study at Clinicaltrials.gov (identifier number: NCT01015378). Two groups of patients were considered: one received a short-course IV antibiotic arm (ceftriaxone and metronidazole) for up to 5 days (followed by 5 days of oral antibiotics); the other received a long-course IV arm between days 5 and 10. The primary outcome was the recurrence-free survival time.

Results

Follow-up was completed for 256 patients-50% men and 50% women, with a median age of 56 years (range, 24-85 years). The average follow-up was 50 months (range, 19-89 months). Of the 256 patients included in the study, 46 patients received a short-course IV antibiotic treatment and 210 received a long-course treatment. The recurrence-free survivals were very similar between the two groups, which was supported by a log rank test (P = 0.772). Four treatment failures, all in the long-course IV antibiotic treatment group, occurred.

Conclusion

Treatment of diverticulitis with a short IV antibiotic treatment is possible and does not modify the recurrence rate in patients with uncomplicated diverticulitis.

Citations

Citations to this article as recorded by

Italian guidelines for the diagnosis and management of colonic diverticulosis and diverticular disease
Marilia Carabotti, Costantino Sgamato, Antonio Amato, Benedetta Beltrame, Gian Andrea Binda, Bastianello Germanà, Gioacchino Leandro, Luigi Pasquale, Sergio Peralta, Maria Teresa Viggiani, Carola Severi, Bruno Annibale, Rosario Cuomo
Digestive and Liver Disease.2024; 56(12): 1989. CrossRef
Konservative Therapie der Divertikulitis
Stephan K. Böhm
coloproctology.2023; 45(3): 163. CrossRef
Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis
Ethan M. Balk, Gaelen P. Adam, Monika Reddy Bhuma, Kristin J. Konnyu, Ian J. Saldanha, Michael D. Beland, Nishit Shah
Annals of Internal Medicine.2022; 175(3): 379. CrossRef
Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians
Amir Qaseem, Itziar Etxeandia-Ikobaltzeta, Jennifer S. Lin, Nick Fitterman, Tatyana Shamliyan, Timothy J. Wilt
Annals of Internal Medicine.2022; 175(3): 399. CrossRef
S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)
Ludger Leifeld, Christoph-Thomas Germer, Stephan Böhm, Franz Ludwig Dumoulin, Thomas Frieling, Martin Kreis, Alexander Meining, Joachim Labenz, Johan Friso Lock, Jörg-Peter Ritz, Andreas Schreyer, Wolfgang Kruis
Zeitschrift für Gastroenterologie.2022; 60(04): 613. CrossRef
Recurrence of Uncomplicated Diverticulitis: A Meta-Analysis
Guhyun Kang, Soomin Son, Young-Min Shin, Jung-Soo Pyo
Medicina.2022; 58(6): 758. CrossRef
German guideline diverticular disease/diverticulitis
Wolfgang Kruis, Christoph‐Thomas Germer, Stephan Böhm, Franz Ludwig Dumoulin, Thomas Frieling, Jochen Hampe, Jutta Keller, Martin E. Kreis, Alexander Meining, Joachim Labenz, Johann F. Lock, Jörg Peter Ritz, Andreas G. Schreyer, Ludger Leifeld
United European Gastroenterology Journal.2022; 10(9): 940. CrossRef
Treatment with Ceftriaxone in Complicated Diverticulitis Increases the Incidence of Intra-Abdominal Enterococcus faecium Detection
Julius Pochhammer, Axel Kramer, Matthias Orth, Michael Schäffer, Jan Henrik Beckmann
Surgical Infections.2021; 22(5): 543. CrossRef
Risk factors for recurrence after acute colonic diverticulitis: a systematic review
Line Hupfeld, Jakob Burcharth, Hans-Christian Pommergaard, Jacob Rosenberg
International Journal of Colorectal Disease.2017; 32(5): 611. CrossRef
Acute colonic diverticulitis: an update on clinical classification and management with MDCT correlation
Maxime Barat, Anthony Dohan, Karine Pautrat, Mourad Boudiaf, Raphael Dautry, Youcef Guerrache, Marc Pocard, Christine Hoeffel, Clarisse Eveno, Philippe Soyer
Abdominal Radiology.2016; 41(9): 1842. CrossRef
The Wind of Change: Uncomplicated Diverticulitis
Hungdai Kim
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Safety of Nonoperative Management After Acute Diverticulitis: Javier Suarez Alecha, Sonia Amoza Pais, Xavi Batlle Marin, Begoña Oronoz Martinez, Enrique Balen Ribera, Concepción Yarnoz Irazabal; Ann Coloproctol. 2014;30(5):216-221. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.216

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Abstract PDF

Purpose

The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery.

Methods

We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode.

Results

Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458).

Conclusion

After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.

