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Recurrence of Acute Right Colon Diverticulitis Following Nonoperative Management: A Systematic Review and
Yongjin F Lee1, Dalun D Tang1, Samik H Patel1
1Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, Michigan.
Diseases of the Colon and Rectum
|September 24, 2020
Summary
Nonoperative management for right-sided diverticulitis is safe and feasible, with a low recurrence rate of 12%. Urgent surgery for recurrence is uncommon, indicating favorable outcomes for this approach.
Area of Science:
- Gastroenterology
- Surgical Outcomes
Background:
- Current guidelines for right colon diverticulitis management are lacking.
- Treatment strategies are often adapted from left-sided diverticulitis protocols.
- Understanding recurrence risk and morbidity is crucial for surgical decision-making.
Purpose of the Study:
- To determine the recurrence rate of Hinchey classification I/II right-sided diverticulitis after nonoperative management.
- To evaluate the morbidity associated with recurrence in these patients.
Main Methods:
- A systematic review of PubMed, EMBASE, and Cochrane Database of Collected Reviews up to June 2019.
- Inclusion of observational cohort studies (9 retrospective, 2 prospective) with 1584 adult participants.
- Pooled analysis of recurrence rates using a random-effects model.
Main Results:
- The pooled recurrence rate was 12% (95% CI, 10%-15%) over a median follow-up of 34.2 months.
- 9.9% of recurrent cases required urgent surgery; no mortality was reported.
- Excluding studies with percutaneous drainage did not significantly alter the recurrence rate.
Conclusions:
- Nonoperative management of Hinchey I/II right-sided diverticulitis is a safe and viable option.
- The risk of recurrence is relatively low.
- Complications necessitating urgent surgery are infrequent.
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