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[Surgical therapy in right-sided diverticulitis].

P Hildebrand¹, M Birth, H-P Bruch

¹Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck. PhilippHildebrand@yahoo.com

Zentralblatt Fur Chirurgie

|April 26, 2005

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Right-sided diverticulitis is a rare condition that can mimic appendicitis. Surgical resection is safe for complicated cases, with hypoganglionosis potentially playing a role in its development.

Area of Science:

Gastroenterology
Colorectal Surgery
Surgical Pathology

Background:

Left-sided diverticulitis is common in Western countries.
Right-sided diverticulitis is rare and presents with symptoms similar to acute appendicitis.
Surgical experience in right-sided diverticulitis requires analysis.

Purpose of the Study:

To analyze surgical experience in right-sided colonic diverticulitis.
To determine the incidence, clinical presentation, and surgical indications for right-sided diverticulitis.
To evaluate histopathological findings and outcomes of right-sided diverticulitis surgery.

Main Methods:

Retrospective analysis of patients undergoing ileocolic resection or right colectomy for right-sided diverticulitis.
Prospective registry database of patients with right-sided and sigmoid diverticular disease (1996-2003).

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Focus on incidence, symptoms, surgical procedures, histopathology (including immunohistochemistry), and outcomes.

Main Results:

Right-sided diverticulitis accounted for 2.5% of all diverticulitis resections (12/481 patients).
Preoperative diagnosis of acute appendicitis was made in 4 patients; ultrasonography was the primary diagnostic tool.
Right colectomy was performed in 9 patients; 75% showed local perforation, and 5/12 had hypoganglionosis or aganglionosis.

Conclusions:

Differentiating right-sided diverticulitis from acute appendicitis is challenging due to its rarity.
Treatment for complicated right-sided diverticulitis mirrors that of left-sided disease, involving surgical resection.
Resection with primary anastomosis is safe, even laparoscopically in experienced centers; the role of hypoganglionosis/aganglionosis in etiology is speculative.