Citations

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Elective surgical versus conservative management of complicated diverticulitis: A systematic review and meta‐analysis
Marcus Yeow, Nicholas Syn, Choon Seng Chong
Journal of Digestive Diseases.2022; 23(2): 91. CrossRef
Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases
Hitoshi Kameyama, Toshiyuki Yamazaki, Akira Iwaya, Hiroaki Uehara, Shiori Utsumi, Motoharu Hirai, Masaru Komatsu, Akira Kubota, Tomohiro Katada, Kazuaki Kobayashi, Daisuke Sato, Naoyuki Yokoyama, Shirou Kuwabara, Tetsuya Otani
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Matthew Symer, Heather L. Yeo
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Do Patients Mandate Resection After a First Episode of Acute Diverticulitis of the Colon with a Complication?
Ryan Francis Bendl, Roberto Bergamaschi
Advances in Surgery.2017; 51(1): 179. CrossRef
20-Year Trends in the Management of Diverticulitis Across New York State: an Analysis of 265,724 Patients
Ryan Lamm, Steven N. Mathews, Jie Yang, Lijuan Kang, Dana Telem, Aurora D. Pryor, Mark Talamini, Jill Genua
Journal of Gastrointestinal Surgery.2017; 21(1): 78. CrossRef
Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications
Bikash Devaraj, Wendy Liu, James Tatum, Kyle Cologne, Andreas M. Kaiser
Diseases of the Colon & Rectum.2016; 59(3): 208. CrossRef
Nonoperative treatment of acute appendicitis in children: A feasibility study
Joseph Hartwich, Francois I. Luks, Debra Watson-Smith, Arlet G. Kurkchubasche, Christopher S. Muratore, Hale E. Wills, Thomas F. Tracy
Journal of Pediatric Surgery.2016; 51(1): 111. CrossRef
Nonoperative Management of Acute Complicated Diverticulitis
Byung Chun Kim
Annals of Coloproctology.2014; 30(5): 206. CrossRef

Case Reports

Colon Cancer After Acute Diverticulitis Treatment: Kwang Hoon Oh, Koon Hee Han, Eun Jung Kim, Je Hoon Lee, Kyu Un Choi, Myung Sik Han, Jae Hong Ahn, Gab Jin Cheon; Ann Coloproctol. 2013;29(4):167-171. Published online August 29, 2013; DOI: https://doi.org/10.3393/ac.2013.29.4.167

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Abstract PDF

Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.

Citations

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Role of endoscopy after an acute episode of diverticulitis
Liliane C. Meireles, Samuel R. Fernandes, Luis C. Ribeiro, José Velosa
European Journal of Gastroenterology & Hepatology.2015; 27(12): 1429. CrossRef
Why perform colonoscopy following acute diverticulitis of the colon?
Antonio Tursi
Surgical Endoscopy.2014; 28(11): 3260. CrossRef
Diagnosis and Treatment of Colon Diverticulitis
Geom Seog Seo, Suck Chei Choi
Korean Journal of Medicine.2013; 85(6): 563. CrossRef

Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon: Pyong Wha Choi; J Korean Soc Coloproctol. 2012;28(6):321-324. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.321

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Abstract PDF

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.

Citations

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Radiological insights into diverticulitis: Clinical manifestations, complications, and differential diagnosis
Mehmet Simsar, Yesim Y Yuruk, Olgun Sahin, Hilal Sahin
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Colouterine fistula relating to diverticulitis: a rare clinical entity
Anoosha Aslam, David J Lewis, Mayooran Veerasingham, Mohamed Z Afzal, Asar Alsaffar
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Colouterine Fistula: A Rare Presentation of Severe Diverticular Disease
Jessica M Orgovan, Byron D Dodson
Cureus.2024;[Epub] CrossRef
A case report of a colouterine fistula treatment: when the patient chooses the steeplechase
Stefano Pontone, Pier Giorgio Nardis, Chiara Eberspacher, Domenico Mascagni
Annals of Coloproctology.2023; 39(4): 366. CrossRef
Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis
Amjad Shaikh, Ayham Khrais, Alexander Le, Alexander J Kaye, Sushil Ahlawat
Cureus.2023;[Epub] CrossRef
Uterocolon Fistula Formation in 50 Year Old Patient with History of 16 Years Intrauterine Device Use: A Case Report
Adiguna Gurnita, Eppy Darmadi Achmad
International Medical Case Reports Journal.2023; Volume 16: 719. CrossRef
Chronic sigmoid diverticulitis causing tubo-ovarian abscess and colo-uterine fistula
Phelopatir Anthony, Tracey Edwards, Nagy Andrawis
Journal of Surgical Case Reports.2023;[Epub] CrossRef
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Imen Ben Ismail, Nada Hammami, Ayoub Zoghlami
ANZ Journal of Surgery.2022; 92(3): 559. CrossRef
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Justin Yan‐Ting Ng, Jessica Yan‐Seen Ng
ANZ Journal of Surgery.2022; 92(6): 1542. CrossRef
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Kaiwu XU, Guangyi LI, Tailiang LU, Zhige YU, Wei PENG, Yongqiang GONG, Chaowu CHEN
Chirurgia.2022;[Epub] CrossRef
A Rare Case of Occult Advanced Uterine Adenocarcinoma With a Neoplastic Enterouterine Fistula on Presentation
Rina Ghorpade, Vyshnavi Iswaravaka, Nitant Parekh, Fiona Tissavirasingham
Cureus.2022;[Epub] CrossRef
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Ricardo Esteban Mentz, Esteban Agustín González Salazar, Juan Pablo Campana, Carlos Alberto Vaccaro, Gustavo Leandro Rossi
Cirugía Española.2021; 99(7): 549. CrossRef
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Francisco Miguel González Valverde, María Jesús Gómez Ramos
International Urogynecology Journal.2021; 32(9): 2553. CrossRef
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Anthony R. Perez, Mary Ellen Chiong-Perez, Crisostomo E. Arcilla, John Isaac Merin
International Journal of Surgery Case Reports.2021; 79(C): 150. CrossRef
Colouterine and Jejunouterine Fistula Secondary to Chronic Diverticulitis
Ilias Galanis, Georgios Floros, Christophoros Theodoropoulos, Myriam Metaxa, Panagiotis Theodoropoulos, Panagiotis Tsintavis, Dimitrios Bartziotas, Georgios Giannos, Georgios Stylianidis, Georgios Papadopoulos, Hirotada Akiho
Case Reports in Gastrointestinal Medicine.2021; 2021: 1. CrossRef
Mini-invasive treatment of colouterine fistula of diverticular origin
Ricardo Esteban Mentz, Esteban Agustín González Salazar, Juan Pablo Campana, Carlos Alberto Vaccaro, Gustavo Leandro Rossi
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Moon Kyoung Cho, Tae Young Kim, Chul Hong Kim
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Shweta Pandey, Saurabh Maheshwari, Uddandam Rajesh, Darshan Singh Grewal, Vibhuti Maria
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Sigmoido-uterine fistula: An uncommon communication!
Gabriel Rodrigues, Krishna Kalyan Reddy Janumpalli, Shyamala Guruvare, Suresh Arjun, Afroz Khan, Balaji Jayasankar
European Journal of Obstetrics & Gynecology and Reproductive Biology.2019; 239: 74. CrossRef
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Rohit Aggarwal, Venkatraman Indiran, Prabakaran Maduraimuthu
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Mehmet Ruhi Onur, Erhan Akpinar, Ali Devrim Karaosmanoglu, Cavid Isayev, Musturay Karcaaltincaba
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Single-incision laparoscopic (SIL) sigmoid colectomy and uterus-preserving repair for colo-uterine fistula secondary to severe diverticular disease: an unusual technical solution for an unusual presentation of a common disease
Balazs Banky, Fergal Marlborough, Iona MacLeod, Talvinder S Gill
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Original Articles

