Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy

Abstract

Received May 25, 2007, Accepted June 11, 2007 Correspondence to: Suk Kyun Chang, Department of Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62, Youido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: +82-2-3779-1175, Fax: +82-2-786-0802 E-mail: cmcgslee@catholic.ac.kr Purpo se: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotom y. W e retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatm ent m odality. M etho ds: Among 104 patients w ho w ere treated for right colonic diverticulitis from January 1997 to M ay 2005, w e enrolled 90 patients who had been diagnosed by the operation or a barium enem a study (BE), and who had not been lost to follow -up. Patients were divided into three groups based on treatment modality: Group 1 (n= 28), conservative m anagement w ith intravenous antibiotics; Group 2 (n= 46), aggressive resection; Group 3 (n= 16), appendectomy w ith intravenous antibiotics. Results: U ltrasound and computed tomography (CT) detected 12 (22.6% ) and 21 (87.5% ) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2% ) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3% ). The length of hospital stay was significantly different between the groups (P<0.001): 4.9± 3.1 days in Group 1, 7.5± 3.7 days in Group 2, and 3.8± 0.9 days in Group 3. Two patients (7.1% ) in Group 1, 2 patients (4.3% ) in Group 2, and 5 patients (31.3% ) in Group 3 had recurrent diverticulitis during the follow-up period (P= 0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P= 0.0086). C o nclusio ns: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate. J Korean Soc C oloprocto l 2007;23:223-231