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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
  • 4,433 View
  • 143 Download
  • 2 Web of Science
  • 1 Citations
AbstractAbstract PDF
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
  • 3,777 View
  • 64 Download
AbstractAbstract 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
  • 6,916 View
  • 173 Download
  • 13 Web of Science
  • 13 Citations
AbstractAbstract 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  
  • 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
  • 29,196 View
  • 104 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract 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
  • 5,076 View
  • 98 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract 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
  • 4,216 View
  • 69 Download
  • 6 Web of Science
  • 6 Citations
AbstractAbstract PDFSupplementary 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
  • 4,471 View
  • 96 Download
  • 23 Web of Science
  • 23 Citations
AbstractAbstract 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  
  • 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
  • 6,327 View
  • 50 Download
  • 19 Web of Science
  • 19 Citations
AbstractAbstract 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  
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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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AbstractAbstract 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
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    Stephan K. Böhm
    coloproctology.2023; 45(3): 163.     CrossRef
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    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
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    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
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    Guhyun Kang, Soomin Son, Young-Min Shin, Jung-Soo Pyo
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    Julius Pochhammer, Axel Kramer, Matthias Orth, Michael Schäffer, Jan Henrik Beckmann
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    Maxime Barat, Anthony Dohan, Karine Pautrat, Mourad Boudiaf, Raphael Dautry, Youcef Guerrache, Marc Pocard, Christine Hoeffel, Clarisse Eveno, Philippe Soyer
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    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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  • 8 Citations
AbstractAbstract 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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    Marcus Yeow, Nicholas Syn, Choon Seng Chong
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    Matthew Symer, Heather L. Yeo
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    Ryan Francis Bendl, Roberto Bergamaschi
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    Ryan Lamm, Steven N. Mathews, Jie Yang, Lijuan Kang, Dana Telem, Aurora D. Pryor, Mark Talamini, Jill Genua
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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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  • 3 Citations
AbstractAbstract 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

Citations to this article as recorded by  
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    Liliane C. Meireles, Samuel R. Fernandes, Luis C. Ribeiro, José Velosa
    European Journal of Gastroenterology & Hepatology.2015; 27(12): 1429.     CrossRef
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    Antonio Tursi
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    Geom Seog Seo, Suck Chei Choi
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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
  • 6,548 View
  • 57 Download
  • 22 Citations
AbstractAbstract 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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    Ilias Galanis, Georgios Floros, Christophoros Theodoropoulos, Myriam Metaxa, Panagiotis Theodoropoulos, Panagiotis Tsintavis, Dimitrios Bartziotas, Georgios Giannos, Georgios Stylianidis, Georgios Papadopoulos, Hirotada Akiho
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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
  • 3,694 View
  • 41 Download
  • 13 Citations
AbstractAbstract 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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    Sarah Kling, Simran Kripalani, Joceline V. Vu
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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
  • 5,694 View
  • 37 Download
  • 28 Citations
AbstractAbstract 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

Citations to this article as recorded by  
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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
  • 6,695 View
  • 51 Download
  • 16 Citations
AbstractAbstract 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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