Is Conservative Treatment with Antibiotics the Correct Strategy for Management of Right Colonic Diverticulitis?: A Prospective Study: Tae Jung Kim, In Kyu Lee, Jong Kyung Park, Yoon Suk Lee, Youn Si, Hun Jung, Hyung Jin Kim, Sang Chul Lee, Dae Young Cheung, Lee D. Gorden, Seung Taek Oh; J Korean Soc Coloproctol. 2011;27(4):188-193. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.188

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Abstract PDF

Purpose

The goals of this study were to identify whether conservative treatment with antibiotics in right colonic diverticulitis (RCD) patients, our empirical method used until now, is adequate and to determine how the natural history of RCD is affected by conservative treatment.

Methods

This study was designed as a case-control study. Group I was comprised of 12 patients who were managed conservatively, and clinical data were retrospectively collected. In group II, a total of 49 patients, diagnosed by using diagnostic criteria for RCD and managed conservatively, were prospectively included.

Results

The period of fasting was 2.7 days, and the hospital stay was 4.6 days in all patients. The intravenous and the oral antibiotic periods were 3.8 days and 9.8 days, respectively. There were no statistically significant differences in treatment results between the two groups except the duration of fasting and the hospitalization, and there were no complications under conservative treatment. Eight patients (13.1%) had recurrent diverticulitis during the follow-up period. The recurrence risk showed no significant difference between the groups. The RCD-free period after management was 60.1 months, and patients with recurrent RCD were treated by conservative treatment or laparoscopic surgery.

Conclusion

Conservative treatment with antibiotics is the optimal treatment of choice for RCD and shows no increase in complications.

Citations

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Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature
Isabelle Uhe, Jeremy Meyer, Manuela Viviano, Surrennaidoo Naiken, Christian Toso, Frédéric Ris, Nicolas C. Buchs
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Yongjin F. Lee, Dalun D. Tang, Samik H. Patel, Michael A. Battaglia, Beth-Ann Shanker, Robert K. Cleary
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B. Schiltz, C. Dumont, N. C. Buchs, Ph. Morel, F. Ris
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Right colonic diverticulitis in Caucasians: presentation and outcomes versus left-sided disease
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Clinical Characteristics of Primary Epiploic Appendagitis: Young Un Choi, Pyong Wha Choi, Yong Hwan Park, Jae Il Kim, Tae Gil Heo, Je Hoon Park, Myung Soo Lee, Chul Nam Kim, Surk Hyo Chang, Jeong Wook Seo; J Korean Soc Coloproctol. 2011;27(3):114-121. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.114

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Abstract PDF

Purpose

Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.

Methods

We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.

Results

In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).

Conclusion

In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

Citations

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Case Report

A Case of Colovesical Fistula Induced by Sigmoid Diverticulitis: Hwa-Yeon Yang, Woo-Young Sun, Taek-Gu Lee, Sang-Jeon Lee; J Korean Soc Coloproctol. 2011;27(2):94-98. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.94

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Abstract PDF

Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.

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Original Articles

Comparative Study of the Clinical Features and Treatment for Right and Left Colonic Diverticulitis: Seok Hoon Kim, Chang Gyoo Byun, Jin Woo Cha, Seok Ho Choi, Young Taek Kho, Dong Yup Seo; J Korean Soc Coloproctol. 2010;26(6):407-412. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.407

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Abstract PDF

Purpose

Colonic diverticulitis is an uncommon disease in Korea, but the incidence of the disease is increasing. The right colon is the more preferred site for diverticulitis in Korea, but the incidence of left diverticulitis is increasing. Therefore, comparing the clinical features and treatments for right diverticulitis with those for left diverticulitis may help us to treat the disease more properly.

Methods

This study was performed retrospectively by reviewing the medical records of 96 patients with colonic diverticulitis, in whom either conservative or operative treatments were performed.

