Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Zhilong Ma, Weiwei Liu, Jia Zhou, Le Yao, Wangcheng Xie, Mingqi Su, Jin Yang, Jun Shao, Ji Chen, Zhilong Ma, Weiwei Liu, Jia Zhou, Le Yao, Wangcheng Xie, Mingqi Su, Jin Yang, Jun Shao, Ji Chen

Abstract

Background: Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD.

Methods: We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment.

Results: A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis.

Conclusions: Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.

Keywords: Acute Right Colon Diverticulitis; Conservative treatment; Recurrence; Surgical treatment.

Conflict of interest statement

All authors declare that they have no conflict of interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
A Hinchey stage I diverticulitis: Arrow points to the inflamed cecal diverticulum with thickening of the colonic wall of the cecum, the patient received conservative. B Hinchey stage II diverticulitis: Arrow points to inflamed mass, the patient was executed diverticulectomy with appendectomy. C Hinchey stage III diverticulitis: Arrow points to localized abscess, the patient was executed ileocecal resection. D Hinchey stage IV diverticulitis: Arrow points to free air and ruptured abscess, the patient underwent emergency right hemicolectomy
Fig. 2
Fig. 2
Flow and outcomes of study patients

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