Giant colonic diverticulitis, an extremely rare presentation of a rare disease: clinical presentation and literature review

Introduction: Giant colonic diverticulum (GCD) is rare phenomenon, with less than 200 cases described in the literature. One of the complications of GCD is diverticulitis. To date, there is paucity of data addressing the diagnosis and management of GCD complicated by acute diverticulitis. Objective: To better understand the diagnostic tools, the initial management, and the long-term follow-up for this group of patients as well as to recommend a proper multidisciplinary approach to this infrequent disease. Method A systematic literature search was performed using the PubMed, Embase, and Cochrane databases to identify all the published studies on GCD complicated by diverticulitis. Two of the authors assessed the relevance of the included full-text papers. The articles were assessed independently. Results: In total, 12 cases were identified. Our results show that 10/11 (91%) of the patients who had computed tomography (CT) scans during the initial evaluation had a correct diagnosis. There was no case of failure to non-operative approach (7/7). The patients who had an emergency operation were treated so due to diffuse peritonitis (two patients), acute hemorrhage arising from ulcers within the diverticula (one patient), and misdiagnosis (one patient). Conclusion: Giant colonic diverticulitis is a very rare disease. Computed tomography scan is a valuable tool for the initial diagnosis as well as for treatment strategy planning. Non-operative management is a viable option for patients without diffuse peritonitis. Interval endoscopy is recommended if no contraindication exists. (AU)

Evaluación de opciones terapéuticas para la enfermedad diverticular del colon / Evaluation of therapeutic options for diverticular disease of the colon

Introducción: La enfermedad diverticular del colon es una entidad de reciente aparición, con un aumento manifiesto en el siglo XX. El manejo quirúrgico más apropiado ha sido siempre controvertido con respecto a su estado más grave: la diverticulitis. Existen principalmente dos opciones terapéuticas: la cirugía de Hartmann y la resección con anastomosis primaria. Objetivo: Evaluar las opciones terapéuticas para la peritonitis diverticular de colon izquierdo Grado III de Hinchey. Métodos: Se realizó un estudio descriptivo, de serie de casos, a partir de la discusión e implementación de un método de tratamiento estándar aplicado a esa patología en el Hospital Clínico Quirúrgico de Holguín desde 2014 hasta 2016. El universo y la muestra coinciden con 78 pacientes intervenidos. Resultados: El proceder quirúrgico más utilizado fue la resección con anastomosis primaria. La mayor parte de las intervenciones tuvo una duración de más de 2 horas. El proceder de Hartmann fue el que más complicaciones y mortalidad posoperatorias presentó. Conclusiones: Se determinó que entre las técnicas quirúrgicas actuales para el tratamiento de la diverticulitis Grado III de Hinchey. El proceder de RAP constituye la terapéutica más adecuada(AU)

Introduction: The diverticular disease of the colon is a recent ailment having remarkable increase in the 20th century. The most appropriate surgical management of this disease has always been a topic of controversy about its most severe condition, that is, diverticulitis. There are two main therapeutic options: Hartmann's surgery and primary anastomosis resection. Objective: To evaluate the therapeutic options for Hinchey III left-sided colon diverticular peritonitis. Methods: A descriptive case-series study was conducted on the basis of discussion and implementation of a standard method of treatment used for this pathology in the Clinical and Surgical Hospital of Holguin from 2014 to 2016. The universe and the sample were the same, with 78 surgical patients. Results: The most used surgical procedure was primary anastomosis resection. Most of the interventions lasted more than 2 hours. Hartmann's procedure was the one with more complications and high postoperative mortality. Conclusions: Among the current surgical techniques for the treatment of Hinchey III diverticulitis, it was established that the primary anastomosis resection is the most adequate therapy(AU)

Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis

PURPOSE: Colonic diverticulitis is uncommon in Korea, but the incidence is rapidly increasing nowadays. The clinical features and the factors associated with complications of diverticulitis are important for properly treating the disease. METHODS: A retrospective review of the medical records of 225 patients that were prospectively collected between October 2007 and September 2016 was conducted. RESULTS: Diverticulitis was detected mainly in men and women aged 30 to 50 years. Diverticulitis more frequently affected the right colon (n = 194, 86.2%), but age was higher in case of left colonic involvement (42 years vs. 57 years, P < 0.001). Percentages of comorbidities (65.6% vs. 23.8%, P < 0.001), complications (65.6% vs. 6.2%, P < 0.001), and surgical treatment (50.0% vs. 4.1%, P < 0.001) were significantly higher in patients with left colonic diverticulitis. In the multivariate analysis, a risk factor for complicated diverticulitis was left colonic involvement (P < 0.001; relative risk [RR], 47.108; 95% confidence interval [CI], 12.651–175.413). In complicated diverticulitis, age over 50 was the only significant risk factor for surgical treatment (P = 0.024; RR, 19.350; 95% CI, 1.474–254.023). CONCLUSION: In patients over 50 years of age with left colonic diverticulitis, a preventive colectomy should be reconsidered as one of the options for treatment.

Management of Colonic Diverticulitis Tailored to Location and Severity: Comparison of the Right and the Left Colon

PURPOSE: This study assessed optimal management of colonic diverticulitis as functions of disease location and severity and factors associated with complicated diverticulitis. METHODS: This retrospective review analyzed 202 patients diagnosed between 2007 and 2014 at Chonbuk National University Hospital, South Korea, with colonic diverticulitis by using abdominopelvic computed tomography. Diverticulitis location was determined, and disease severity was categorized using the modified Hinchey classification. RESULTS: Patients included 108 males (53.5%) and 94 females (46.5%); of these, 167 patients (82.7%) were diagnosed with right-sided and 35 (17.3%) with left-sided colonic diverticulitis. Of the 167 patients with right-sided colonic diverticulitis, 12 (7.2%) had complicated and 155 (92.8%) had uncomplicated diverticulitis; of these, 157 patients (94.0%) were successfully managed conservatively. Of the 35 patients with left-sided colonic diverticulitis, 23 (65.7%) had complicated and 12 (34.3%) had uncomplicated diverticulitis; of these, 23 patients (65.7%) were managed surgically. Among patients with right-sided diverticulitis, those with complicated disease were significantly older (54.3 ± 12.7 years vs. 42.5 ± 13.4 years, P = 0.004) and more likely to be smokers (66.7% vs. 32.9%, P = 0.027) than those with uncomplicated disease. However, among patients with left-sided diverticulitis, those with complicated disease had significantly lower body mass index (BMI; 21.9 ± 4.7 kg/m² vs. 25.8 ± 4.3 kg/m², P = 0.021) than those with uncomplicated disease. CONCLUSION: Conservative management may be effective in patients with right-sided diverticulitis and patients with uncomplicated left-sided colonic diverticulitis. Surgical management may be required for patients with complicated left-sided diverticulitis. Factors associated with complicated diverticulitis include older age, smoking and lower BMI.

Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment

PURPOSE: This study included all patients treated at the University Hospital of Geneva for a first episode of uncomplicated diverticulitis. Risks of recurrence and treatment failure were evaluated by comparing the results between short-course and long-course intravenous (IV) antibiotic therapy groups. METHODS: The records of all patients hospitalized at our facility from January 2007 to February 2012 for a first episode of uncomplicated diverticulitis (Hinchey Ia), as confirmed by computed tomography, were prospectively collected. We published an auxiliary analysis from this registered study at Clinicaltrials.gov (identifier number: NCT01015378). Two groups of patients were considered: one received a short-course IV antibiotic arm (ceftriaxone and metronidazole) for up to 5 days (followed by 5 days of oral antibiotics); the other received a long-course IV arm between days 5 and 10. The primary outcome was the recurrence-free survival time. RESULTS: Follow-up was completed for 256 patients-50% men and 50% women, with a median age of 56 years (range, 24-85 years). The average follow-up was 50 months (range, 19-89 months). Of the 256 patients included in the study, 46 patients received a short-course IV antibiotic treatment and 210 received a long-course treatment. The recurrence-free survivals were very similar between the two groups, which was supported by a log rank test (P = 0.772). Four treatment failures, all in the long-course IV antibiotic treatment group, occurred. CONCLUSION: Treatment of diverticulitis with a short IV antibiotic treatment is possible and does not modify the recurrence rate in patients with uncomplicated diverticulitis.

Safety of Nonoperative Management After Acute Diverticulitis

PURPOSE: The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. METHODS: We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. RESULTS: Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458). CONCLUSION: After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.