Results

Eighty-six patients had right diverticulitis (RD), and 10 patients had left diverticulitis (LD). The mean age of the patients was older for LD. Sixteen patients (18.6%) with RD had complications, and 7 patients (8.1%) underwent operations. On the other hand, 4 patients (40%) with LD had complications, and 3 patients (30%) underwent operations. The rates of complications and operations among old-aged patients were higher. The operations for 7 patients with RD who underwent surgery were 6 ileocecectomies and 1 diverticulectomy. On the other hand, the operations for the 3 patients with LD who underwent surgery were 2 resections and anastomoses and 1 diverticulectomy. The reasons for the operations were abscess formation, recurrence, perforation, and development of generalized peritonitis without response to conservative treatment.

Conclusion

The incidence of LD is lower than that of RD in Korea, but the rate of complications and operations seems higher in LD. Therefore, patients who complain of left lower abdominal pain need to be thoroughly examined for LD.

Citations

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Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment: Ma Ru Kim, Bong-Hyeon Kye, Hyung Jin Kim, Hyeon-Min Cho, Seong Taek Oh, Jun-Gi Kim; J Korean Soc Coloproctol. 2010;26(6):402-406. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.402

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25 Citations

Abstract PDF

Purpose

The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis.

Methods

One hundred fifty-eight patients with right-sided colonic diverticulitis were evaluated. Clinical history, physical and radiologic findings, and treatments were reviewed retrospectively. Also, additional episodes and treatment modalities were checked.

Results

Our patients were classified according to treatment modality; 135 patients (85.4%) underwent conservative treatment, including antibiotics and bowel rest, and 23 patients (14.6%) underwent surgery. The mean follow-up length was 37.3 months, and 17 patients (17.5%) underwent recurrent right-sided colonic diverticulitis. Based on treatment modality, including surgery and antibiotics, no significant differences in the clinical features and the recurrence rates were noted between the two groups.

Conclusion

Conservative management with bowel rest and antibiotics could be considered as a safe and effective option for treating right-sided colonic diverticulitis. This treatment option for right-sided colonic diverticulitis, even if the disease is complicated, may be the treatment of choice.

Citations

Citations to this article as recorded by

Trends and Outcomes in Acute Colonic Diverticulitis: A Single-Center Three-Year Retrospective Cohort Study From Greece
Michail Angelos Papaoikonomou, Europi Michailidou, Aggeliki Chlorou, Dimitrios Apostolou, Nikolaos Krokos
Cureus.2025;[Epub] CrossRef
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Review

Right Colonic Diverticulitis: In Kyu Lee; J Korean Soc Coloproctol. 2010;26(4):241-245. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.241

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Abstract PDF

Although right colonic diverticultis (RCD) has been reported to be a rare disease in Western countries, RCD is a common diagnosis, with an incidence per 2.9-17 case of appendicitis, in Korea. Many Western studies have reported that it is difficult to differentiate the presenting symptoms of RCD from those of appendicitis before surgery because the signs and symptoms are similar. However, performing a computed tomography scan after the application of the diagnostic criteria for RCD has increased the preoperative RCD diagnostic rate. Treatment strategies have been difficult to define for this condition due to its low preoperative diagnosis rate. However, recent reports have shown that conservative medical treatment of uncomplicated RCD can be recommended and that such treatment is effective due to the benign and self-limited natural history of RCD. Therefore, in this review, we discuss the controversies surrounding RCD management.

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Original Articles

Management of Right Colon Diverticulitis.: Jang, Jong Ik , Lim, Yang Soo , Choi, Jong Woo , Lee, Yoon Sik; J Korean Soc Coloproctol. 2010;26(1):22-28.; DOI: https://doi.org/10.3393/jksc.2010.26.1.22

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4 Citations

Abstract PDF

PURPOSE
There are still many controversial aspects in the management of right colon diverticulitis. The aim of this study is to find an appropriate treatment for right colon diverticulitis.
METHODS
We retrospectively reviewed the medical records of 88 patients who were admitted with right colon diverticulitis to Wallace Memorial Baptist Hospital from January 2001 to December 2007.
RESULTS
The patients enrolled in this study included 52 men and 36 women. The mean age was 39.6 yr, ranging from 13 to 84 yr. Fifty-four of 88 patients underwent conservative treatment for right colon diverticulitis, and 34 of 88 patients underwent operative treatment. There were 5 cases of recurrence in the conservative treatment group, but there were no cases of recurrence in the operative treatment group. We experienced 43 cases with right colon diverticulitis at the operational fields, including 9 cases that underwent conservative treatment after an appendectomy: eleven cases that underwent conservative treatment after an appendectomy or an appendectomy with diverticulectomy, 19 cases that underwent an ileocecectomy, and 13 cases that underwent a right hemicolectomy. There were no statistically significant difference in complications among 3 groups (P=0.148). However, there were statistical differences among the 3 groups in the length of hospital stay (P=0.016), and the use of intravenous antibiotics (P<0.001), and the use of oral antibiotics (P=0.019).
CONCLUSION
When the preoperative diagnosis is exact, uncomplicated right colon diverticulitis can be managed by conservative treatment. On the other hand, an ileocecectomy or a right hemicolectomy is the proper treatment for complicated right colon diverticulitis. However, if uncomplicated right colon diverticulitis is diagnosed intraoperatively, conservative treatment or a diverticulectomy should be considered.

