AIM： To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS： The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed to...AIM： To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS： The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS： Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients （13.8%） in stage 0, 139 patients （73.5%） in stage I a, 23 patients （12.2%） in stage I b, and 1 patient （0.5%） in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients （97.9%）. One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage I b required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients （8.2%） who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy.CONCLUSION： Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.展开更多
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 spre...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 "rightsided 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 nonoperative 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.展开更多
Diverticular disease of the colon is a common disease worldwide.Although the disease is asymptomatic in about 70-80 % of patients,it represents,at least in Western countries,one of the most important gastrointestinal ...Diverticular disease of the colon is a common disease worldwide.Although the disease is asymptomatic in about 70-80 % of patients,it represents,at least in Western countries,one of the most important gastrointestinal diseases in terms of direct and indirect health costs.Pathogenesis of the disease is still unknown.However,it is the result of complex interactions between colonic structure,intestinal motility,diet and genetic factors.Whilst efficacious preventive strategies remain to be identified,fibre supplementation in the diet is recommended.Why symptoms develop is still unclear.Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa,induced by changes in bacterial microflora, could affect the enteric nervous system,which is crucial for normal gut function,thus favouring symptom development. This hypothesis could be extrapolated also for diverticular disease,since bacterial overgrowth is present,at least in a subgroup of patients.These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.展开更多
基金Supported by The research paper scholarship of the graduate school of Kyung Hee University in the second semester of 2007
文摘AIM： To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS： The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS： Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients （13.8%） in stage 0, 139 patients （73.5%） in stage I a, 23 patients （12.2%） in stage I b, and 1 patient （0.5%） in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients （97.9%）. One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage I b required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients （8.2%） who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy.CONCLUSION： Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.
文摘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 "rightsided 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 nonoperative 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.
文摘Diverticular disease of the colon is a common disease worldwide.Although the disease is asymptomatic in about 70-80 % of patients,it represents,at least in Western countries,one of the most important gastrointestinal diseases in terms of direct and indirect health costs.Pathogenesis of the disease is still unknown.However,it is the result of complex interactions between colonic structure,intestinal motility,diet and genetic factors.Whilst efficacious preventive strategies remain to be identified,fibre supplementation in the diet is recommended.Why symptoms develop is still unclear.Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa,induced by changes in bacterial microflora, could affect the enteric nervous system,which is crucial for normal gut function,thus favouring symptom development. This hypothesis could be extrapolated also for diverticular disease,since bacterial overgrowth is present,at least in a subgroup of patients.These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.
