Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1721-1735
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1721
Right sided diverticulitis in western countries: A review
Angelo Gabriele Epifani, Diletta Cassini, Roberto Cirocchi, Caterina Accardo, Francesca Di Candido, Massimiliano Ardu, Gianandrea Baldazzi
Angelo Gabriele Epifani, Caterina Accardo, Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
Diletta Cassini, Francesca Di Candido, Massimiliano Ardu, Gianandrea Baldazzi, Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
Roberto Cirocchi, Department of General and Oncological Surgery, University of Perugia, Perugia 06123, Italy
Author contributions: Cassini D designed the research; Epifani AG and Cirocchi R performed the research and wrote the paper; Accardo C and Epifani AG analysed the data; Cirocchi R, Baldazzi G, Di Candido F and Ardu M supervised the paper; All authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Diletta Cassini, MD, PhD, Surgeon, Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Viale G Matteotti 83-20099 Sesto San Giovanni (Milan), Sesto San Giovanni 20099, Italy. diletta_cassini@yahoo.it
Received: March 30, 2021
Peer-review started: March 30, 2021
First decision: May 13, 2021
Revised: May 28, 2021
Accepted: November 30, 2021
Article in press: November 30, 2021
Published online: December 27, 2021
Processing time: 268 Days and 19.4 Hours
Abstract
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.

Keywords: Right-sided diverticulitis; Cecal diverticulitis; Right colonic diverticulitis; Western countries; Emergency surgery; Diverticulitis

Core Tip: This paper underlined the importance to collect more data on right-sided diverticulitis to understand if it is a more common condition than we thought, and if we really need more selective guidelines or we can simply apply the principles already proposed for left-sided diverticulitis.