Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

Lee, Kil-Yong; Lee, Jae Im; Park, Youn Young; Oh, Seong Taek

doi:10.1186/s12876-021-01672-1

Cited by 6 publications

(16 citation statements)

References 20 publications

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“…The possible disadvantages of this approach are the difficulty in dissecting the inflamed diverticulum and the risk of inadequate treatment, as there is a risk of advanced adenomas and neoplasia. 22 30 Although none of our patients had incidental findings of cancer on the anatomopathological examination, other authors 25 30 have reported them.…”

Section: Discussionmentioning

confidence: 70%

“…22 Lee et al evaluated 330 patients with uncomplicated RCD and revealed that 20.9% had adenomas detected on follow-up colonoscopy, suggesting that routine colonoscopy should be advised even for patients with an uncomplicated crisis. 30 Regarding the classification of acute diverticulitis, in 1978, Hinchey et al 31 proposed classifying perforated diverticulitis from stages I (pericolic abscess) to IV (generalized fecal peritonitis) (►Table 2). Since then, with the introduction of CT to daily clinical practice, Wasvary et al, 32 in 1999, modified the original classification by adding non-complicated diverticulitis as stage 0, and subdivided stage I into two: stage Ia, with phlegmon or pericolic inflammation, and stage Ib, with pericolic or mesocolic abscess (►Table 3).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Sobrado

Caldas

Facanali

et al. 2022

Journal of Coloproctology

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Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy. Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment. Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed. Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period. Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Sobrado

Caldas

Facanali

et al. 2022

Journal of Coloproctology

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“…This retrospective study involved a cohort of 162 patients (age ≥18 years), treated at the Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. Acute RCD was defined according to previous studies, as the presence of colonic diverticular disease with localized colonic wall thickening and/or stranding of pericolonic fat [1,11,18]. A diagnosis of acute RCD was confirmed by abdominal ultrasonography (US), computed tomography (CT), colonoscopy, and further clinical assessments.…”

Section: Patients and Data Collectionmentioning

confidence: 99%

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Chen

Zhou

et al. 2022

Preprint

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Background: Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD. Methods: We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment. Results: A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis. Conclusions: Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.

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“…[8] Differentiation between acute uncomplicated and complicated diverticulitis seems debatable concerning the need for a routine colonoscopy. [9][10][11][12][13][14] Most industrialized countries have implemented screening programs for the early detection of CRC. Furthermore, it is established that screening colonoscopy (SC) is cost-effective and preventive.…”

Section: Introductionmentioning

confidence: 99%

To Scope or not to Scope; Value of Routine Colonoscopy after Uncomplicated Diverticulitis in Switzerland. A Retrospective Cohort Study

Hess

Gnägi

Seppey

et al. 2022

Preprint

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Purpose Diverticular disease is common in the western world. Due to the risk of undetected underlying colorectal cancer, most guidelines recommend a follow-up colonoscopy after an episode of diverticulitis. With the increased accuracy of computer tomography scans, there is an increased challenge to these guidelines in cases of uncomplicated diverticulitis. The aim of this study was to investigate the compliance to the recommended follow-up colonoscopies and to report the incidence of detection of advanced neoplasms. Methods In this single-center retrospective cohort study, all patients > 18 years that were admitted to the Hospital Center Biel with an episode of acute uncomplicated diverticulitis between 01.01.2013 and 31.12.2017 were identified. The incidence of advanced neoplasia was calculated by analyzing the follow-up colonoscopies performed and reviewing the histological findings. Results 257 Patients with uncomplicated diverticulitis were included in this study. The mean age of the patients was 63 (range 22–96) years, and 54.5% were female. In 197 (77%) patients we recommended a follow-up colonoscopy. However, only 144 (73%) of these patients underwent the procedure. In the histological analysis, 2 (1.2%) carcinomas, one high-grade adenoma (0.6%) and 20 low-grade adenomas (12%) were detected. Conclusion The compliance to the recommendation of follow-up colonoscopies after uncomplicated diverticulitis is poor and has to be improved. A follow-up colonoscopy has its justification because of relevant findings in almost 14% of patients, more so in patients above screening age with 20% pathological findings, including 2 (5%) carcinomas.

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Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

Cited by 6 publications

References 20 publications

Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

To Scope or not to Scope; Value of Routine Colonoscopy after Uncomplicated Diverticulitis in Switzerland. A Retrospective Cohort Study

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