Image-guided conservative management of right colonicdiverticulitis

Abstract

AIM:To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS:The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS:Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION:Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

The Surgical Rate and Recurrence Rate in Right Colonic Diverticulitis Using the CT-Based Modified Hinchey Classification

“…These findings corroborate previous smaller studies that advocated non-surgical treatment for patients with right colonic diverticulitis (4,18,19). The uncomplicated disease course in these patients is similar to that of stage Ia of left colonic diverticulitis (20,21).…”

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

“…Successful results of non-operative management of uncomplicated RCD in both Western and Asian patients have been published before [6,12,14,24,[28][29][30][31]37,40]. All but one of our RCD patients received antibiotics as part of their conservative treatment.…”

“…Taking into account the mild disease course of RCD demonstrated by this study and the good results of non-operative, and even non-antibiotic, therapy found in recent Asian studies, it seems justified to use the same diagnostic and treatment guideline for both left-and right-sided diverticulitis. Imaging also allows clinicians to determine the optimal management according to the severity of the diverticulitis [40]. This policy will definitively shift RCD from a surgical diagnosis to a radiological diagnosis.…”

Acute right‐sided colonic diverticulitis mimicking appendicitis: A report of two cases

“…The impact of diverticular disease on Western society is substantial, affecting 50% of those older than 60 years, and up to 80% of those aged 80 years and older 5. Diverticular disease is predominant in the left colon in Western populations, whereas it is much more common in the right colon in Asians 3–6. Of those with diverticular disease, 10–25% will develop diverticulitis 7…”