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Does localization change management in complicated right and left-sided diverticulitis?
Turan Acar1, Yunus Sür2, Nihan Acar3
1Department of General Surgery, Fenerbahçe University, İzmir Medicana International Hospital, İzmir 35170, Türkiye.
World Journal of Gastrointestinal Surgery
|January 2, 2026
Summary
Right-sided colon diverticulitis (RCD) and left-sided colon diverticulitis (LCD) present different clinical features and treatment needs. Understanding these differences is key for effective management of complicated diverticulitis (CD).
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Colorectal Surgery
Background:
- Colonic diverticula distribution varies globally, leading to distinct clinical presentations of right-sided colon diverticulitis (RCD) and left-sided colon diverticulitis (LCD).
- Complicated diverticulitis (CD) often necessitates hospitalization, with treatment ranging from conservative management to surgical intervention, influenced by patient condition, disease severity (Hinchey stage), and location.
- Disparities in RCD and LCD impact emergency and elective surgical rates.
Purpose of the Study:
- To delineate the clinical characteristics of complicated diverticulitis (CD).
- To highlight the clinical and management differences between RCD and LCD.
- To outline current treatment strategies for CD based on colonic localization.
Main Methods:
- Retrospective analysis of a prospective database from a single center.
- Inclusion of 253 patients hospitalized for CD, categorized into RCD and LCD groups.
- Statistical comparison using Student's t-test and Mann-Whitney U test to identify significant differences between groups.
Main Results:
- LCD was more prevalent (82.2%) than RCD (17.8%), with most cases classified as Hinchey 1A diverticulitis (49.8%).
- Surgery for LCD was more common in males. Abscess was a primary surgical indication for RCD, while perforation was for LCD.
- Malignancy was more frequently observed in LCD patients undergoing surgery. Hartmann's procedure dominated emergency surgeries, and laparoscopic colectomy with anastomosis was preferred for elective procedures.
Conclusions:
- Diverticulitis management requires an individualized, evidence-based approach due to its benign nature but complex presentation.
- Colonic localization of diverticulitis is a critical factor in determining the optimal treatment strategy.
- Recognizing RCD and LCD differences is essential for tailoring patient care and surgical planning.
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