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Short- and Long-Term Outcomes of Right-Sided Diverticulitis: Over 15 Years of North American Experience

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Abstract

Background

Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center.

Methods

This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis.

Results

Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2–130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001).

Conclusions

Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.

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Acknowledgements

This project was presented as a poster at the following conferences: American Society of Colon and Rectal Surgeons Tripartite Meeting in Seattle, Washington, USA, from June 10–14, 2017; Canadian Association of General Surgeons Canadian Surgery Forum in Victoria, British Columbia, Canada, from September 14–16, 2017; and University of Toronto Division of General Surgery Annual Assembly in Toronto, Ontario, Canada, on May 16, 2018.

Funding

This project was not funded by a grant or financial relationship.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Jesse Zuckerman

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada

    Richard Garfinkle, Carol-Ann Vasilevksy, Gabriela Ghitulescu, Julio Faria, Nancy Morin & Marylise Boutros

  3. Faculty of Medicine, McGill University, Montreal, Canada

    Marylise Boutros

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  1. Jesse Zuckerman
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  2. Richard Garfinkle
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  3. Carol-Ann Vasilevksy
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  4. Gabriela Ghitulescu
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  5. Julio Faria
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  7. Marylise Boutros
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Correspondence to Marylise Boutros.

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Zuckerman, J., Garfinkle, R., Vasilevksy, CA. et al. Short- and Long-Term Outcomes of Right-Sided Diverticulitis: Over 15 Years of North American Experience. World J Surg 44, 1994–2001 (2020). https://doi.org/10.1007/s00268-020-05431-3

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  • DOI: https://doi.org/10.1007/s00268-020-05431-3

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