The Surgical Rate and Recurrence Rate in Right Colonic Diverticulitis Using the CT-Based Modified Hinchey Classification

Abstract

Purpose:The purpose of this report is to retrospectively analyze the need for surgery, and the recurrence rate, using a CT-based method in patients with right colonic diverticulitis. Materials and Methods: For the purposes of our study, we included 416 patients with a mean age of 41.9 (238 of which were men), with a diagnosis of colonic diverticulitis that was based on CT findings. These findings were reviewed by two independent radiologists, who localized diverticulitis and determined it using a modified Hinchey classification. We were able to follow-up with 384 patients over a period of 30 months. Results: Out of the 416 patients, 396 of them had right colonic diverticulitis. In right colonic diverticulitis, the κ value in determining the modified Hinchey classification was 0.80. 98.2% (389/396) of the patients with right colonic diverticulitis had stages Ia-II. The surgery rate was 4.6% (17/366) and 28% (5/18) for right and left colonic diverticulitis, respectively (p < 0.001). In the instances of right colonic diverticulitis, the surgery rate was 2.8% (10/359) for stages Ia-II, while all seven patients with stage III or IV underwent surgery. The recurrence rate was 6.5% (23/356) and 15% (2/13) for right and left colonic diverticulitis, respectively (p = 0.224). Conclusion:The CT-based modified Hinchey classification of right colonic diverticulitis showed good interobserver agreement. Most patients with right colonic diverticulitis had lower stages (Ia-II) at the point of CT, rarely needed surgery, and had a low recurrence rate. Index termsCT Colon Diverticulitis Surgery Recurrence

Conventional-Dose CT Versus 2-mSv CT for Right Colonic Diverticulitis as an Alternate Diagnosis of Appendicitis: Secondary Analysis of Large Pragmatic Randomized Trial Data

“…Previous studies [5,6,14] on the CT diagnosis of right colonic diverticulitis had important limitations. First, without surgical or pathologic confirmation, it was necessary to determine disease positivity based on the index test (i.e., CT) itself in most included patients.…”

“…complications requiring surgery were expected to be rare. Before retrospective image review, the readers were requested to review an article [5] summarizing typical image findings of right colonic diverticulitis (e.g., inflamed diverticula with adjacent fat infiltration and/or segmental colonic wall thickening).…”

“…First, to our knowledge, this is the first study to formally measure the diagnostic performance of CT for right colonic diverticulitis. Assessment of diagnostic performance was inherently limited in previous studies [5,6,14] that included only patients with right colonic diverticulitis as their final diagnosis. Second, although the bias associated with lack of an independent reference standard is impossible to mitigate, we carefully designed the study to mitigate this bias.…”

“…The two conditions are similar in symptoms and physical findings [1,2] but very different in management. Surgery is rarely indicated for right colonic diverticulitis [3,4] because recurrence or complications including perforation or fistula are much rarer and milder than in left colonic diverticulitis [2,[5][6][7], with unclear underlying mechanism. The reported surgical rate for right colonic diverticulitis was only 4% in a large retrospective cohort study [5].…”

“…Surgery is rarely indicated for right colonic diverticulitis [3,4] because recurrence or complications including perforation or fistula are much rarer and milder than in left colonic diverticulitis [2,[5][6][7], with unclear underlying mechanism. The reported surgical rate for right colonic diverticulitis was only 4% in a large retrospective cohort study [5]. Differentiating right colonic diverticulitis from appendicitis is important, particularly in Eastern Asia, where the prevalence of right colonic diverticulitis is higher than in other geographic regions [1,8].…”