Skip to main content


Log in

Perforated diverticulitis: is the right and left difference present here too?

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript



It is unclear if location of disease matters in perforated diverticulitis. Management guidelines for perforated diverticulitis currently do not make a distinction between right perforated diverticulitis (RPD) and left perforated diverticulitis (LPD). We aim to compare disease presentation and management outcomes between RPD and LPD.


This was a 10-year retrospective comparative cohort study of 99 patients with acute perforated diverticulitis between 2004 and 2013 in a single institution. Patients were divided into RPD and LPD groups based on location of disease and compared. Disease presentation was compared using modified Hinchey classification. Management outcomes assessed were failure of therapy, length of stay, mortality, surgical complications, and disease recurrence. Univariate analysis was performed using Student’s t test and χ2 test where appropriate.


RPD patients were younger (45.7 ± 16.1 versus 58.3 ± 14.7 years) and presented with lower modified Hinchey stage and no Hinchey IV diverticulitis when compared to LPD (14.3% Hinchey III versus 44.0% Hinchey III or IV). Conservative management of Hinchey I and II RPD and LPD was similarly successful (96.1 versus 96.5%), although RPD patients had shorter inpatient stay (4.6 ± 2.2 versus 6.3 ± 3.8 days) and less disease recurrence (3.1 versus 17.9%). Ten (20.4%) Hinchey I and II RPD patients were initially misdiagnosed with appendicitis and underwent surgery.


LPD is a more aggressive disease presenting with greater clinical severity in older patients and is associated with frequent disease recurrence when treated conservatively. Misdiagnosis of RPD as appendicitis is common and may lead to unnecessary surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Kim JH, Cheon JH, Park S, Kim BC, Lee SK, Il KT et al (2008) Relationship between disease location and age, obesity, and complications in Korean patients with acute diverticulitis: a comparison of clinical patterns with those of Western populations. Hepatogastroenterology 55(84):983–986

    PubMed  Google Scholar 

  2. Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T (1984) Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum 27(8):531–537

    Article  CAS  PubMed  Google Scholar 

  3. Chan CC, Lo KK, Chung EC, Lo SS, Hon TY (1998) Colonic diverticulosis in Hong Kong: distribution pattern and clinical significance. Clin Radiol 53(11):842–844

    Article  CAS  PubMed  Google Scholar 

  4. Lee Y-S (1986) Diverticular disease of the large bowel in Singapore. Dis Colon Rectum 29(5):330–335

    Article  CAS  PubMed  Google Scholar 

  5. Tan K-K, Wong J, Yan Z, Chong C-S, Liu JZ, Sim R (2014) Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg 84(3):181–184

    Article  PubMed  Google Scholar 

  6. Reisman Y, Ziv Y, Kravrovitc D, Negri M, Wolloch Y, Halevy A (1999) Diverticulitis: the effect of age and location on the course of disease. Int J Color Dis 14(4–5):250–254

    Article  CAS  Google Scholar 

  7. Hughes LE (1969) Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis. Gut 10(5):336–344

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Magness LJ, Sanfelippo PM, van Heerden JA, Judd ES (1975) Diverticular disease of the right colon. Surg Gynecol Obstet 140(1):30–32

    CAS  PubMed  Google Scholar 

  9. Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, Yamamoto T (2015) Characteristics of colonic diverticulitis and factors associated with complications. Dis Colon Rectum 58(12):1174–1181

    Article  PubMed  Google Scholar 

  10. Schneider LV, Millet I, Boulay-Coletta I, Taourel P, Loriau J, Zins M (2017) Right colonic diverticulitis in Caucasians: presentation and outcomes versus left-sided disease. Abdom Radiol 42(3):810–817

    Article  Google Scholar 

  11. Oh H-K, Han EC, Ha H-K, Choe EK, Moon SH, Ryoo S-B, Jeong SY, Park KJ (2014) Surgical management of colonic diverticular disease: discrepancy between right- and left-sided diseases. World J Gastroenterol 20(29):10115–10120

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim SH, Byun CG, Cha JW, Choi SH, Kho YT, Seo DY (2010) Comparative study of the clinical features and treatment for right and left colonic diverticulitis. J Korean Soc Coloproctol 26(6):407–412

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003) Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 186(6):696–701

    Article  PubMed  Google Scholar 

  14. Kruis W, Germer C-T, Leifeld L, German Society for Gastroenterology, Digestive and Metabolic Diseases and The German Society for General and Visceral Surgery (2014) Diverticular disease: guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery. Digestion 90(3):190–207

    Article  PubMed  Google Scholar 

  15. Andersen JC, Bundgaard L, Elbrønd H, Laurberg S, Walker LR, Støvring J, Danish Surgical Society (2012) Danish national guidelines for treatment of diverticular disease. Dan Med J 59(5):C4453

