Right-Sided Diverticulitis May Be Treated Conservatively

A new study shows that most patients with acute right-sided diverticulitis seldom require emergency surgery, unless acute appendicitis is misdiagnosed preoperatively.

A researcher at Okinawa Prefectural Chubu Hospital (Okinawa, Japan) conducted a retrospective review of the medical records of 100 patients with acute right-sided diverticulitis, admitted to the hospital between 1994 and 2005, with the aim of establishing guidelines for patients with right-sided diverticulitis--a rare clinical entity in Western countries. At present, there are only guidelines for those with acute left-sided diverticulitis, despite the fact that in some Asian countries diverticulitis affects the right side of the colon more often than the left side.

The results showed that the mean age of these patients was significantly lower than that of those with left-sided diverticulitis (43.4 years compared to 54.8 years, respectively). Emergency laparotomy was performed for suspected acute appendicitis in 10 of these patients. Initial conservative therapy did not fail in any of the remaining 100 patients, although 5 of these patients underwent subsequent elective surgery, and 8 (8.4%) of the remaining 95 patients suffered recurrent right-sided diverticulitis, which was treated successfully with conservative therapy. The study was published in the April 2010 issue of Surgery Today.

"Most cases of uncomplicated right-sided diverticulitis, even if it is recurrent, can be treated conservatively,” concluded study author Kazuhide Matsushima, M.D., of the department of surgery.

Diverticulitis is a common digestive disease usually found in the large intestine. Diverticulitis develops from diverticulosis, the formation of pouches (diverticula) on the outer surface of the colon; diverticulitis results if one of these diverticula becomes inflamed. Patients often present with a classic triad of left lower quadrant pain, fever, and leukocytosis, and may also complain of nausea or diarrhea; others may be constipated. Left-sided diverticular disease (involving the sigmoid colon) is most common in the West, while right-sided diverticular disease is more prevalent in Asia and Africa.

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Okinawa Prefectural Chubu Hospital