Citations

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Primary epiploic appendagitis: Reconciling CT and clinical challenges
Jamel Saad, Hussein Ali Mustafa, Asem Mohamed Elsani, Fawaz Alharbi, Saad Alghamdi
Indian Journal of Gastroenterology.2014; 33(5): 420. CrossRef
Management of Right Colonic Uncomplicated Diverticulitis: Outpatient Versus Inpatient Management
Hyoung‐Chul Park, Byoung Seup Kim, Bong Hwa Lee
World Journal of Surgery.2011;[Epub] CrossRef
Clinical Characteristics of Primary Epiploic Appendagitis
Young Un Choi, Pyong Wha Choi, Yong Hwan Park, Jae Il Kim, Tae Gil Heo, Je Hoon Park, Myung Soo Lee, Chul Nam Kim, Surk Hyo Chang, Jeong Wook Seo
Journal of the Korean Society of Coloproctology.2011; 27(3): 114. CrossRef
A Case of Ascending Colon Diverticulitis with Perforation in a Child
Joon Woo Baek, Jae Young Shin, Jee Hyun Lee, So Young Jung, Ah Young Jung, Jeong Won Kim, Kon Hee Lee
Korean Journal of Pediatric Gastroenterology and Nutrition.2010; 13(2): 193. CrossRef

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy.: Lee, In Kyu , Kim, Su Hong , Lee, Yoon Suk , Kim, Hyung Jin , Lee, Sang Kuon , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek , Jeon, Hae Myung , Kim, Jun Gi , Kim, Eung Kook , Chang, Suk Kyun; J Korean Soc Coloproctol. 2007;23(4):223-231.; DOI: https://doi.org/10.3393/jksc.2007.23.4.223

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32 Download
17 Citations

Abstract PDF

PURPOSE
The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality.
METHODS
Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics.
RESULTS
Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086).
CONCLUSIONS
To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.

Citations

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Right‐sided acute diverticulitis in a North African country: Presentation and management in one surgical center
Laila Jedidi, Aymen Mabrouk, Hela Ghali, Anis Ben Dhaou, Senda Ben Lahouel, Sami Daldoul, Houyem Said Latiri, Mounir Ben Moussa
World Journal of Surgery.2024; 48(6): 1509. CrossRef
Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina
René M. Palacios Huatuco, Diana A. Pantoja Pachajoa, Julian E. Liaño, Héctor A. Picón Molina, Rafael Palencia, Alejandro M. Doniquian, Matías Parodi
Annals of Coloproctology.2023; 39(2): 123. CrossRef
Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature
Isabelle Uhe, Jeremy Meyer, Manuela Viviano, Surrennaidoo Naiken, Christian Toso, Frédéric Ris, Nicolas C. Buchs
Colorectal Disease.2021; 23(10): 2515. CrossRef
Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis
Le Huy Luu, Nguyen Lam Vuong, Vo Thi Hong Yen, Do Thi Thu Phuong, Bui Khac Vu, Nguyen Viet Thanh, Nguyen Thien Khanh, Nguyen Van Hai
Surgical Endoscopy.2020; 34(5): 2019. CrossRef
Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study
Yosuke Sasaki, Fumiya Komatsu, Naoyasu Kashima, Takahiro Sato, Ikutaka Takemoto, Sho Kijima, Tadashi Maeda, Takamasa Ishii, Taito Miyazaki, Yoshiko Honda, Nagato Shimada, Yoshihisa Urita
World Journal of Clinical Cases.2019; 7(12): 1393. CrossRef
Right-sided acute diverticulitis: A single Western center experience
Francesco Monari, Maurizio Cervellera, Basilio Pirrera, Umberto D'Errico, Samuele Vaccari, Laura Alberici, Valeria Tonini
International Journal of Surgery.2017; 44: 128. CrossRef
Diagnosis and Management of Right Colonic Diverticular Disease: A Review
Francesco Ferrara, Jesús Bollo, Letizia V. Vanni, Eduardo M. Targarona
Cirugía Española (English Edition).2016; 94(10): 553. CrossRef
Diagnóstico y tratamiento de la enfermedad diverticular del colon derecho: revisión de conjunto
Francesco Ferrara, Jesús Bollo, Letizia V Vanni, Eduardo M Targarona
Cirugía Española.2016; 94(10): 553. CrossRef
Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated?
Renol M. Koshy, Abdelrahman Abusabeib, Saif Al-Mudares, Mohamed Khairat, Adriana Toro, Isidoro Di Carlo
World Journal of Emergency Surgery.2016;[Epub] CrossRef
Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack
Hyoung-Chul Park, Byung Seup Kim, Kwanseop Lee, Min Jeong Kim, Bong Hwa Lee
International Journal of Colorectal Disease.2014; 29(10): 1217. CrossRef
Surgical management of colonic diverticular disease: Discrepancy between right- and left-sided diseases
Heung-Kwon Oh
World Journal of Gastroenterology.2014; 20(29): 10115. CrossRef
Is Conservative Treatment with Antibiotics the Correct Strategy for Management of Right Colonic Diverticulitis?: A Prospective Study
Tae Jung Kim, In Kyu Lee, Jong Kyung Park, Yoon Suk Lee, Youn Si, Hun Jung, Hyung Jin Kim, Sang Chul Lee, Dae Young Cheung, Lee D. Gorden, Seung Taek Oh
Journal of the Korean Society of Coloproctology.2011; 27(4): 188. CrossRef
Management of Right Colon Diverticulitis
Jong Ik Jang, Yang Soo Lim, Jong Woo Choi, Yoon Sik Lee
Journal of the Korean Society of Coloproctology.2010; 26(1): 22. CrossRef
Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment
Ma Ru Kim, Bong-Hyeon Kye, Hyung Jin Kim, Hyeon-Min Cho, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2010; 26(6): 402. CrossRef
Right Colonic Diverticulitis
In Kyu Lee
Journal of the Korean Society of Coloproctology.2010; 26(4): 241. CrossRef
A Case of Ascending Colon Diverticulitis with Perforation in a Child
Joon Woo Baek, Jae Young Shin, Jee Hyun Lee, So Young Jung, Ah Young Jung, Jeong Won Kim, Kon Hee Lee
Korean Journal of Pediatric Gastroenterology and Nutrition.2010; 13(2): 193. CrossRef
Laparoscopic and Open Surgery for Right Colonic Diverticulitis
In Kyu Lee, Yoon Suk Lee, Sung Jip Kim, D. Lee Gorden, Dae Youn Won, Hyeung Jin Kim, Hyeun Min Cho, Hae Myung Jeon, Jun-Gi Kim, Seong Taek Oh
The American Surgeon™.2010; 76(5): 486. CrossRef

