Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period.

Abstract

INTRODUCTION:

In contrast to sigmoid diverticular disease, right colonic diverticulitis is a rare disease in Western countries. The clinical presentation is often similar to acute appendicitis.

OBJECTIVE:

The aim of this study was to analyze surgical challenge in right-sided diverticulitis.

MATERIALS AND METHODS:

All patients who underwent resection for both right-sided and sigmoid diverticular disease were registered prospectively in a database (observation period, 1996-2005). A retrospective analysis of all patients who underwent resection for right-sided colonic diverticulitis (ileocolic resection, right colectomy) was performed. Special focus was set on incidence, clinical symptoms, indication, procedure, clinical outcome, and histopathologic findings including immunohistochemistry.

RESULTS:

From a total of 593 patients treated surgically for recurring or acute complicated diverticular disease, the majority (97.8%) suffered from sigmoid diverticulitis (n = 580), whereas 2.2% (n = 16) underwent surgery for right-sided diverticulitis (including three patients with combined sigmoid and cecal diverticulitis). Related to the total number of appendectomies (n = 1167), this represented an incidence of 1.4%. In five of 16 patients, acute appendicitis was presumed preoperatively. Most common diagnostic was ultrasonography. In the group of patients with right-sided diverticulitis, the most common procedure was right hemicolectomy (n = 10), followed by ileocolic resection (n = 3) and combined right colonic resection with sigmoid resection (n = 3). Histopathological investigation confirmed complicated diverticulitis of the cecum with local perforation or abscess in 75% of the patients (12/16). Hypoganglionosis or aganglionosis was diagnosed in seven of the 16 resected specimens.

DISCUSSION:

As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis may be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis. As most cases will remain clinically unimminent, surgery is only indicated in complicated right-sided cases. Resection of the inflamed colonic segment with primary anastomosis is safe and can be performed laparoscopically. It can only be speculated whether hypoganglionosis or aganglionosis is a causative factor in the etiology of right-sided diverticulitis.

• Authors: P Hildebrand, M Kropp, F Stellmacher, U J Roblick, H-P Bruch, O Schwandner
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 392 Issue 2 Pg. 143-7 (Mar 2007) ISSN: 1435-2443 [Print] Germany
• PMID: 17072664 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Diverticulitis, Colonic (metabolism, pathology, surgery)
• Female
• Humans
• Immunohistochemistry
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Sigmoid Diseases (surgery)
• Treatment Outcome