Does localization change management in complicated right and left-sided diverticulitis?

Table 1 Demographic and clinical features of patients (n = 253)

Item	Value
Gender, n (%)
Female	126 (49.8)
Male	127 (50.2)
Age (year; mean)	59.59 ± 14.97 (21-90)
Age group (year), n (%)
≤ 50	70 (27.7)
50-70	112 (44.2)
≥ 70	71 (28.1)
CCI (mean)	2.28 ± 1.99
Immunosuppression, n (%)	17 (6.7)
Localization, n (%)
Right colon	45 (17.8)
Left colon	208 (82.2)
Prior finding, n (%)
Abscess	35 (13.8)
Bleeding	6 (2.4)
Fistula	3 (1.2)
Obstruction	8 (3.2)
Perforation	59 (23.3)
Peritonitis	5 (2)
Sole persistent abdominal pain	137 (54.2)
Hinchey, n (%)
1A	126 (49.8)
1B	50 (19.8)
2	44 (17.4)
3	29 (11.5)
4	4 (1.6)
Number of episodes, n (%)
1	216 (85.4)
2	29 (11.5)
≥ 3	8 (3.2)

CCI: Charlson comorbidity index.

Table 2 Management of patients (n = 253)

Item	Value
Percutaneous drainage, n (%)	39 (15.4)
Type of treatment, n (%)
Conservative	195 (77.1)
Surgical	58 (22.9)
Emergency	32 (12.6)
Elective	26 (10.3)
Surgical indication, n (%)
Complication or concomitant malignancy1	51 (87.9)
Recurrent episodes	7 (12.1)
Surgery type, n (%)
DD	3 (5.2)
Hartmann’s procedure	19 (32.8)
Colectomy with anastomosis	36 (62)
Open	20 (34.4)
Laparoscopic	16 (27.6)
Postoperative complication, n (%)	23 (39.7)
Early period	14 (60.9)
SSI	7 (30.7)
Anastomosis leak	3 (13)
Intraabdominal abscess	2 (8.7)
Evisceration	1 (4.3)
Brid ileus	1 (4.3)
Late period	9 (39.1)
Incisional hernia	5 (21.7)
Parastomal hernia	3 (13)
Anastomosis stenosis	1 (4.3)
Colonoscopic finding, n (%)
Sole diverticul/diverticulitis	219 (86.6)
Polyp(s)	23 (9.1)
Malignancy or suspected malignancy	10 (4)
Ulcerative colitis	1 (0.4)
The mean length of hospital stays (day; range)	5.15 ± 2.82 (2-23)
Mortality, n (%)	3 (1.2)

¹Abscess, bleeding, fistula, obstruction, perforation, peritonitis.

DD: Diversion with a proximal colostomy and drainage of the perforated area without resection; SSI: Surgical site infection.

Table 3 Comparison of right colon and left colon diverticula

	Right colon (n = 45)	Left colon (n = 208)	P value
Gender, n (%)
Female	21 (46.7)	105 (50.5)	0.643
Male	24 (53.3)	103 (49.5)
Age (year; mean)	49.27 ± 15.54	61.83 ± 13.91	0.001
Age group (year), n (%)
≤ 50	23 (51.1)	47 (22.6)	0.001
50-70	17 (37.8)	95 (45.7)
≥ 70	5 (11.1)	66 (31.7)
CCI (mean)	1.02 ± 1.42	2.57 ± 2	0.001
Immunosuppression, n (%)	3 (6.7)	14 (6.7)	0.988
Prior finding, n (%)
Abscess	10 (22.2)	25 (12)	0.006
Bleeding	-	6 (2.9)
Fistula	-	3 (1.4)
Obstruction	1 (2.2)	7 (3.4)
Perforation	1 (2.2)	58 (27.9)
Peritonitis	1 (2.2)	4 (1.9)
Sole persistent abdominal pain	32 (71.1)	105 (50.5)
Hinchey, n (%)
1A	30 (66.7)	96 (46.2)	0.016
1B	11 (24.4)	39 (18.8)
2	2 (4.4)	42 (20.2)
3	2 (4.4)	27 (13)
4	-	4 (1.9)
Number of episodes, n (%)
1	45 (100)	171 (82.2)	0.009
2	-	29 (13.9)
≥ 3	-	8 (3.8)
Percutaneous drainage, n (%)	2 (4.4)	37 (17.8)	0.025
Type of treatment, n (%)
Medical	41 (91.1)	154 (74)	0.041
Surgical	4 (8.9)	54 (26)
Emergency	3 (6.7)	29 (13.9)
Elective	1 (2.2)	25 (12.1)
Performed surgery, n (%)
DD	-	3 (5.6)	0.08
Hartmann’s procedure	-	19 (35.1)
Colectomy with anastomosis
Open	3 (75)	17 (31.5)
Laparoscopic	1 (25)	15 (27.8)
Postoperative complication, n (%)	-	23 (26.1)	0.697
The mean length of hospital stays (day)	3.69 ± 1.16	5.48 ± 2.98	0.001
Mortality, n (%)	-	3 (1.4)	-

