Short- and Long-Term Outcomes of Right-Sided Diverticulitis: Over 15 Years of North American Experience.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
27
2
2020
medline:
21
1
2021
entrez:
27
2
2020
Statut:
ppublish
Résumé
Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center. This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis. Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001). Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
Sections du résumé
BACKGROUND
Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center.
METHODS
This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis.
RESULTS
Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001).
CONCLUSIONS
Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
Identifiants
pubmed: 32100064
doi: 10.1007/s00268-020-05431-3
pii: 10.1007/s00268-020-05431-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1994-2001Références
Dis Colon Rectum. 2020 Mar 23;:
pubmed: 32217858
Br J Surg. 2012 Feb;99(2):276-85
pubmed: 22105809
Am Surg. 1997 Oct;63(10):871-3
pubmed: 9322661
J Gastrointest Surg. 2017 Jan;21(1):78-84
pubmed: 27456012
Int J Colorectal Dis. 2013 Jun;28(6):849-54
pubmed: 23070046
Radiology. 1998 Sep;208(3):611-8
pubmed: 9722836
Surg Today. 2010 Apr;40(4):321-5
pubmed: 20339986
Dig Dis Sci. 2008 Dec;53(12):3049-54
pubmed: 18463980
Gastrointest Tumors. 2017 Mar;3(3-4):136-140
pubmed: 28611980
Int J Colorectal Dis. 2002 Nov;17(6):365-73
pubmed: 12355211
World J Gastroenterol. 2014 Aug 7;20(29):10115-20
pubmed: 25110438
Dis Colon Rectum. 2013 Nov;56(11):1259-64
pubmed: 24105001
Am J Surg. 1993 Dec;166(6):666-9; discussion 669-71
pubmed: 8273846
Langenbecks Arch Surg. 2007 Mar;392(2):143-7
pubmed: 17072664
Dis Colon Rectum. 2014 Mar;57(3):284-94
pubmed: 24509449
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1609-13
pubmed: 23856358
Am J Surg. 2004 Feb;187(2):233-7
pubmed: 14769311
Dis Colon Rectum. 2011 Jun;54(6):663-71
pubmed: 21552049
J Clin Gastroenterol. 2016 Aug;50(7):611-2
pubmed: 26974757
World J Surg. 2006 Oct;30(10):1929-34
pubmed: 16983473
J Am Coll Surg. 1999 Jun;188(6):629-34; discussion 634-5
pubmed: 10359355
Intest Res. 2017 Apr;15(2):195-202
pubmed: 28522949
BMC Res Notes. 2011 Oct 06;4:383
pubmed: 21978459
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Dis Colon Rectum. 2010 Jun;53(6):861-5
pubmed: 20484998
Eur J Gastroenterol Hepatol. 2012 Nov;24(11):1254-8
pubmed: 22872077
Gastrointest Endosc. 2014 Mar;79(3):378-89; quiz 498-498.e5
pubmed: 24434085
Dis Colon Rectum. 2011 Mar;54(3):283-8
pubmed: 21304297
Dis Colon Rectum. 1982 Apr;25(3):254-6
pubmed: 7067566
ANZ J Surg. 2014 Mar;84(3):181-4
pubmed: 23796226
Lancet. 2004 Feb 21;363(9409):631-9
pubmed: 14987890
Am Surg. 1999 Jul;65(7):632-5; discussion 636
pubmed: 10399971
Surg Endosc. 2012 Oct;26(10):2926-30
pubmed: 22538691
Ann Surg. 2010 Apr;251(4):670-4
pubmed: 20224374
Dis Colon Rectum. 2016 Mar;59(3):216-23
pubmed: 26855396
Dis Colon Rectum. 1984 Jul;27(7):454-8
pubmed: 6745016
World J Surg. 2007 Feb;31(2):383-7
pubmed: 17219286
Int J Colorectal Dis. 2008 Dec;23(12):1151-7
pubmed: 18704462
Dis Colon Rectum. 2016 Oct;59(10):e437
pubmed: 27602936
J Korean Soc Coloproctol. 2010 Dec;26(6):402-6
pubmed: 21221240