Colonic diverticulitis in young <scp>A</scp>sians: a predominantly mild and right‐sided disease

Tan, Ker‐Kan; Wong, Joshua; Yan, Zhiyan; Chong, Choon Seng; Liu, Jody Z; Sim, Richard

doi:10.1111/ans.12273

Cited by 32 publications

(23 citation statements)

References 23 publications

(70 reference statements)

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“…This study noted that diverticulitis in young (<50 years of age) Asians is also often right-sided and mild in nature, with recurrent episodes an uncommon occurrence [12].…”

Section: Discussionmentioning

confidence: 65%

Caecal diverticulitis: Presentation and management

Cristaudo

Pillay

Naidu

2015

Annals of Medicine &Amp; Surgery

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IntroductionWhile left sided colonic diverticular disease is common in Western countries, right sided colonic diverticular disease is rare. With increasing migration from Asia, many western countries including Australia, are now seeing more right sided diverticular disease, of which caecal diverticulitis is the commonest. This study aims to determine the incidence of caecal diverticulitis in patients presenting with colonic diverticulitis, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis.MethodsData was collected using the Queen Elizabeth II Hospital medical records database identifying patients diagnosed with colonic diverticulitis and, more specifically, those with caecal diverticulitis from January 2007 to December 2013. Only those patients who had confirmed caecal diverticulitis on imaging studies or at laparoscopy on their first admission were included in this study.ResultsA total of 632 patients with colonic diverticulitis were admitted to our institution over a seven-year period, of which 13 patients had caecal diverticulitis (2.06%). Of the 13 patients, twelve were of Asian background and ten were considered young (≤50 years of age). The main complaints were right sided abdominal pain (n = 11, 84.6%) and diarrhoea (n = 5, 38.5%). Nine were diagnosed using computed tomography (n = 9/10, 90%), three on laparoscopy and one using ultrasound (n = 1/2, 50%). Ten patients were treated successfully by conservative means.DiscussionA high index of suspicion in Asian patients with atypical symptoms of appendicitis, especially diarrhoea, may provide the diagnosis of caecal diverticulitis.

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“…This study noted that diverticulitis in young (<50 years of age) Asians is also often right-sided and mild in nature, with recurrent episodes an uncommon occurrence [12].…”

Section: Discussionmentioning

confidence: 65%

Caecal diverticulitis: Presentation and management

Cristaudo

Pillay

Naidu

2015

Annals of Medicine &Amp; Surgery

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“…In contrast, several Asian studies demonstrate good results of a conservative management of RCD patients. Moreover, these studies demonstrate that acute RCD patients present with less complications and have a milder disease course than LCD patients [4,9,10,[12][13][14][29][30][31].…”

Section: Introductionmentioning

confidence: 76%

“…In the Asian population, colonic diverticulitis is merely a disease of middle aged patients, mostly right-sided, and originating from solitary true congenital diverticula in the cecum. The typical muscular wall hypertrophy seen in LCD, is never present in RCD [9][10][11][12][13][14]. On the contrary, diverticulitis in Caucasians is mainly a disease of the elderly population, commonly left-sided, and originating from multiple acquired pseudo-diverticula [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Disease Course of Right- and Left-sided Diverticulitis in a Western Population

Wegdam¹,

Andeweg²

2016

J Gastrointest Dig Syst

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Aim: To evaluate the similarities and differences in disease courses between right-and left-sided diverticulitis in a Western population. Methods:All consecutive patients admitted in a Dutch regional hospital between 2004 and 2008 for conservative or operative management of clinically and radiologically confirmed acute right-and left-sided diverticulitis were analyzed retrospectively. Diverticulitis was clinically suspect if the patient presented with lower abdominal pain combined with at least one elevated inflammatory parameter (temperature, WBC, CRP or ESR). Diverticulitis was radiologically confirmed if at least US or CT demonstrated signs of acute right-or left-sided diverticulitis. Differences in incidence, patient characteristics, clinical presentation and disease course between the two diagnoses were analyzed. Results:The hospital system yielded 425 patients with a diverticulosis/diverticulitis discharge coding. 57% was excluded because these patients had another diagnosis demonstrated by imaging, besides diverticulosis (19%), had no imaging at all (16%), were elective or referred (7%), were not admitted (4%) or had other reasons (11%). A total of 183 admitted patients with both clinical and radiological confirmed acute colonic diverticulitis were included. The incidence of right-sided diverticulitis was 8%. Patients with right-sided diverticulitis were predominantly female (86% compared to 47% in leftsided diverticulitis, P = 0.05). Median CRP at presentation was lower in right sided diverticulitis, 30 compared to 71 mg/L (P = 0.001). No other differences in clinical presentation, like the severity of diverticulitis, and disease course, like the need for acute surgery, were found between right and left-sided diverticulitis.Conclusions: Disease course of acute right-sided diverticulitis in Caucasians is comparable to left-sided diverticulitis. Left-sided diverticulitis treatment guidelines may also apply for the right-sided diverticulitis in Caucasians.

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“…Diverticulosis can affect any part of the colon, and although left-sided diverticulosis is more common in Europe and North America: the right colon is more commonly affected in Japan, Singapore and China [3,4]. The pathogenesis of diverticular disease is thought to involve an interplay of low dietary fibre resulting in high intraluminal pressures within the colon, disordered gut motility and increased colonic wall resistance [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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Colonic diverticulitis in young Asians: a predominantly mild and right‐sided disease

Cited by 32 publications

References 23 publications

Caecal diverticulitis: Presentation and management

Caecal diverticulitis: Presentation and management

Disease Course of Right- and Left-sided Diverticulitis in a Western Population

Management of Acute Diverticulitis and its Complications

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