CCI: Charlson comorbidity index; DD: Diversion with a proximal colostomy and drainage of the perforated area without resection.

Table 4 Comparison of patients undergoing observation and surgery

	Right colon (n = 45)			Left colon (n = 208)
	Observation (n = 41)	Surgery (n = 4)	P value	Observation (n = 154)	Surgery (n = 54)	P value
Gender, n (%)
Female	20 (48.8)	1 (25)	0.363	88 (57.1)	17 (31.5)	0.001
Male	21 (51.2)	3 (75)		66 (42.9)	37 (68.5)
Age (year; mean)	49.32 ± 15.65	48.75 ± 16.58	0.95	61.47 ± 14.09	62.87 ± 13.43	0.52
Age group, n (%)						0.957
≤ 50	21 (51.2)	2 (50)	0.621	35 (22.7)	12 (22.2)
50-70	16 (39)	1 (25)		71 (46.1)	24 (44.4)
≥ 70	4 (9.8)	1 (25)		48 (31.2)	18 (33.4)
CCI (mean)	1.02 ± 1.44	1 ± 1.41	0.97	2.5 ± 1.93	2.75 ± 2.18	0.42
Immunosuppression, n (%)	3 (7.3)	-	0.575	9 (5.8)	5 (9.3)	0.001
Prior finding, n (%)
Abscess	7 (17.1)	3 (75)	0.001	16 (10.4)	9 (16.7)	0.001
Bleeding	-	-		5 (3.2)	1 (1.9)
Fistula	-	-		-	3 (5.6)
Obstruction	1 (2.4)	-		3 (1.9)	4 (7.4)
Perforation	1 (2.4)	-		32 (20.8)	26 (48.1)
Peritonitis	-	1 (25)		-	4 (7.4)
Sole persistent abdominal pain	32 (78)	-		98 (63.6)	7 (13)
Hinchey, n (%)
1A	30 (73.2)	-	0.001	92 (59.7)	4 (7.4)	0.001
1B	10 (24.4)	1 (25)		34 (22.1)	5 (9.3)
2	1 (2.4)	1 (25)		24 (15.6)	18 (33.3)
3	-	2 (50)		4 (2.6)	23 (42.6)
4	-	-		-	4 (7.4)
Number of episodes, n (%)			-
1	41 (100)	4 (100)		141 (91.6)	30 (55.6)	0.389
2	-	-		13 (8.4)	16 (29.6)
≥ 3	-	-		-	8 (14.8)
Percutaneous drainage, n (%)	1 (2.4)	1 (25)	0.037	23 (14.9)	14 (25.9)	0.069
Accompanying lesion on colonoscopy, n (%)	1 (2.4)	1 (25)		21 (13.5)	11 (19.4)
Polyp	1 (2.4)	-	0.005	19 (12.3)	3 (5.6)	0.001
Malignancy	-	1 (25)		1 (0.6)	8 (14.8)
Ulcerative colitis	-	-		1 (0.6)	-
The mean length of hospital stays (day), (range)	3.49 ± 0.84	5.75 ± 2.06	0.11	4.68 ± 1.5	7.74 ± 4.6	0.001
Mortality, n (%)	-	-	-	-	3 (5.6)	-

CCI: Charlson comorbidity index.