The Clinical Analysis of Colonic Diverticulitis Accompanying Acute Abdomen.: Song, Joon Ho , Paik, Chong Dae , Lee, Sang Hee , Kim, Han Sun; J Korean Soc Coloproctol. 2002;18(6):390-396.

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12 Download

Abstract PDF: PURPOSE
With the gradual changes in diet pattern, the incidence of diverticular disease have progressively increased. The diverticular disease including diverticulitis is difficult to diagnose prior to the operation as it mimics common acute abdominal conditions like acute appendicitis. Also, controversies abound as regards the optimal treatment, ranging from conservative treatment to colon resection. The aim of the present paper was to review diagnosis and treatment strategy followed by a clinical appraisal.
METHODS
We studied retrospectively 101 patients who were diagnosed as colonic diverticulitis for 10 years period between January, 1991 and December, 2000 at Seoul Red Cross Hospital, Dept. of Surgery.
RESULTS
There were 59 males and 42 females. The male to female ratio was 1.4 : 1. During admission, everyone complained abdominal pain as an initial symptom, especially on the right lower quadrant. The right colon was the most common site with single diverticulitis. The diagnosis of diverticulitis was performed by ultrasonography, CT scan, and colon study, barium enema, colonofiberscopy except in 17 cases which were diagnosed preoperatively having appendicitis. Two treatment groups were identified. Group I (n=48) received conservative treatment with or without appendectomy, while group II (n=53) underwent definitive surgery. Overall, there was no difference in clinical outcome except for the duration of antibiotics between two groups.
CONCLUSIONS
In treating uncomplicated diverticulitis, the conservative treatment should be considered at first. Conservative treatment with systemic antibiotics have resulted in a comparable outcome to that of the surgical group with low morbidity and low recurrence rate. Therefore, without serious complications such as hemorrhage, fistula, septic condition, inability to exclude carcinoma, clinical deterioration, young age, right colon diverticulitis, chronic stricture or the use of steroid, we propose that a conservative approach be adopted.

Clinical Analysis of Diverticulosis of the Cecum and Ascending Colon.: Kim, Gyu Yeol , Nam, Chang Woo , Ko, Byung Kyun , Cho, Hong Rae , Park, Chan Jin , Choi, Dae Hwan; J Korean Soc Coloproctol. 1998;14(3):595-604.

1,566 View
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Abstract PDF: BACKGROUND
Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult.
METHODS
Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997.
RESULTS
During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases).
CONCLUSION
These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.

The Usefulness of Colonoscopy in the Management of Right Side Colonic Diverticulitis.: Lee, Eun Kyu , Kim, Hung Dai , Son, Beong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2001;17(6):283-288.

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Abstract PDF: PURPOSE
Most patients who finally diagnosed as the cecal and ascending colonic diverticulitis would complain pain on right low quadrant of abdomen. So many of them unfortunately would be performed emergency operation for presumed appendicitis. We are purposed to verify the usefulness of colonoscopy for the diagnosis and aimed to treat many patients with this disease conservatively.
METHODS
We reviewed retrospectively the medical records of the 46 patients who diagnosed as the cecal and ascending colonic diverticulitis under admission at general surgery department during 4 years from January, 1997 to December, 2000.
RESULTS
The mean age was 40.1 years and the male to female ratio was 1.2:1. Most common clinical manifestation was abdominal pain (46 cases) and nausea/vomiting (13 cases), fever/chill (4 cases) followed. On physical examination on abdomen, 26 patients had tenderness with rebound tenderness on right low quadrant and 18 patients showed only tenderness on right low quadrant. The mean peripheral WBC count was 10,600.9/mm2. Diagnostic tools were abdominal ultrasonography (34 cases), abdominal CT (13 cases), barium enema (8 cases) and colonoscopy (22 cases). The sensitivities of each modalities were 52.6%, 46.2%, 33.3% and 81.8% respectively. The respective mean hospital days depending on the treatment arms were as follows: 6.0 days of the conservatively treated group, 8.0 days of whom were operated as exploratory laparotomy with incidental appendectomy and 16.9 days of whom were operated as Right-hemicolectomy. 17 patients of 24 colonoscopy-done patients were recovered with conservative treatment, compared with only 7 patients of 22 colonoscopy-undone patients (P=0.0005). 2 cases of the conservatively managed groups were operated later due to recurrences (mean follow up periods=20 months). 2 operated patients had complications of postoperative ileus.
CONCLUSIONS
Based on our study, the indications of colonoscopy are that in whom impressed clinically as acute appendicitis, on physical examination there be obvious tenderness on right low quadrant but obscure rebound tenderness, on peripheral blood smear the WBC counts range from normal to mild increased (<15,000/mm2), and on ultrasonography, appendix couldn't be detected or colonic wall show thickening. In patients who selected fit for indications, colonoscopy is safe and highly sensitive. We would manage these patients more conservatively, and may reduce their hospital stay.

