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KMID : 0356720070230040223
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Journal of the Korean Society of Coloproctology
2007 Volume.23 No. 4 p.223 ~ p.231
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Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy
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Lee In-Kyu
Kim Soo-Hong
Lee Yoon-Suk
Kim Hyung Jin
Lee Sang-Kuon
Kang Won-Kyung
An Chang-Hyeok
Oh Seung-Tack
Jeon Hae-Myung
Kim Jun-Gi
Kim Eung-Kook
Chang Suk-Kyun
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Abstract
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Purpose: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively
diagnosed patients, the recurrence rate, and the hospital stay by treatment modality.
Methods: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics.
Results: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P＜0.001): 4.9±3.1 days in Group 1, 7.5±3.7 days in Group 2, and 3.8±0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P= 0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086).
Conclusions: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence
rate. J Korean Soc Coloproctol 2007;23:223-231
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KEYWORD
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Diverticulitis, Right colon, Diagnosis, Treatment strategy
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