Annals of Coloproctology

Original Articles

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

Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients: Jae Ho Park, Kyung Jong Kim; Ann Coloproctol. 2018;34(1):16-22. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.16

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Abstract PDF

Purpose

The management of a colonoscopic perforation (CP) varies from conservative to surgical. The objective of this study was to evaluate the outcomes between surgical and conservative treatment of patients with a CP.

Methods

From 2003 to 2016, the medical records of patients with CP were retrospectively reviewed. Patients were divided into 2 groups depending on whether they initially received conservative or surgical treatment.

Results

During the study period, a total of 48 patients with a CP were treated. Among them, 5 patients had underlying colorectal cancer and underwent emergency radical cancer surgery; these patients were excluded. The mean age of the remaining 43 patients was 64.5 years old, and the most common perforation site was the sigmoid colon (15 patients). The initial conservative care group included 16 patients, and the surgery group included 27 patients. In the conservative group, 5 patients required conversion to surgery (failure rate: 5 of 16 [31.3%]). Of the surgery group, laparoscopic surgery was performed on 19 patients and open surgery on 8 patients, including 2 conversion cases. Major postoperative complications developed in 11 patients (34.4%), and postoperative mortality developed in 4 patients (12.5%). The only predictor for poor prognosis after surgery was a high American Society of Anesthesiologists physical status classification.

Conclusion

In this study, conservative treatment for patients with a CP had a relatively high failure rate. Furthermore, surgical treatment showed significant rates of complications and mortality, which depended on the general status of the patients.

Citations

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Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef

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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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

The Necessity of a Routine Interval Appendectomy Necessary in Adults?: Initial Experience.: Park, Jong Deok , Lee, Chang Ho , Kim, Jong Hun , Kim, Yong Kon , Lee, Min Ro; J Korean Soc Coloproctol. 2010;26(1):12-16.; DOI: https://doi.org/10.3393/jksc.2010.26.1.12

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Abstract PDF: PURPOSE
The traditional management of a periappendiceal abscess or a perforated appendicitis has been initial conservative treatment, followed by an interval appendectomy (IA). However, the necessity of the interval appendectomy has been questioned by an increasing number of studies recently. The purpose of this study was to clarify the role of conservative treatment, instead of IA, in managing a perforated appendicitis or a periappendiceal abscess after successful initial conservative treatment.
METHODS
We prospectively studied 26 out of 80 patients who had been admitted for a perforated appendicitis or a periappendiceal abscess to Chonbuk National University Hospital from March 2005 to December 2007. These 26 patients were initially treated by using conservative treatment instead of surgery. We analyzed these 26 patients' progression and prognosis after treatment. The IAs were conducted at intervals of 6 to 12 wk after colonoscopy when the patient wanted an operation.
RESULTS
Twenty-three out of 26 (88.5%, 23/26) patients were improved after initial conservative treatment. Only 3 patients who were not improved were managed surgically. Four out of 23 patients who were relieved by conservative treatment underwent an IA voluntarily at intervals of 6 to 12 wk. Of the remaining 19 patients without IA, 1 patient (5%, 1/19) suffered a recurrence after 6 mo, and an appendectomy was performed. Eighteen (78%, 18/23) patients without an IA have shown no recurrence for 15 mo, and they are still being followed up.
CONCLUSION
We conclude that a routine IA after successful initial conservative treatment for a perforated appendicitis or a periappendiceal abscess seems unnecessary. Those patients should undergo colonoscopy to detect any underlying diseases and to rule out coexistent colorectal cancer.

Safety of Conservative Treatment of Colonoscopic Perforation.: Na, Eun Jong , Kim, Kyung Jong , Min, Young Don; J Korean Soc Coloproctol. 2005;21(6):384-389.

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Abstract PDF: PURPOSE
Colonoscopy is a relatively safe procedure. However, various complications, such as hemorrhage or perforation, can occur, and among them, perforation can lead to death. This study was designed to evaluate the clinical characteristics and the treatment of colonoscopic perforation, as well as the availability of conservative treatment as the initial management.
METHODS
We reviewed the medical records of the 11 patients who had been treated for colonoscopic perforation from May 2003 to April 2005.
RESULTS
Six perforations were related to diagnostic colonoscopy whereas five occurred from therapeutic colonoscopy. The sigmoid colon was the most common perforation site (6 patients), followed by the cecum 2 patients and the transverse colon, splenic flexure, and the rectum 1 patient each. Five patients were diagnosed during colonoscopy. Six patients were diagnosed 12~48 hours after the colonoscopy. Three patients who showed definite signs of peritonitis underwent emergency operations. A conservative treatment was done in eight patients; among them, one patient had an operation on the 3rd. day after the perforation. The remaining seven patients underwent conservative treatment and were followed for up to 1 month without complications. Among these patients, one patient had a recurrent perforation on the 33rd day after the initial perforation, and an operation was done.
CONCLUSIONS
These results suggest that conservative treatment in patients with colon perforations is safe and effective unless there are obvious signs of generalized peritonitis.

Randomized Controlled Trial

Topical Glyceryl Trinitrate (GTN) Versus Conservative Treatment (CT) in Chronic Anal Fissure: Prospective and Randomized Study.: Lee, Kwang Real , Cho, Kyung Ah , Hwang, Do Yeon , Kim, Kuhn Uk , Park, Weon Kap , Yoon, Seo Gu , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 2000;16(6):360-364.

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Abstract PDF: PURPOSE
This study was designed to compare the effect of treatment using glyceryl trinitrate (GTN) ointment with that of conservative treatment (CT) on chronic anal fissure.
METHODS
As a preliminary study, maximal resting pressures of the anal canal were checked in 13 patients having chronic anal fissure before and 10 minutes after application of 0.2% GTN ointment. As the study groups, 59 patients having chronic anal fissure were randomly allocated to the GTN and the placebo groups. All the patients in both groups were given oral analgesics, sedatives, and bulk-forming agents. They had applied 0.2% GTN ointment or a placebo ointment three times a day to their perianal skin. Maximal resting pressures of the anal canal were checked at the beginning and at the endpoint of the treatment period which continued for 6 weeks. If there was complete healing of the fissure in the middle of the treatment, the treatment was stopped. Sixteen patients were lost during the study.
RESULTS
Among the rest, 22 and 21 patients were included in the GTN group and the placebo group, respectively. The maximal resting pressure decreased significantly in all groups (p<0.05). The healing rates, the recurrence rates, and the operation rates were not significantly different between the GTN group and placebo group (p>0.05).
CONCLUSION
The effect of GTN on the symptomatic relief and results of treatment in patients having chronic anal fissure is not superior to that of conservative treatment.

Case Report

The Conservative Treatment of Rectal Perforation after Insertion of A Stent and Chemo-Radiotherephy in the Patient with Obstructive Rectal Cancer.: Jung, Jai Hun , Kim, Seog Mo , Kim, Cheong Yong , Ko, Kang Seog; J Korean Soc Coloproctol. 2000;16(1):41-46.

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Abstract PDF: The use of self-expanding metal stent has been widely reported that its utility can make a palliative decompression treatment and one stage operation without doing colostomy in the patient with unresectable and resectable obstructive colorectal cancer, respectively. It, however, can sometimes cause complications such as intestinal perforation. We report that the conservative treantment could be possible without removing stent or performing laparotomy in case of intestinal perforation during chemoradiotheraphy after insert of stent for relieving colonic obstruction in the 53 years old female patient with stage IV rectal cancer.

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