Langenbeck's Archives of Surgery

, Volume 392, Issue 2, pp 143–147 | Cite as

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

  • P. Hildebrand
  • M. Kropp
  • F. Stellmacher
  • U. J. Roblick
  • H.-P. Bruch
  • O. Schwandner
Original Article

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.

Keywords

Diverticulitis Right colon Appendicitis Surgery 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • P. Hildebrand
    • 1
  • M. Kropp
    • 1
  • F. Stellmacher
    • 2
  • U. J. Roblick
    • 1
  • H.-P. Bruch
    • 1
  • O. Schwandner
    • 3
  1. 1.Department of SurgeryUniversity Hospital Schleswig-Holstein, Campus LübeckLübeckGermany
  2. 2.Department of PathologyUniversity Hospital Schleswig-Holstein, Campus LübeckLübeckGermany
  3. 3.Department of SurgeryCaritas-Krankenhaus St. JosefRegensburgGermany

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