Emergency surgery for right colonic diverticulitis has a low morbidity versus left-sided disease

Abstract

Purpose/Background: Right-sided diverticulitis is much more common in Asians compared to Caucasians. Clinically its presentation mimics acute appendicitis. The aim of this study was to analyze and compare the outcome of right colonic diverticulitis with those of left-sided disease. Methods/Interventions: We conducted a retrospective review of patients presenting with diverticulitis from 2004 to 2014 to a tertiary referral unit. Patient demographics, Hinchey classification, need for emergency surgery, perioperative outcome and recurrence were evaluated. Results/Outcome(s): In total 360 patients presented with diverticulitis, of which 218(61%) were right-sided disease and 142 (39%) were left-sided. The mean age was 61 years. One hundred and fifty-nine (44%) patients were male; 201 (55%) were female. All patients presented with abdominal pain. Leukocytosis and fever were present in 253 (70%) and 136 (38%) patients respectively. The mean hospital stay was 9 days. The majority of patients were Hinchey I (278, 77%) and II (38, 11%). The mean age (Right: 57yrs vs Left: 68yrs; p<0.001) and length of stay (Right: 6 days vs 15 days; p< 0.001) were significantly less in right diverticulitis. Cardiovascular disease (P<0.001) and accidents (p=0.003) were more likely in patients with left diverticulitis. There was no significant difference in sex or the need for emergency surgery between the 2 groups. One hundred patients (28%) underwent emergency surgery. Sixty-seven (31%) patients with right diverticulitis required emergency surgery however 53 (79%) of these were based on a presumptive clinical diagnosis of acute appendicitis. When these were excluded, left diverticulitis patients were more likely to require emergency surgery (Right 4% vs Left 9%, p<0.001). Postoperative morbidity was also significantly higher (Right 7% vs Left 36%, p<0.04). There was no difference in operative or 30-day mortality. Recurrence rate was 8% and 10% in right and left-sided disease respectively (p=0.6). Conclusions/Discussion: Diverticulitis of the right colon is a common clinical entity in the Asian population. Without proper imaging, their presentation can often be confused with appendicitis. Patients are younger and the disease course is more benign. In cases where emergency surgery is required, right-sided diverticulitis is associated with a lower operative morbidity compared to left-sided disease.