Division of General Surgery, University of Toronto, Toronto, ON, Canada.
Division of Colon and Rectal Surgery, Jewish General Hospital, 3755 Cote Ste Catherine Rd, Montreal, QC, 304H3T 1E2, Canada.
World J Surg. 2020 Jun;44(6):1994-2001. doi: 10.1007/s00268-020-05431-3.
Right-sided colonic diverticulitis represents less than 5% of diverticulitis cases in North America. The purpose of this study was to describe the management and outcomes for patients with a first episode of right-sided diverticulitis in a North American center.
This was a retrospective cohort study, including all patients managed for right-sided diverticulitis at a single tertiary-care institution from 2000 to 2017. Patient demographics, disease characteristics, and treatment strategies were described. Short- (emergency surgery, operative morbidity, treatment failure) and long-term (recurrence, elective operation) outcomes were reported. Patients with right-sided diverticulitis were then compared to a cohort of patients with left-sided diverticulitis.
Sixty-seven patients were managed for a first episode of right-sided diverticulitis, three (4.5%) of which were subsequently diagnosed with right-sided colon cancer; 64 patients therefore formed the population. Mean age was 51.2 ± 17.7 years. Eight patients (12.5%) self-identified as being Asian. The majority of patients had uncomplicated disease (90.6%); six (9.4%) presented with complicated diverticulitis. Most cases were diagnosed by computed tomography (78.1%), while 17.2% were diagnosed intra-operatively and 4.7% by pathology. Almost all patients diagnosed by computed tomography were managed nonoperatively. Fifteen patients (23.4%) were managed surgically: ten for suspected appendicitis, three for suspected colon mass, and two for diffuse peritonitis. After a median follow-up of 74.8 months (IQR 30.2-130.5), only two patients (3.1%) developed recurrent right-sided diverticulitis. Among patients managed nonoperatively, recurrence was significantly lower in patients with right-sided diverticulitis relative to left-sided diverticulitis (4.1% vs. 32.8%, p < 0.001).
Right-sided diverticulitis can be successfully managed nonoperatively with low rates of recurrence. In populations in which this condition is more seldom observed, underlying colon cancers should be considered.
右半结肠憩室炎在北美不到 5%的憩室炎病例中。本研究的目的是描述北美中心首次发生右半结肠憩室炎患者的治疗方法和结果。
这是一项回顾性队列研究，纳入了 2000 年至 2017 年在一家三级保健机构接受右半憩室炎治疗的所有患者。描述了患者的人口统计学、疾病特征和治疗策略。报告了短期（急诊手术、手术发病率、治疗失败）和长期（复发、择期手术）结局。然后将右半憩室炎患者与左半憩室炎患者进行比较。
67 例患者因首次发生右半憩室炎接受治疗，其中 3 例（4.5%）随后被诊断为右半结肠癌；因此，64 例患者构成了研究人群。平均年龄为 51.2±17.7 岁。8 例（12.5%）患者自我认定为亚裔。大多数患者为单纯性疾病（90.6%）；6 例（9.4%）为复杂性憩室炎。大多数病例通过计算机断层扫描（CT）诊断（78.1%），17.2%术中诊断，4.7%通过病理诊断。几乎所有通过 CT 诊断的患者均接受非手术治疗。15 例（23.4%）患者接受手术治疗：10 例疑似阑尾炎，3 例疑似结肠肿块，2 例弥漫性腹膜炎。中位随访 74.8 个月（IQR 30.2-130.5）后，仅 2 例（3.1%）患者发生右半憩室炎复发。在非手术治疗患者中，右半憩室炎患者的复发率明显低于左半憩室炎患者（4.1% vs. 32.8%，p<0.001）。
右半结肠憩室炎可通过非手术治疗成功治疗，复发率较低。在这种情况较为少见的人群中，应考虑潜在的结肠癌。
