The effectiveness of conservative approach in right colon diverticulitis

Abstract

BACKGROUND: Approximately 10%-25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis. METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated. RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment. CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.

2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting

“…As a treatment option, non-operative methods should be preferred, in cases without diffuse peritonitis although differentiating benign and malignant cases pre-operatively is often difficult [123]. Surgical treatment is usually used in the treatment of complicated cases [116,124,125]. Resection of the inflamed colon with primary anastomosis can be performed by laparoscopy in experienced centers [126].…”

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

“…As a treatment option, non-operative methods should be preferred in cases without diffuse peritonitis, although differentiating benign and malignant cases pre-operatively is often difficult [ 164 ]. Surgical treatment is usually used in the management of complicated cases [ 165 , 166 ]. Resection of the inflamed colon with primary anastomosis may be performed laparoscopically in experienced centers [ 167 ].…”

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

“…Although both our own study and previous studies [14,21] showed that conservative treatment of acute RCD was safe and effective, it remains unclear whether or not patients with uncomplicated and complicated RCD are both recommended for the same treatment. All patients were, therefore, divided into either a uncomplicated group or a complicated group, according to their radiological imaging features and clinical assessment.…”

“…Conservative treatment with intravenous antibiotics and bowel rest is usually recommended for the management of acute uncomplicated RCD in Asia [12][13][14][15].…”