Colonic Diverticulitis Complicating Colo-ovarian Fistula and Tuboovarian Abscess Formation in on Old Woman

The inflammation of colonic diverticulum, diverticulitis, is occasionally accompanied by several complications, such as bleeding, bowel obstruction, fistula and abscess formation. Both colo-ovarian fistula and tuboovarian abscess formation, as complications of diverticulitis, are rare. Here, we report a case of colonic diverticulitis which ultimately resulted in colo-ovarian fistula and tuboovarian abscess formation. A 76-year-old female was presented with lower abdominal pain, diarrhea and intermittent hematochezia for about 1 month. According to the abdominal computed tomography, tuboovarian abscess was shown to adhere to the inflamed sigmoid diverticulum. Sigmoidoscopy revealed pus flowing from the opening of the diverticulum at the sigmoid colon. Hence, the patient underwent oophorosalpingectomy and low anterior resection. Thereafter, she was treated with bowel rest and broad spectrum antibiotics, and finally recovered. Although rare, colonic diverticulitis may result in colo-ovarian fistula causing tuboovarian abscess formation in postmenopausal patients. Early recognition of the condition and appropriate treatment, including surgery and antibiotics, are necessary in order to achieve full recovery from complicated diverticulitis.

Clinical Predictors Associated with the Severity of Colonic Diverticulitis

BACKGROUND/AIMS: Colonic diverticular diseases are increasing in Korea due to aging of the population and westernization of people's lifestyle. The aim of this study was to investigate the clinical predictors associated with the severity of colonic diverticulitis in Korea. METHODS: We retrospectively reviewed the medical records of 107 patients who were hospitalized with diverticulitis and underwent abdominopelvic computerized tomography at Dankook University Hospital between March 2002 and August 2011. The severity of colonic diverticulitis was evaluated by using Modified Hinchey classification, stage 0 to stage Ia were classified as mild group and stage Ib to stage IV were classified as severe group. Patients??records were assessed for age, sex, underlying diseases, history of diverticulitis, associated symptoms, location of diverticulitis, white blood cells, and C-reactive protein (CRP). RESULTS: Male to female ratio was 1.6:1 with the mean age of 43.1 years. Eighty-three patients (77.6%) were in the mild group and 24 patients (22.4%) were in the severe group. In multivariated analysis, the clinical predictors associated with the severity of colonic diverticulitis were left location (odds ratio [OR], 7.268; P=0.030), duration of symptoms (> or =3 days; OR, 4.174; P=0.022), and elevated CRP (> or =5 mg/dL; OR, 4.576; P=0.018). CONCLUSIONS: Left location, duration of symptom, and elevated CRP were the meaningful predictors for severity of colonic diverticulitis. When confronting with patients with these risk factors, we should keep in mind about the possibility of severe diverticulitis.

Diverticulitis aguda colónica: etiología, diagnóstico y alternativas terapéuticas / Acute colonic diverticulitis: etiology, diagnosis and therapeutic alternatives

La enfermedad diverticular es una patología frecuente en nuestra población, la cual corresponde a la herniación de la mucosa a través de puntos de debilidad en la pared colónica. La inflamación y/o perforación de los divertículos suele provocar un cuadro clínico de urgencia, el cual debe ser diagnosticado y resuelto de forma óptima. El diagnóstico clínico se confirma con la tomografía computada de abdomen y pelvis, y de acuerdo a los hallazgos se clasifica y decide la terapeútica adecuada. En los casos de diverticulitis simple donde solo ocurre la inflamación del divertículo, el reposo intestinal y los antibióticos endovenosos son la terapia más efectiva. Ante la presencia de diverticulitis complicada (absceso, peritonitis purulenta o fecaloidea) existen múltiples opciones que comprenden desde el drenaje del absceso vía percutánea, operación de Hartmann, resección y anastomosis primaria, y lavado laparoscópico. En el presente artículo se expone la etiopatogenia, diagnóstico, tratamiento médico y las múltiples alternativas quirúrgicas en los pacientes con diverticulitis aguda complicada.

