Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

Abstract

Background: In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis. Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared. Results: 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis (P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment. Conclusions: In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.