Diverticulitis of the right colon

While more common in Asia, right-sided diverticulitis affects approximately 5% of the population in the western world and accounts for 1.5% of patients presenting with diverticulitis. Right colon diverticulae are usually solitary, may be multiple, and many are true diverticulae, containing all the layers of the bowel wall. While most rightsided colonic diverticulae are pseudodiverticulae, some are congenital. The clinical spectrum of diverticulitis of the right colon has great variability: in some, acute diverticulitis is benign and self-limited but in others, it may be fulminant. Right-sided colonic diverticulitis and acute appendicitis are nearly impossible to distinguish from each other based only on the clinical evaluation. Given this fact, the diagnosis of rightsided diverticulitis was often determined in the operating room. According to some reports, in the past, most patients with caecal diverticulitis were operated on with a preoperative diagnosis of acute appendicitis. Therefore, most research has focused on controversies regarding the appropriate operative management of right-sided colonic diverticulitis encountered in surgery. To avoid diagnosis in surgery and determine the proper course of treatment, preoperative radiological evaluation is essential. The liberal use of CT whenever appendicitis is suspected has led to more accurate diagnoses of right-sided colon diverticulitis, leading to recommendations of more conservative treatments following diagnosis. Accordingly, it seems that the natural history of right-sided colonic diverticulitis is benign, meaning that surgical intervention can be avoided in the vast majority of patients. Since most cases respond to medical therapy, surgery is indicated only in complicated right-sided cases such as free perforation with purulent or fecal peritonitis. However, elective resection should be considered in cases of frequent recurrent attacks of right-sided diverticulitis that considerably alter patient quality of life, or in cases in which colon cancer cannot be ruled out.