Difference in Clinical Features between Appendicitis and Right-Sided Colonic Diverticulitis on Initial Diagnosis.: Lee, Eun Kyu , Kim, Hungdai , Son, Beong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2005;21(4):201-206.

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Abstract PDF: PURPOSE
Most patients who are finally diagnosed as having cecal and right-sided colonic diverticulitis complain of pain in the right lower quadrant of the abdomen, many of them unfortunately undergo an emergency operation for presumed appendicitis. Our purpose was to differentiate the diagnosis of right-sided colonic diverticulitis from appendicitis in an emergency setting.
METHODS
We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among them, 92 patients who had been diagnosed as having right-sided colonic diverticulitis were classified as Group I. In the remaining 358 patients with appendicitis, 268 patients with simple appendicitis were classified as Group II and 90 patients with perforated appendicitis were classified as Group III.
RESULTS
The sex ratios were similar among 3 groups. The mean age of Group I (36.5+/-10.1 years) was significantly different from that of Group II (30.7+/-14.8 years, P=0.002), but not from that of Group III (38.7+/-20.9). Incidences of fever/chill and nausea/vomiting were less common in Group I (P<0.05). The duration of prodromal symptoms in Group I (2.6 days) was longer than that of Group II (1.6 days, P=0.02), but was not significantly different from that of Group III (3.3 days, P=0.83). The mean WBC count was significantly smaller in Group I (10913.8/mm3) than in Group II (13238.3/mm3) and III (15589.3/mm3, P<0.001). The percentage of segment form in differential counts was smaller in Group I (73.6%) than in Group II (79.1%) and III (81.8%, P<0.001). The percentage of lymphocytes in differential counts was larger in Group I (17.7%) than in Group II (13.9%) and Group III (9.4%, P<0.001).
CONCLUSIONS
Among the patients who complain of pain in the right lower quadrant abdomen in an emergency setting, cecum and right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations, relatively younger patients (20~40 years), infrequent prodromal symptoms, absent rebound tenderness with a laterally deviated maximal tenderness point, and absent or mild leucocytosis with a relatively low fraction of segment forms associated with a higher fraction of lymphocytes in CBC.

Surgical Management of Cecal Diverticulitis Detected during Appendectomy.: Park, Chul Woon , Kim, Bong Goo , Kim, Ki Sang , Byun, Young Hoon , Cho, Kwang Ho , Byun, Sang Hyun , Kim, Byung Ju; J Korean Soc Coloproctol. 2001;17(1):15-19.

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Abstract PDF: PURPOSE
Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease.
METHODS
Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998.
RESULTS
There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage.
CONCLUSION
We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.

Surgical Treatment of Right Colon Diverticulitis.: Lee, Do Sang , Lee, Chul Soo , Sung, Gi Young , Song, Moo Hyung , Kim, Wook , Park, Il Young , Won, Jong Man; J Korean Soc Coloproctol. 2000;16(5):302-308.

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Abstract PDF: PURPOSE
Diverticular disease of the cecum and ascending colon is a relatively uncommon disease and there are some difficulties in the accurate preoperative diagnosis and the proper surgical treatment. This study is aimed to determine what is the proper procedure during the emergency operation of right colon diverticulitis.
METHODS
This study is a retrospective clinical analysis of 86 cases of the right colon diverticulitis from January 1992 to December 1999.
RESULTS
1) The incidence of right colon diverticulitis (RCD) was 2.1% of that of appendicitis and the RCD to sigmoid colon diverticulitis ratio was 9.6:1.2) The highest incidence was noted at the fourth decades and average age was 37 years. Male to female ratio was 1.9:1. 3) Most patients (73 cases, 85%) had right lower quadrant abdominal pain. 4) The duration of symptom was less than 3 days in 54 cases (63%). 5) The preoperative confirmation by radiologic work-up was not decisive, but barium enema might be more accurate than other studies and CT was more accurate method than ultrasound. 6) The correct preoperative diagnosis was made only in 13 cases (15%) and the remaining misdiagnoses were appendicitis with or without complications in 72 cases (83%). 7) Operative procedures varied markedly according to multiplicity, extent of inflammation and complications; diverticulectomy and appendectomy in 48 cases (56%), ileocecectomy in 15 cases (17%) and right hemicolectomy in 11 cases (13%). 8) The most commom postoperative complication was wound infection. 9) Among the 30 cases who took diverticulectomy or diverticulectomy and appendectomy, remained diverticulums were found in 14 cases (47%), especially 11 cases (37%) on the right colon. And so multiplicity of right colon reached about 37%.
CONCLUSIONS
The authors suggest that one should suspect RCD in fourth decade patients with right lower quadrant pain for more than 3 days with unusual clinical findings. Barium enema can be used because of the high accuracy rate but CT is a safe tool in complicated or urgent situation. The operative modalities should be selected on the extent of the disease and it is sufficient to treat a single diverticulitis with diverticulectomy or diverticulectomy and appendectomy but right hemicolectomy should be recommanded in the suspicious multiplicity or malignancy.

Management of Cecal Diverticulitis.: Sung, Jong Je , Song, Dan , Hong, Gaun Yue , Park, Nae Kyeong; J Korean Soc Coloproctol. 2004;20(5):251-256.

