Abstract
BackgroundThe incidence of colonic diverticular disease varies with national origin, cultural background and diet. The frequency of this disease increases with advancing age. Right-sided diverticular disease is uncommon and reported to occur in 1-2% of surgical specimens in European and American series. In contrast the disease is more prevalent and reported in 43-50% of specimens in Asian series. Various lines of evidence suggest this variation may represent hereditary differences. The aim of the study is to report all cases of right sided diverticular disease underwent surgical resection or identified during pathological examination of right hemicoloectomy specimensMethodsA retrospective review of all surgical specimens with right sided colonic diverticular disease selected from a larger database of all colonic diverticulosis and diverticulitis surgical specimen reported between January 1993 and December 2010 at the Pathology Department McMaster University Medical Centre Canada. The clinical and pathological features of these cases were reviewedResultsThe review identified 15 cases of right colon diverticulosis. The clinical diagnoses of these cases were appendicitis, diverticulitis or adenocarcinoma. Eight cases of single congenital perforated diverticuli were identified and seven cases were incidental multiple acquired diverticuli found in specimen resected for right side colonic carcinomas/large adenomas. Laparotomy or laparoscopic assisted haemicolectomies were done for all cases. Pathological examination showed caecal wall thickening with inflammation associated with perforated diverticuli. Histology confirmed true solitary diverticuli that exhibited in two cases thick walled vessels in the submucosa and muscular layer indicating vascular malformation/angiodysplasia. Acquired diverticuli tend to be multiple and are mostly seen in specimens resected for neoplastic right colon diseases.ConclusionSingle true diverticular disease of the right colon is usually of congenital type and affects younger age group and may be associated with angiodysplasia in some cases. Multiple false diverticuli are more seen in association with caecal carcinoma or large adenomas. These are usually asymptomatic and are more seen in older patients. However this study dose not reflects the true incidence of the disease in the general population.
Highlights
The incidence of colonic diverticular disease varies with national origin, cultural background and diet
Two cases presented with bright red blood per rectum and one with a large enough bleed to require two units of packed red blood cells Three patients presented with acute abdomen with features of perforation and emergency exploratory surgery was performed
The other cases were incidental findings encountered during the examination of right hemicoloectomy specimens resected for colonic carcinoma or large villous adenoma
Summary
The incidence of colonic diverticular disease varies with national origin, cultural background and diet. The prevalence depends on variable factors such as national origin, cultural background and consumed diet The occurrence of this disease appears to increases with age [1]. Human cancers produce several types of matrix metalloproteinase (MMPs) that are able to degrade extracellular matrix [4] and perhaps lead to the development of diverticular disease. Patients with this disease are usually asymptomatic; 10-20% of those affected may present with clinical symptoms, due to complication of diverticular diseases such as inflammation or hemorrhage. The incidence of diverticular disease is on the rise, due to the growing of the elderly population [4,5]
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