Department of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, 37000 Tours, France.
Department of Digestive Surgery, Rouen University Hospital, 76000 Rouen, France.
J Visc Surg. 2019 Sep;156(4):296-304. doi: 10.1016/j.jviscsurg.2019.01.005. Epub 2019 Jan 23.
Right colonic Diverticulitis (RD) is rare in Europe; few studies have focused on it and its management is not standardised. The aim of this study was to analyse the clinical presentation (complicated, uncomplicated), acute phase management and long-term outcome of RD in western countries.
From 2003 to 2017, 93 consecutive patients who presented with RD were retrospectively included at 11 French Hospital Centres.
The study population consisted of two groups: Uncomplicated Right Diverticulitis (URD) group (63.5%, (n=59)) and Complicated Right Diverticulitis (CRD) group (36.5%, [n=34]). 84.7% (n=50/59) of URD were treated conservatively. 41.2% (n=14/34) of patients with CRD had emergency surgery (mostly laparotomy) for Hinchey III peritonitis, clinical intolerance or hemodynamic instability. Altogether 5.2% (n=2/34) patients with CRD had surgery after a cooling off period (initially abscess). The overall rate of severe postoperative complications was low (8%). Recurrence rate was low and comparable in both groups: 6.8% (n=4/59) for URD and 8.8% (n=3/34) for CRD, all recurrences occurred in the same locations with an uncomplicated form, 42.9% (n=3/7) of them had elective laparoscopic surgery and the rest were conservatively treated. Median follow up was 33.2 months.
Conservative treatment can be proposed safely and efficiently for URD and for selected patients with CRD. Surgery should be reserved for unstable patients or patients with severe forms of complicated diverticulitis in emergency.
右结肠憩室炎（RD）在欧洲较为罕见；鲜有研究对此进行专门探讨，其治疗也尚未标准化。本研究旨在分析西方国家 RD 的临床表现（复杂型、非复杂型）、急性期管理和长期结局。
2003 年至 2017 年，在 11 家法国医院中心，回顾性纳入 93 例连续就诊的 RD 患者。
研究人群包括两组：非复杂型右憩室炎（URD）组（63.5%，59 例）和复杂型右憩室炎（CRD）组（36.5%，34 例）。84.7%（50/59）的 URD 患者接受了保守治疗。41.2%（14/34）的 CRD 患者因 Hinchey III 级腹膜炎、临床不耐受或血流动力学不稳定而行急症手术（主要为剖腹手术）。共有 5.2%（2/34）的 CRD 患者在冷却期（最初为脓肿）后行手术。严重术后并发症发生率总体较低（8%）。两组的复发率均较低且相似：URD 为 6.8%（4/59），CRD 为 8.8%（3/34），所有复发均发生在相同部位，且为非复杂型，其中 42.9%（3/7）患者行择期腹腔镜手术，其余患者行保守治疗。中位随访时间为 33.2 个月。
URD 可安全有效地行保守治疗，对部分 CRD 患者也可选择保守治疗。对于不稳定患者或患有严重复杂型憩室炎的患者，应保留手术治疗。