Diverticular disease of the colon is a quite frecuent pathology in our population, this refers to small outpouchings from the colonic lumen due to mucosal herniation through the colonic wall .Inflammation and/or perforation of the diverticula usually cause a clinical emergency which must be diagnosed and solved optimally. Clinical diagnosis must be confirmed by an abdominal and pelvic computed tomography scanning, according to the findings should be classified and decide on appropriate treatment. Patients with simple diverticulitis, inflammation of diverticulum only, should be hospitalized and treated with bowel rest and intravenous antibiotics. In the presence of complicated diverticulitis (abscess, purulent or fecaloid peritonitis) there are multiple options ranging from: percutaneous abscess drainage, laparoscopic lavage, resection and primary anastomosis, and Hartmann resection. The following article describes the pathogenesis, diagnosis, medical treatment and surgical options for patients with complicated acute diverticulitis.

A Case of Colovesical Fistula Induced by Sigmoid Diverticulitis

Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.

Enfermedad diverticular del colón complicada en pacientes menores de 35 años: presentación de dos casos y revisión de la literatura / Complicated diverticular colon disease in patients younger than 35 years: report of two cases and literature review

Introducción: La enfermedad diverticular complicada del colon es rara en pacientes jóvenes, estimándose una incidencia menor a 10 % en las grandes series. Casos clínicos: Se describen dos pacientes menores de 35 años de edad con complicaciones de enfermedad diverticular, atendidos en el Hospital Juárez de México; ambos presentaron cuadro de abdomen agudo de pocos días de evolución y requirieron cirugía de urgencia, con buena evolución posoperatoria. Conclusiones: Algunos autores consideran que la diverticulitis en los pacientes jóvenes puede tener un comportamiento con más complicaciones que en lo mayores. Incluso se recomienda la resección electiva del segmento afectado después del primer episodio de diverticulitis. No obstante, informes recientes han señalado que el comportamiento de las complicaciones de la enfermedad diverticular puede ser el mismo en los pacientes jóvenes y en los de mayor edad.

BACKGROUND: Complicated colonic diverticular disease in young patients is a rare entity, with an incidence <10% from all patients in the largest series. CLINICAL CASES: We present two cases of complicated diverticular disease in patients <35 years old treated at the Hospital Juárez of México City. Both patients had acute abdominal pain with several days of evolution. In both patients, emergency surgery was performed and postoperative evolution was favorable. CONCLUSIONS: Some authors have concluded that diverticulitis in younger patients demonstrates a more aggressive course than in older patients and with an increased risk of complications. Therefore, most physicians recommended elective resection after a single attack in such patients. Conversely, some recent reports highlighted that the clinical course and complications are similar in both age groups.

Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment

PURPOSE: The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis. METHODS: One hundred fifty-eight patients with right-sided colonic diverticulitis were evaluated. Clinical history, physical and radiologic findings, and treatments were reviewed retrospectively. Also, additional episodes and treatment modalities were checked. RESULTS: Our patients were classified according to treatment modality; 135 patients (85.4%) underwent conservative treatment, including antibiotics and bowel rest, and 23 patients (14.6%) underwent surgery. The mean follow-up length was 37.3 months, and 17 patients (17.5%) underwent recurrent right-sided colonic diverticulitis. Based on treatment modality, including surgery and antibiotics, no significant differences in the clinical features and the recurrence rates were noted between the two groups. CONCLUSION: Conservative management with bowel rest and antibiotics could be considered as a safe and effective option for treating right-sided colonic diverticulitis. This treatment option for right-sided colonic diverticulitis, even if the disease is complicated, may be the treatment of choice.

Clinical characteristics of right versus left colonic diverticulitis / 대한내과학회지

BACKGROUND/AIMS: Left colonic diverticulitis is relatively common in western nations. Although the incidence of colonic diverticulitis is increasing in Korea, very little is known regarding its clinical characteristics in korean patients. METHODS: We compared the clinical characteristics of right versus left colonic diverticulitis via the retrospective review of 37 cases treated at the Kyungpook National University Hospital, Korea, from July 1998 to December 2006. Diagnosis was confirmed via computed tomography (CT), barium study, colonoscopy, and/or surgery. RESULTS: Eighteen men and 19 women (median age, 45.0 years; range, 21~75 years) were included. The ratio of right to left colonic diverticulitis was 30:7. The male to female ratio for right colonic diverticulitis was 16:14 and the median age was 38.5 years (range, 21~72 years). The male to female ratio for left colonic diverticulitis was 2:5 and the mean age was 57.0 years (range, 45~75 years). Left colonic diverticulitis was more frequently associated with intestinal perforation (p=0.001) and old age (p=0.005). Surgical intervention was more common in left versus right colonic diverticulitis (p=0.009). CONCLUSIONS: These results indicate that although left colonic diverticulitis is relatively rare among koreans, it develops later in life and is more frequently complicated than right colonic diverticulitis.

