Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period

Abstract

As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis may be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis. As most cases will remain clinically unimminent, surgery is only indicated in complicated right-sided cases. Resection of the inflamed colonic segment with primary anastomosis is safe and can be performed laparoscopically. It can only be speculated whether hypoganglionosis or aganglionosis is a causative factor in the etiology of right-sided diverticulitis.

Is there need for surgery to confirm diagnosis of right-sided diverticulitis in spite of relevant clinical and radiological findings?

“…[23] Therefore, it is logical to perform surgical treatment only if complications of diverticulitis occur or malignancy is strongly suspected based on clinical findings. [8,24,25] Recurrence after conservative treatment of RCD has been reported in previous studies. In Komuta's study, failure of conservative management was 20.5% (16 of 80 patients with acute uncomplicated RCD).…”

“…Surgical treatment may be necessary for diverticular bleeding unresponsive to conservative management, or recurrent and/or complicated diverticulitis in cases with perforation, abscess formation, intestinal obstruction, or fistula. [2,8] Therefore, treatment of RCD remains a controversial issue.…”

Right Colonic Diverticular Perforation With Lateral Abdominal Wall Abscess: A Rare Occurrence

“…Factors such as the number of episodes of inflammation, the age of the patient, and his/her overall medical condition play a role in determining whether or not a patient should undergo surgical resection. Prophylactic resection to avoid complications is not justified [4,5].…”

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

“…Although RCD is more often diagnosed due to the routine use of radiological imaging, incidence of RCD remains low in the Western world [1][2][3]. In countries like Korea, China or Japan, the incidence of RCD is about a tenfold higher [4][5][6].…”

“…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.…”