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Right sided diverticulitis in western countries: A review
Angelo Gabriele Epifani1, Diletta Cassini2, Roberto Cirocchi3
1Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy.
Background:
Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.
Aim:
To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.
Methods:
MEDLINE and PubMed searches were performed using the key words "right-sided diverticulitis'', ''right colon diverticulitis'', ''caecal diverticulitis'', ''ascending colon diverticulitis'' and ''caecum diverticula'' in order to find relevant articles published until 2021.
Results:
A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.
Conclusion:
The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.
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