Introduzione Right sided colonic diverticulitis is a rare condition in Western countries while is common in Asian ones. In most cases, right colonic diverticulitis mimicks an acute appendicitis and it is often diagnosed when explorative laparoscopy excludes the presence of appendicits. We report our experience in the treatment of right-side diverticulitis. Pazienti e metodi From September 2011 to May 2015 170 patients underwent surgical intervention for diverticular disease in our unit, both in emergency or elective setting. Pre- intra- and postoperative data of patients were prospectively registered. Uni and multivariate analysis was performed both for factors associated with postoperative morbidity and conversion to laparotomy. Statistical analysys was performed with SPSS v. 13.0. Significance was considered for p value < 0.05. Risultati 17 patients (10%) was affected by right colonic diverticulitis and only 3 of them (17.6%) came from Asian countries. Male/female ratio was 1:1 with mean age of 5115 years, statistically lower respect to our cohort of patients with left side diverticulitis (6714 years; P<0.001). In 16 cases (94,1%) a surgical exploration was performed due to clinical and laboratoristic diagnosis of acute appendicitis. Only one patient underwent elective surgery for recurrent episodes of acute diverticulitis that required two hospital admissions. In 9 cases (52.9%) the disease was localized in the ascending colon while in the other 8 patients there was a caecal diverticulitis. 12 patients (70.6%) had Hinchey 1-2, in one case there were a generalized purulent peritonitis and in one case we found hemoperitoneum from diverticular bleeding. 13 patients (76.5%) underwent colonic resection with anastomosis while in the other 4 cases a diverticulectomy was performed with no postoperative events. Surgical interventions were performed with mini-invasive approach in 13 patients (76.5%) with a conversion rate of 29.4% (5 patients). Mean postoperative stay was 9 11 days. Overall postoperative morbidity rate was 12.6% (3 patients) according Calvien Dindo Classification. There was no postoperative in-hospital mortality. We also performed multivariate analysis to identify factors predicting overall, surgical ad medical complications but we did not find any significant factor. Also the logistic regression to identify factor predicting conversion from laparoscopic to open approach failed to find an independent variable. Conclusioni In our experience, right side colonic diverticulitis is a rare but not irrelevant condition also in Caucasian young individuals. Clinical and laboratoristic features of right diverticulitis can mimick other pathological contidion as acute appendicitis and often is misdiagnosed. Patients with acute right colonic diverticulitis can be treated safely with colonic resection and anastomosis. In selected cases isolated diverticulectomy can be an adequate approach.
RIGHT SIDED DIVERTICULITIS IN EMERGENCY AND ELECTIVE SETTINGS: A SINGLE CENTRE EXPERIENCE
MONARI, FRANCESCO;VACCARI, SAMUELE;PICARIELLO, ERIKA;ROMANO, ANGELA;LEONE, ANTONIO;CERVELLERA, MAURIZIO;TONINI, VALERIA
2015
Abstract
Introduzione Right sided colonic diverticulitis is a rare condition in Western countries while is common in Asian ones. In most cases, right colonic diverticulitis mimicks an acute appendicitis and it is often diagnosed when explorative laparoscopy excludes the presence of appendicits. We report our experience in the treatment of right-side diverticulitis. Pazienti e metodi From September 2011 to May 2015 170 patients underwent surgical intervention for diverticular disease in our unit, both in emergency or elective setting. Pre- intra- and postoperative data of patients were prospectively registered. Uni and multivariate analysis was performed both for factors associated with postoperative morbidity and conversion to laparotomy. Statistical analysys was performed with SPSS v. 13.0. Significance was considered for p value < 0.05. Risultati 17 patients (10%) was affected by right colonic diverticulitis and only 3 of them (17.6%) came from Asian countries. Male/female ratio was 1:1 with mean age of 5115 years, statistically lower respect to our cohort of patients with left side diverticulitis (6714 years; P<0.001). In 16 cases (94,1%) a surgical exploration was performed due to clinical and laboratoristic diagnosis of acute appendicitis. Only one patient underwent elective surgery for recurrent episodes of acute diverticulitis that required two hospital admissions. In 9 cases (52.9%) the disease was localized in the ascending colon while in the other 8 patients there was a caecal diverticulitis. 12 patients (70.6%) had Hinchey 1-2, in one case there were a generalized purulent peritonitis and in one case we found hemoperitoneum from diverticular bleeding. 13 patients (76.5%) underwent colonic resection with anastomosis while in the other 4 cases a diverticulectomy was performed with no postoperative events. Surgical interventions were performed with mini-invasive approach in 13 patients (76.5%) with a conversion rate of 29.4% (5 patients). Mean postoperative stay was 9 11 days. Overall postoperative morbidity rate was 12.6% (3 patients) according Calvien Dindo Classification. There was no postoperative in-hospital mortality. We also performed multivariate analysis to identify factors predicting overall, surgical ad medical complications but we did not find any significant factor. Also the logistic regression to identify factor predicting conversion from laparoscopic to open approach failed to find an independent variable. Conclusioni In our experience, right side colonic diverticulitis is a rare but not irrelevant condition also in Caucasian young individuals. Clinical and laboratoristic features of right diverticulitis can mimick other pathological contidion as acute appendicitis and often is misdiagnosed. Patients with acute right colonic diverticulitis can be treated safely with colonic resection and anastomosis. In selected cases isolated diverticulectomy can be an adequate approach.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
