대한대장항문학회

Purpose : Diverticular disease of the cecum and ascending colon is a relatively uncommon<br>disease and there are some difficulties in the accurate preoperative diagnosis and the proper<br>surgical treatment. This study is aimed to determine what is the proper procedure during the<br>emergency operation of right colon diverticulitis. Methods : This study is a retrospective<br>clinical analysis of 86 cases of the right colon diverticulitis from January 1992 to December<br>1999. Results : 1) The incidence of right colon diverticulitis (RCD) was 2.1% of that of<br>appendicitis and the RCD to sigmoid colon diverticulitis ratio was 9.6：1. 2) The highest<br>incidence was noted at the fourth decades and average age was 37 years. Male to female<br>ratio was 1.9：1. 3) Most patients (73 cases, 85%) had right lower quadrant abdominal pain.<br>4) The duration of symptom was less than 3 days in 54 cases (63%). 5) The preoperative<br>confirmation by radiologic work-up was not decisive, but barium enema might be more<br>accurate than other studies and CT was more accurate method than ultrasound. 6) The<br>correct preoperative diagnosis was made only in 13 cases (15%) and the remaining<br>misdiagnoses were appendicitis with or without complications in 72 cases (83%). 7) Operative<br>procedures varied markedly according to multiplicity, extent of inflammation and<br>complications; diverticulectomy and appendectomy in 48 cases (56%), ileocecectomy in 15<br>cases (17%) and right hemicolectomy in 11 cases (13%). 8) The most commom postoperative<br>complication was wound infection. 9) Among the 30 cases who took diverticulectomy or<br>diverticulectomy and appendectomy, remained diverticulums were found in 14 cases (47%),<br>especially 11 cases (37%) on the right colon. And so multiplicity of right colon reached about<br>37%. Conclusions : The authors suggest that one should suspect RCD in fourth decade<br>patients with right lower quadrant pain for more than 3 days with unusual clinical findings.<br>Barium enema can be used because of the high accuracy rate but CT is a safe tool in<br>complicated or urgent situation. The operative modalities should be selected on the extent of<br>the disease and it is sufficient to treat a single diverticulitis with diverticulectomy or<br>diverticulectomy and appendectomy but right hemicolectomy should be recommanded in the<br>suspicious multiplicity or malignancy.<br>