Treatment of right colonic diverticulitis: the role of nonoperative treatment

Ma Ru Kim, Bong-Hyeon Kye, Hyung Jin Kim, Hyeon-Min Cho, Seong Taek Oh, Jun-Gi Kim, Ma Ru Kim, Bong-Hyeon Kye, Hyung Jin Kim, Hyeon-Min Cho, Seong Taek Oh, Jun-Gi Kim

Abstract

Purpose: The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis.

Methods: One hundred fifty-eight patients with right-sided colonic diverticulitis were evaluated. Clinical history, physical and radiologic findings, and treatments were reviewed retrospectively. Also, additional episodes and treatment modalities were checked.

Results: Our patients were classified according to treatment modality; 135 patients (85.4%) underwent conservative treatment, including antibiotics and bowel rest, and 23 patients (14.6%) underwent surgery. The mean follow-up length was 37.3 months, and 17 patients (17.5%) underwent recurrent right-sided colonic diverticulitis. Based on treatment modality, including surgery and antibiotics, no significant differences in the clinical features and the recurrence rates were noted between the two groups.

Conclusion: Conservative management with bowel rest and antibiotics could be considered as a safe and effective option for treating right-sided colonic diverticulitis. This treatment option for right-sided colonic diverticulitis, even if the disease is complicated, may be the treatment of choice.

Keywords: Colonic diverticulitis; Diverticulitis; Drug therapy.

Conflict of interest statement

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

Figures

Fig. 1
Fig. 1
CT shows complicated diverticulitis on the cecum; a 5.6 × 5.4 cm2 ill-defined, mass-like heterogeneous contrast-enhancing lesion in the pericecal area.

References

    1. Lee IK, Kim SH, Lee YS, Kim HJ, Lee SK, Kang WK, et al. Diverticulitis of the right colon: tips for preoperative diagnosis and treatment strategy. J Korean Soc Coloproctol. 2007;23:223–231.
    1. Lo CY, Chu KW. Acute diverticulitis of the right colon. Am J Surg. 1996;171:244–246.
    1. Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, et al. Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004;187:233–237.
    1. Park JK, Sung JK, Choi SH, Yun SS, Lee S. Clinical analysis of right colon diverticulitis. J Korean Surg Soc. 2003;64:44–48.
    1. Lane JS, Sarkar R, Schmit PJ, Chandler CF, Thompson JE., Jr Surgical approach to cecal diverticulitis. J Am Coll Surg. 1999;188:629–634.
    1. Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, et al. Management of right colon diverticulitis: a 10-year experience. World J Surg. 2006;30:1929–1934.
    1. Kim KY, Kim IK, Jung SW, Park KH, Park YJ. Analysis on the surgical treatment of colonic diverticulitis. J Korean Surg Soc. 2007;73:36–41.
    1. Oh JP, Kim BG. Cecal Diverticulitis and its managements. J Korean Surg Soc. 1997;53:243–251.
    1. Cho HJ, Cho SY, Oh JH. Clinical analysis of right colonic diverticulitis that was operated under the impression of acute appendicitis. J Korean Soc Coloproctol. 2000;16:18–24.
    1. Janes S, Meagher A, Faragher IG, Shedda S, Frizelle FA. The place of elective surgery following acute diverticulitis in young patients: when is surgery indicated? An analysis of the literature. Dis Colon Rectum. 2009;52:1008–1016.
    1. Park HC, Chang MY, Lee BH. Nonoperative management of right colonic diverticulitis using radiologic evaluation. Colorectal Dis. 2010;12:105–108.
    1. Moon HJ, Park JK, Lee JI, Lee JH, Shin HJ, Kim WS, et al. Conservative treatment for patients with acute right colonic diverticulitis. Am Surg. 2007;73:1237–1241.
    1. Kang JY, Melville D, Maxwell JD. Epidemiology and management of diverticular disease of the colon. Drugs Aging. 2004;21:211–228.
    1. Shyung LR, Lin SC, Shih SC, Kao CR, Chou SY. Decision making in right-sided diverticulitis. World J Gastroenterol. 2003;9:606–608.
    1. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Aggressive resection is indicated for cecal diverticulitis. Am J Surg. 2003;185:135–140.
    1. Kirkwood KS, Maa J. The appendix. In: Sabiston DC, Townsend CM, editors. Sabiston textbook of surgery: the biological basis of modern surgical practice. 18th ed. Philadelphia: Saunders/Elsevier; 2008. pp. 1333–1347.
    1. Matsushima K. Management of right-sided diverticulitis: a retrospective review from a hospital in Japan. Surg Today. 2010;40:321–325.
    1. Yang SC, Lee KP, Shon SK, Kim MW, Min JS. Clinical analysis of colonic diverticular disease in Koreans. Korean J Gastroenterol. 1987;19:485–490.
    1. Park SJ, Choi SI, Lee SH, Lee KY. Image-guided conservative management of right colonic diverticulitis. World J Gastroenterol. 2009;15:5838–5842.
    1. Tonelli F, Di Carlo V, Liscia G, Serventi A. Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons. Ann Ital Chir. 2009;80:3–8.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir