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. 2021 Dec 27;13(12):1721-1735.
doi: 10.4240/wjgs.v13.i12.1721.

Right sided diverticulitis in western countries: A review

Angelo Gabriele Epifani  1 , Diletta Cassini  2 , Roberto Cirocchi  3 , Caterina Accardo  1 , Francesca Di Candido  4 , Massimiliano Ardu  4 , Gianandrea Baldazzi  4
Affiliations

Right sided diverticulitis in western countries: A review

Angelo Gabriele Epifani et al. World J Gastrointest Surg. .

Abstract

Background: Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.

Aim: To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.

Methods: MEDLINE and PubMed searches were performed using the key words "right-sided diverticulitis'', ''right colon diverticulitis'', ''caecal diverticulitis'', ''ascending colon diverticulitis'' and ''caecum diverticula'' in order to find relevant articles published until 2021.

Results: A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.

Conclusion: The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.

Keywords: Cecal diverticulitis; Diverticulitis; Emergency surgery; Right colonic diverticulitis; Right-sided diverticulitis; Western countries.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Process of studies screening.
Figure 2
Figure 2
World map of included studies: number of patients in each country.
Figure 3
Figure 3
Diagnostic-therapeutic algorithm. uARCD: Uncomplicated acute right-sided colonic diverticulitis; NOM: Non-operative management; cARCD: Complicated acute right-sided colonic diverticulitis; VLS: Videolaparoscopy.
See this image and copyright information in PMC

References

    1. Imaeda H, Hibi T. The Burden of Diverticular Disease and Its Complications: West vs East. Inflamm Intest Dis. 2018;3:61–68. - PMC - PubMed
    1. Markham NI, Li AK. Diverticulitis of the right colon--experience from Hong Kong. Gut. 1992;33:547–549. - PMC - PubMed
    1. Faucheron JL, Roblin X, Bichard P, Heluwaert F. The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage. Colorectal Dis. 2013;15:e266–e270. - PubMed
    1. Blachut K, Paradowski L, Garcarek J. Prevalence and distribution of the colonic diverticulosis. Review of 417 cases from Lower Silesia in Poland. Rom J Gastroenterol. 2004;13:281–285. - PubMed
    1. De Cecco CN, Ciolina M, Annibale B, Rengo M, Bellini D, Muscogiuri G, Maruotti A, Saba L, Iafrate F, Laghi A. Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC) Eur Radiol. 2016;26:639–645. - PubMed