    PubMed  Google Scholar 

  16. Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54(6):663–671

    Article  PubMed  Google Scholar 

  17. Horesh N, Wasserberg N, Zbar AP, Gravetz A, Berger Y, Gutman M, Rosin D, Zmora O (2016) Changing paradigms in the management of diverticulitis. Int J Surg 33:146–150

    Article  PubMed  Google Scholar 

  18. Nelson RS, Ewing BM, Wengert TJ, Thorson AG (2008) Clinical outcomes of complicated diverticulitis managed nonoperatively. Am J Surg 196(6):969–974

    Article  PubMed  Google Scholar 

  19. Wasvary H, Turfah F, Kadro O, Beauregard W (1999) Same hospitalization resection for acute diverticulitis. Am Surg 65(7):632–635 discussion 636

    CAS  PubMed  Google Scholar 

  20. Chung BH, Ha GW, Lee MR, Kim JH, Meijerink W, Cuesta M (2016) Management of colonic diverticulitis tailored to location and severity: comparison of the right and the left colon. Ann Coloproctol 32(6):228–233

    Article  PubMed  PubMed Central  Google Scholar 

  21. Law WL, Lo CY, Chu KW (2001 Sep) Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions. Int J Color Dis 16(5):280–284

    Article  CAS  Google Scholar 

  22. Ha GW, Lee MR, Kim JH (2015) Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg. Apr;n/a-n/a

  23. Bridoux V, Antor M, Schwarz L, Cahais J, Khalil H, Michot F, Tuech JJ (2014) Elective operation after acute complicated diverticulitis: is it still mandatory? World J Gastroenterol 20(25):8166–8172

    Article  PubMed  PubMed Central  Google Scholar 

  24. Germer CT, Reibetanz J (2017) Hohes Rezidivrisko nach konservativer Therapie einer komplizierten Divertikulitis. Der Chir 88(3):258–258

    Article  CAS  Google Scholar 

  25. Lamb MN, Kaiser AM (2014) Elective resection versus observation after nonoperative management of complicated diverticulitis with abscess: a systematic review and meta-analysis. Dis Colon Rectum 57(12):1430–1440

    Article  PubMed  Google Scholar 

  26. Andeweg CS, Berg R, Staal JB, ten Broek RPG, van Goor H (2016) Patient-reported outcomes after conservative or surgical management of recurrent and chronic complaints of diverticulitis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 14(2):183–190

    Article  PubMed  Google Scholar 

  27. Buchwald P, Dixon L, Wakeman CJ, Eglinton TW, Frizelle FA (2016) Hinchey I and II diverticular abscesses: long-term outcome of conservative treatment. ANZ J Surg

  28. Kaiser AM, Jiang J-K, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, Essani R, Beart RW (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100(4):910–917

    Article  PubMed  Google Scholar 

  29. Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97(6):952–957

    Article  CAS  PubMed  Google Scholar 

  30. Toro A, Mannino M, Reale G, Cappello G, Di Carlo I (2012) Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years. Chirurgia (Bucur) 107(5):598–604

    CAS  Google Scholar 

  31. Cirocchi R, Trastulli S, Vettoretto N, Milani D, Cavaliere D, Renzi C, Adamenko O, Desiderio J, Burattini MF, Parisi A, Arezzo A, Fingerhut A (2015) Laparoscopic peritoneal lavage. Medicine (Baltimore) 94(1):e334

    Article  Google Scholar 

  32. Reyes-Espejel L, Ruiz-Campos M, Correa-Rovelo JM, García-Osogobio S (2015) Sigmoidectomía con anastomosis primaria para diverticulitis complicada. Rev Gastroenterol México 80(4):255–259

    Article  CAS  Google Scholar 

  33. Escalante GR, Bustamante-Lopez L, Lizcano A, Acosta MB (2016) Peritoneal lavage in complicated acute diverticulitis. J Clin Gastroenterol 50:S83–S85

    Article  Google Scholar 

  34. Shin J-H, Son B-H, Kim H (2007) Clinically distinguishing between appendicitis and right-sided colonic diverticulitis at initial presentation. Yonsei Med J 48(3):511–516

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lee IK, Jung SE, Gorden DL, Lee YS, Jung DY, Oh ST, Kim JG, Jeon HM, Chang SK (2008) The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Color Dis 23(12):1151–1157

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Wijaya Ramesh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soh, N.Y.T., Teo, N.Z., Tan, C.J.H. et al. Perforated diverticulitis: is the right and left difference present here too?. Int J Colorectal Dis 33, 525–529 (2018).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: