Right Colonic Perforation in an Asian Population: Predictors of Morbidity and Mortality

Abstract

Diverticulitis is the commonest cause of right colonic perforation in Asians. Patients with higher ASA score and malignant perforation are at risk of higher morbidity and mortality. Resection with primary anastomosis is safe and patients who require stomas are more likely to do worse.

There Is No Role for Colonoscopy after Diverticulitis among Asian Patients Less than 50 Years of Age

“…In contrast, although there were only 7 cases of left-sided diverticulitis in our study, 1 patient had faeculent peritonitis, suggesting that right-sided diverticulitis may take on a more indolent course compared to the left-sided disease. This has been supported in several recent local studies [6][7][8] .…”

“…Right-sided diverticulitis was determined as lesions arising from the caecum to the transverse colon [7,8] . Hinchey's classification was used to grade the severity of the diverticulitis [9,10] .…”

Predictors of Outcome Following Surgery in Colonic Perforation: An Institution’s Experience Over 6 Years

“…7,8 This has resulted in a significant proportion of patients undergoing unnecessary surgery on the misdiagnosis of acute appendicitis. 9 To complicate matters, left-sided diverticuli in the elderly Asian population still result in similar complications observed in the Western population. [21][22][23] This is also seen [18][19][20] Grade of complications (GOC)…”

“…MPI has been adopted in our institution in recent years and has been shown to correspond to the patients' outcome. 9,[30][31][32] Compared to right-sided perforation, over 80% of our patients with left-sided perforation had stoma created with Hartmann's procedure accounting for 90% of them. Even though there was no difference seen in the degree of peritonitis or ASA score, the likely explanation for this difference is due to the higher quoted incidence of an anastomotic dehiscence in a colocolic or colorectal anastomosis compared to an ileo-colic anastomosis, especially in an unprepared colon.…”

“…[5][6][7][8] Differentiation between malignant from diverticular perforation is also crucial as it determines the extent of surgery, but data are limited in the current literature. 9 Furthermore, the ideal surgical procedure in tackling colonic perforation is still controversial with a wide spectrum of recommendations. [10][11][12][13][14][15] All these issues prompted us to undertake this study with the primary aim to review the outcome of patients who underwent surgery for colonic perforation.…”