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Abstract PDF: PURPOSE
Diverticular disease of the cecum and ascending colon is a relatively uncommon disease, and is often difficult to diagnose. The purpose of this study was to investigate the clinical features of patients who underwent surgical treatment for cecal diverticulitis.
METHODS
A retrospective review was conducted between January 1998 and December 2002 of 44 patients treated at the Department of Surgery, Soonchunghyang Gumi Hospital.
RESULTS
All patients presented with right lower quadrant pain and tenderness. Preoperatively, 34 patients were diagnosed with acute appendicitis. The surgical procedures for cecal diverticulitis were an appendectomy only (5 cases), a diverticulectomy with appendectomy (31 cases), and a right hemicolectomy (8 cases). Postoperative complications were found in 17 cases: wound infection (13 cases), and partial intestinal obstruction (2 cases).
CONCLUSIONS
When cecal diverticulitis is found at the time of an operation, surgical management is a safe treatment with low morbidity and a low recurrence rate. A diverticulectomy with appendectomy is a safe and effective procedure for the treatment of cecal diverticulitis if there is no evidence of free perforation or abscess formation. If the diverticulitis is complicated, undistinguishable from a malignancy, a resection (ileocecal resection, right hemicolectomy) should be considered for the surgical treatment.

Usefulness of Laparoscopic-assisted Surgery for the Treatment of Colonic Diverticulitis.: Ha, Seok Hyo , Kim, Gyu Sung , Jo, Hae Chang , Rhee, Jung Ahn , Bae, Byung Jo; J Korean Soc Coloproctol. 2004;20(1):20-26.

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Abstract PDF: PURPOSE
Colonic diverticulitis was rare in Korea in the past. However, it is progressively increasing probably because of a prolonged life span and a westernized diet pattern. Especially, right-sided colonic diverticulitis is difficult to differentiated from acute appendicitis. The purpose of this study was to verify the usefulness of laparoscopic-assisted surgery for the diagnosis and treatment of colonic diverticulitis.
METHODS
We retrospectively reviewed 65 patients with colonic diverticulitis who underwent surgery from January 1998 to December 2002.
RESULTS
The mean age of the patients was 36.3 years. Males were more prevalent than females (1.6:1). Abdominal ultrasonography (USG) was used as a diagnostic tool in 40 cases (61.5%), abdominal USG with colon enema in 8 cases (12.3%), and abdominal USG with abdominal CT in 4 cases (6.2%). The preoperative diagnosis was acute appendicitis in 52 patients (80.0%), perforated diverticulitis in 10 patients (15.4%), peritonitis in 2 patients (3.5%), and peptic ulcer perforation in 1 patient (1.5%). The postoperative diagnosis was simple diverticulitis in 47 cases (72.3%). The cecum was the most commonly involved area (55 cases, 84.6%). The types of open surgery were an appendectomy in 17 cases (26.1%), a right hemicolectomy in 17 cases (26.1%), a cecectomy in 6 cases (9.2%). The types of laparoscopic- assisted surgery were an appendectomy in 17 cases (26.1%), a laparoscopic-assisted right hemicolectomy in 4 cases (6.2%), and an anterior resection in 1 case (1.5%). The postoperative complication rate was 11.9% (5 cases). All of these occurred with the open technique, but no statistically significant difference existed between the complication rates for the two operative procedures (P=0.158). The mortality rate was zero for both operative procedures. The length of hospital stay (4.72+/-4.3 vs 10.1+/-6.2)(P=0.001) was significantly shorter in the laparoscopic-assisted group than in the open group.
CONCLUSIONS
Preoperative diagnosis is sometimes difficult in patients with colonic diverticulitis. We consider laparoscopic-assisted surgery to be a useful diagnostic and therapeutic modality in such cases. The laparoscopic technique offers particular advantages to diverticulitis patients because of the short hospital stay and the low morbidity and mortality rates.

Clinical Analysis of Right Colonic Diverticulitis That was Operated under the Impression of Acute Appendicitis.: Cho, Hyeoun Jun , Cho, Seung Yeon , Oh, Jae Hwan; J Korean Soc Coloproctol. 2000;16(1):18-24.

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Abstract PDF: PURPOSE
Because there are no significant differences of the clinical findings between the appendicitis and cecal diverticulitis, it is very difficult to make a correct diagnosis preoperatively and to choose a appropriate management intraoperatively. The purpose of this study is to investigate the clinical charateristics of right diveticulitis and to evaluate the appropriateness of surgical management.
METHODS
We reviewed 45 cases of right colonic diverticulitis which underwent emergency operation under the impression of acute appendicitis during 10 years from January 1988 to December 1997.
RESULTS
Of them, 38 cases were treated by diverticulectomy with appendectomy (Group I), and 7 cases were treated by resection (ileocecal resection or right hemicolectomy) (Group II). The male to female ratio was 4:1, and the mean age was 38.2 years. In Group I, all cases had a solitary inflamed cecal diverticulum. In group II, two cases had a solitary cecal diverticulitis, whereas five cases had multiple ones. Postoperative complications were found in 14 cases, but all of them were not significant. Postoperative Barium enema was performed in 22 cases of Group I, in two cases of Group II. In Group I, 8 cases had a residual diverticulum at postoperative Barium enema. In Group II, no residual diverticulum was shown. Follow-up study by Telephone was done at 16 cases, there were no symptomatic recurrences.
CONCLUSIONS
In conclusion, when right colonic diverticulitis is found at the time of operation, surgical management is a safe treatment with low morbidity and low recurrence rate. Diverticulectomy with appendectomy is a safe surgical procedure for the uncomplicated diverticulitis. If diverticulitis is complicating, multiple or undistinguishable with malignancy, resection (ileocecal resection, right hemicolectomy) should be considered as a primary surgical treatment. Postoperative colon study is helpful, due to high incidence of residual diverticulum.

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