Diverticulitis of the right colon revisited.

Abstract

R ight colonic diverticulitis is an an common disorderthat is usually mistaken clinically for acute ap pendicitis.In the past, diagnosishas rarely been made preoperatively. If CT is performed for suspected acuteappendicitis, however, the correct diagnosis of right colonic diverticulitis can often be suggested or established. Unless complicationssuch as abscessformationor free perforation haveoccurred,patientsmay be initiallytreatedmedicallywithouttheneedfor surgery, in contrast with patients with acute appendicitis. The purposeof this articleis to review the clinical and imaging featuresof right-sided colonic diverticulitis, with empha sis on the CT appearance of this condition. Potier

Image-guided conservative management of right colonicdiverticulitis

“…To date, no therapeutic guidelines for patients with right colonic diverticulitis have been established [3,[6][7][8][9][19][20][21] . In contrast, practice parameters for the treatment of left colonic diverticulitis do exist [17] .…”

“…Many studies have focused on left colonic diverticulitis and subsequently, therapeutic guidelines have been established, while that of right colonic diverticulitis still remains controversial [2][3][4][5][6][7][8] . In the past, the majority of patients with right colonic diverticulitis were faced with an operation for presumed appendicitis [3,4,9] .…”

“…Much of this information is based on case series data, which have relatively small sample sizes and the preoperative diagnosis was not made using imaging studies. Recent studies suggest that colonic diverticulitis can be correctly diagnosed by computed tomography (CT) scan [6,7,10] , or ultrasonography (US) [11][12][13][14] , and with the use of these imaging studies, right colonic diverticulitis is more common than has been previously assumed [7] . The aim of this study was to evaluate the clinical course and results of medical therapy in patients with right colonic diverticulitis, of which the final diagnosis was based on radiographic evidence from CT or US, or operative findings.…”

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

“…operative, treatment of RCD in Caucasians [3,5,[19][20][21][23][24][25]. The historical concept that RCD in the Western world was a more aggressive disease than LCD was merely a reflection of the unfamiliarity with this disease, an inadequate diagnostic workup and decision making in the operating room.…”

“…However, results of this approach in Caucasian RCD patients is hardly supported by evidence. The data consist mainly of case series, evaluating patients in whom RCD was diagnosed postoperatively, and point into a more aggressive therapy in RCD [3,5,[19][20][21][23][24][25]. However, a high operative rate of RCD precludes knowledge on the natural disease course of RCD.…”