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Conservative approach is feasible in the management of acute diverticulitis of the right colon


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    This paper was presented at the Joint Hong Kong Society of Gastroenterology, Hong Kong Society of Digestive Endoscopy and Hong Kong Society for Colo­proctology Scientific Meeting on 27 March 1999.

Dr S. P. Y. Kwok, Department of Surgery, United ­Christian Hospital, Kwun Tong, Hong Kong.


Background:  Acute diverticulitis of the caecum and ascending colon is uncommon. Controversies abound as regards the optimal surgical treatment, ranging from appendectomy, diverticulectomy to right hemicolectomy. The aim of the present paper was to review treatment strategy followed by a critical appraisal.

Methods:  The case notes of 30 patients with acute diverticulitis of the right colon who were treated at the United Christian Hos­pital, Hong Kong from 1992 to 1998 were systematically reviewed. The data were subjected to statistical analysis.

Results:  The median age was 34 years, with a male:female ratio of 1:1.15. All patients presented with acute right lower abdominal pain and localized rebound tenderness. All were diagnosed preoperatively as having appendicitis. The mean duration of symptoms was 2 days (range: 1–6 days). Two treatment groups were identified. Group A (n = 16; 53%) received appendicectomy alone, while group B (n = 14; 47%) underwent diverticulectomy in addition to appendicectomy, including one patient with perforated diverticulitis. Overall, there was no procedure-related morbidity or mortality. Both groups received a similar duration of broad-spectrum anti­biotics. All the patients were interviewed by phone after operation to detect any recurrence of symptoms, with a median follow-up interval of 34 months (range: 11–78 months). There was no recurrence of symptoms in group A, which received appendicectomy and antibiotics. The only difference was operative time.

Conclusion:  For non-perforated diverticulitis of the right colon, appendicectomy and intravenous antibiotics without diverticulectomy is the preferred treatment strategy.