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Different Clinical Characteristics of Right-Sided Versus Left-Sided Colonic Diverticular Complications: A Four-Year
Qi Gao1, Jia-Yuan Peng1, Yue-Qing Bai2
1Department of Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Right-sided colonic diverticular complications occur in younger patients and are less severe than left-sided ones. Right-sided cases show a higher bleeding risk, suggesting different underlying mechanisms for diverticulosis.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Clinical Medicine
Background:
- Diverticular disease is common, but complications can differ based on location.
- Understanding variations in right-sided versus left-sided colonic diverticular complications is crucial for targeted management.
Purpose of the Study:
- To investigate the distinct clinical manifestations and treatment outcomes of right-sided and left-sided colonic diverticular complications.
Main Methods:
- Retrospective analysis of 123 patients diagnosed with diverticulitis or diverticular hemorrhage between January 2019 and December 2023.
- Patients were categorized into right-sided and left-sided groups based on the affected colon segment.
- Clinical characteristics, including age, BMI, presentation, and treatment outcomes, were compared between groups.
Main Results:
- The right-sided group (89 patients) had a significantly lower mean age (43.33 years) and lower BMI > 25 (10.11%) compared to the left-sided group (34 patients, 66.35 years, 24.76% BMI > 25).
- Left-sided diverticulitis showed a higher incidence of severe disease (Hinchey III-IV: 29.41% vs. 1.12%) and required more intensive conservative treatment (30.77% vs. 2.38%).
- Hemorrhage occurred exclusively in the right-sided group (3 cases), while laparotomy was performed in 2 right-sided and 8 left-sided patients.
Conclusions:
- Right-sided diverticulosis presents with younger patients, less severe diverticulitis, and a higher propensity for bleeding compared to left-sided disease.
- Distinct pathophysiological mechanisms may underlie the development and complications of diverticulosis in the right versus left colon.
Abstract:
To determine whether right-sided and left-sided colonic diverticular complications have different clinical manifestations and treatment outcomes. Patients diagnosed with diverticulitis or diverticular hemorrhage from January 2019 to December 2023 were retrieved. Patients were assigned into the right-sided group and the left-sided group according to the colon affected by diverticular complications. For each patient, age, gender, body mass index (BMI), lifestyle, clinical presentation, and concomitant medication were recorded. Clinical characteristics and treatment outcomes were compared with between the two groups. A total of 123 patients were included in this study, 89 in the right-sided group and 34 in the left-sided group. Patients in the right-sided group presented a significantly lower mean age (43.33 vs. 66.35 yrs old, p < 0.0001) and a smaller proportion of patients with BMI above 25 (10.11% vs. 24.76%, p = 0.02). Left-sided group diverticulitis had a significantly higher proportion of Hinchey III to IV (29.41% vs. 1.12%, p = 0.0001) and rate of intensified conservative treatment (30.77% vs. 2.38%, p = 0.0003). Patients in the left-sided group had a higher rate of crowding of diverticula (diverticular number counted >20) (35.29% vs. 1.12%, p < 0.01). Two patients in the right-sided group and eight in the left received laparotomy because of diverticulitis. All three cases of hemorrhage were in the right-sided group. Compared with the left, right-sided diverticulosis is characterized by a younger age, less-virulent diverticulitis, and potentially higher hemorrhagic propensity. Different mechanisms between the groups may exist to mediate the onset and development of diverticulosis and its complications.
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