Right-sided acute diverticulitis: A single Western center experience

Monari, Francesco; Cervellera, Maurizio; Pirrera, Basilio; D'errico, Umberto; Vaccari, Samuele; Alberici, Laura; Tonini, Valeria

doi:10.1016/j.ijsu.2017.06.025

Cited by 15 publications

(22 citation statements)

References 18 publications

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“…[17] However, even appendicitis can show equivocal Alvarado scores and some studies revealed that ARCD patients had a higher or broader range of Alvarado scores. [21][22][23] Therefore, it may not be enough to use this scoring system as a tool to distinguishable between these diseases. Although the Alvarado scores showed a difference between the two groups in our single variable analysis, with a 6-point median value in AA and a 5-point median value in ARCD, it would be difficult to assign clinical meaning because scores of 5 to 6 have an equivocal probability for appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Clinical difference between acute appendicitis and acute right-sided colonic diverticulitis

Song

Lee

et al. 2020

Preprint

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Background: The clinical presentations of acute appendicitis (AA) and acute right-sided colonic diverticulitis (ARCD) are similar, but the usual treatment for each disease differs between surgical and conservative management. This study aimed to identify the clinical differences between AA and ARCD.Method: We performed a single-center retrospective case-control study on adult patients with AA and ARCD confirmed by computed tomography who had visited an emergency department between March 2018 and February 2019. The clinical variables, including past medical history, presented symptoms and signs, and laboratory findings were compared between the two groups. We subsequently performed a logistic regression analysis for differentiating ARCD from AA based on the results of univariate analyses.Results: A total of 222 (79%) and 59 (21%) patients were enrolled in the AA and ARSD groups, respectively. Logistic regression analysis revealed that factors associated with ARCD were a past history of diverticulitis [OR 141.691 (95% CI: 12.222 – 1642.601), p < 0.001], ketonuria [OR 0.268 (95% CI: 0.099 – 0.726), p = 0.010], anorexia [OR 0.037 (95% CI: 0.007 – 0.207), p < 0.001], and neutrophilia [OR 0.179 (95% CI: 0.062 – 0.519), p = 0.002].Conclusion: Anorexia, neutrophilia, and ketonuria were predictors of AA and a history of diverticulitis was a predictor of ARCD.

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Section: Discussionmentioning

confidence: 99%

Clinical difference between acute appendicitis and acute right-sided colonic diverticulitis

Song

Lee

et al. 2020

Preprint

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“…Diverticula are defined as sac-like protrusions from the large intestine wall due to a combination of anatomical, dietary, motility and structural influences [5]. They are divided in two general anatomical types, true and false.…”

Section: Discussionmentioning

confidence: 99%

“Sigmoid diverticulitis mimicking cholecystitis” a clinical challenge

et al. 2019

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Diverticular disease is a common disorder and its incidence increases with ageing. Pathophysiology is multifactorial. Lifestyle, including smoking, alcohol intake, decreased dietary fibres and lack of physical activity, plays a predominant role. Genetics seems also to contribute specifically for right-sided diverticular disease (RSD). The majority of the patients with diverticular disease are asymptomatic. Diverticulitis is the inflammation of the diverticula usually presenting with abdominal pain associated to nausea, vomiting, rectal bleeding, diarrhoea and fever. When the inflammation process affects the diverticula in the ascending colon, the condition represents a clinical challenge as it can be easily misdiagnosed with other acute abdominal emergencies. We reported a case of a 70-year-old female who presented to our Emergency Department (ED) with right upper quadrant pain and an initial clinical suspicion of cholecystitis. Ultrasound (US) and Computed Tomography (CT) demonstrated an anatomical variation of the sigmoid colon diverticulitis. This clinical report demonstrates that ultrasound plays a relevant part as first-step approach to the acute abdominal conditions and its accuracy increases together with other diagnostic tools such as Computer Tomography.

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“…11 While diverticulosis commonly develops on the rightsided colon among Asian populations, such a presentation is rare among Western populations. [1][2][3][4][5][6] Kang et al indicated that the characteristics of colonic diverticular disease may differ in Asian and Western populations. 12 As such, the current study sought to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding.…”

Section: Long-term Outcomesmentioning

confidence: 99%

“…1,2 However, Western populations predominantly develop colonic diverticular disease in the left-sided colon, whereas Asian populations present with right-sided disease. [3][4][5][6] Although right-sided colonic diverticula usually remain asymptomatic, complications, such as diverticulitis, fistula, abscess, and bleeding, may occur. 3 As such, the Japanese Gastroenterological Association had published a clinical guideline for colonic diverticular bleeding and diverticulitis 1 that indicated the effectiveness of endoscopic hemostasis for colonic diverticular bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Although right-sided colonic diverticula usually remain asymptomatic, complications, such as diverticulitis, fistula, abscess, and bleeding, may occur. 3 As such, the Japanese Gastroenterological Association had published a clinical guideline for colonic diverticular bleeding and diverticulitis 1 that indicated the effectiveness of endoscopic hemostasis for colonic diverticular bleeding. Thereafter, arterial embolization or surgery had been recommended for rebleeding after endoscopic hemostasis.…”

Section: Introductionmentioning

confidence: 99%

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Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases

Kameyama

Yamazaki

Iwaya

et al. 2021

Asian J Endoscop Surgery

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Introduction: While Asian populations develop colonic diverticular disease predominantly in the right colon, Western populations mainly present with left-sided disease. The present study aimed to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding. Methods: Medical records of 43 patients who underwent surgery for rightsided colonic diverticular bleeding between 2010 and 2019 were reviewed. Those whose general condition became unstable underwent open surgery at our institution. Patients were then divided into two groups, the open surgery group (n = 17) and laparoscopic surgery group (n = 26), after which operative outcomes between both groups were compared. Results: This study included 36 men and seven women with a median age of 76 (range: 37-91) years. Laparoscopic surgery had a significantly longer operative time (183.5 minutes vs 110 minutes; P < .001) and significantly lower intraoperative blood transfusion rate (19.2% vs 82.4%; P < .001) than open surgery. The laparoscopic surgery group had earlier resumption of postoperative meals than open surgery group (postoperative day 3 vs postoperative day 4; P = .010). No significant difference in postoperative complications was observed between both groups. With regard to long-term outcomes, none of the cases exhibited rebleeding from the right-sided colon. Conclusion:The present study revealed that laparoscopic surgery promoted lower intraoperative blood transfusion rates and earlier resumption of postoperative meals compared to open surgery for right-sided colonic diverticular bleeding. Hence, laparoscopic surgery can be feasible for right-sided colonic diverticular bleeding provided that the patientʼs general condition is stable.

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Right-sided acute diverticulitis: A single Western center experience

Abstract: RCD is a rare but not irrelevant condition. Minimally invasive surgery is often feasible and complication rate is low. In selected patients, diverticulectomy can be a valid alternative to treat this condition providing improved postoperative results.

Cited by 15 publications

References 18 publications

Clinical difference between acute appendicitis and acute right-sided colonic diverticulitis

Clinical difference between acute appendicitis and acute right-sided colonic diverticulitis

“Sigmoid diverticulitis mimicking cholecystitis” a clinical challenge

Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases

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