Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina

René M Palacios Huatuco, Diana A Pantoja Pachajoa, Julian E Liaño, Héctor A Picón Molina, Rafael Palencia, Alejandro M Doniquian, Matías Parodi, René M Palacios Huatuco, Diana A Pantoja Pachajoa, Julian E Liaño, Héctor A Picón Molina, Rafael Palencia, Alejandro M Doniquian, Matías Parodi

Abstract

Purpose: In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD).

Methods: In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed.

Results: Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34).

Conclusion: Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.

Keywords: Colonic diverticulitis; Conservative treatment; Hepatic flexure; Neutrophil to lymphocyte ratio; South America.

Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Institutional algorithm for the diagnosis and treatment of acute diverticulitis. CT, computed tomography; ICU, intensive care unit. aModified Hinchey classification by Wasvary. bAntibiotics adjusted according to the renal function.
Fig. 2.
Fig. 2.
Computed tomotraphy of the abdomen and pelvis showing (A) a severe inflammatory process of diverticular origin at the level of the hepatic flexure of the colon (red circle), and (B) pericolonic fat involvement and thickening of the colon wall (red circle).
Fig. 3.
Fig. 3.
Abdominal computed tomography of a 35-year-old Caucasian female patient. (A) Axial section, acute diverticulitis in the ascending colon. (B) Coronal section, solitary diverticulum. The red circles illustrate the inflamed diverticulum.

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