Clinically Distinguishing between Appendicitis and Right-Sided Colonic Diverticulitis at Initial Presentation

PURPOSE: Most patients diagnosed with right-sided colonic diverticulitis complain of right lower quadrant pain, which is frequently confused for appendicitis and therefore may result in unnecessary emergency surgery. In this paper we intend to differentiate between right-sided colonic diverticulitis and appendicitis by initial presentation in the emergency department. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among these patients, 92 with right-sided colonic diverticulitis were classified as group I; 268 patients with simple appendicitis were classified as group II; and 90 patients with perforated appendicitis were classified as group III. RESULTS: Prodromal symptoms were less common in group I (p < 0.05) than in the other groups. In comparing the location of maximal tenderness among groups, 19.6% of group I patients complained of maximal tenderness at a point lateral to McBurney's point, a greater percentage than those in groups II and III (p=0.002). Group I experienced less leukocytosis (10,913.8/mm(3)) than did groups II (13,238.3/mm(3)) and III (15,589.3/mm(3)). The percentage of segmented forms in the differential counts was also smaller in group I (73.6%) than in groups II (79.1%) and III (81.8%). In addition, the proportion of lymphocytes was larger in group I (17.7%) than in groups II (13.9%) and III (9.3%). CONCLUSION: Among patients complaining of right lower quadrant pain in an emergency setting, right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations: lack of prodromal symptoms, tenderness at a point lateral to McBurney's point, and absent or mild leukocytosis with a low fraction of segmented forms and a high fraction of lymphocytes in the CBC.

Difference in Clinical Features between Appendicitis and Right-Sided Colonic Diverticulitis on Initial Diagnosis

PURPOSE: Most patients who are finally diagnosed as having cecal and right-sided colonic diverticulitis complain of pain in the right lower quadrant of the abdomen, many of them unfortunately undergo an emergency operation for presumed appendicitis. Our purpose was to differentiate the diagnosis of right-sided colonic diverticulitis from appendicitis in an emergency setting. METHODS: We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among them, 92 patients who had been diagnosed as having right-sided colonic diverticulitis were classified as Group I. In the remaining 358 patients with appendicitis, 268 patients with simple appendicitis were classified as Group II and 90 patients with perforated appendicitis were classified as Group III. RESULTS: The sex ratios were similar among 3 groups. The mean age of Group I (36.5+/-10.1 years) was significantly different from that of Group II (30.7+/-14.8 years, P=0.002), but not from that of Group III (38.7+/-20.9). Incidences of fever/chill and nausea/vomiting were less common in Group I (P<0.05). The duration of prodromal symptoms in Group I (2.6 days) was longer than that of Group II (1.6 days, P=0.02), but was not significantly different from that of Group III (3.3 days, P=0.83). The mean WBC count was significantly smaller in Group I (10913.8/mm3) than in Group II (13238.3/mm3) and III (15589.3/mm3, P<0.001). The percentage of segment form in differential counts was smaller in Group I (73.6%) than in Group II (79.1%) and III (81.8%, P<0.001). The percentage of lymphocytes in differential counts was larger in Group I (17.7%) than in Group II (13.9%) and Group III (9.4%, P<0.001). CONCLUSIONS: Among the patients who complain of pain in the right lower quadrant abdomen in an emergency setting, cecum and right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations, relatively younger patients (20~40 years), infrequent prodromal symptoms, absent rebound tenderness with a laterally deviated maximal tenderness point, and absent or mild leucocytosis with a relatively low fraction of segment forms associated with a higher fraction of lymphocytes in CBC.

Clinical Analysis of Right Colonic Diverticulitis That was Operated under the Impression of Acute Appendicitis

PURPOSE: Because there are no significant differences of the clinical findings between the appendicitis and cecal diverticulitis, it is very difficult to make a correct diagnosis preoperatively and to choose a appropriate management intraoperatively. The purpose of this study is to investigate the clinical charateristics of right diveticulitis and to evaluate the appropriateness of surgical management. METHODS: We reviewed 45 cases of right colonic diverticulitis which underwent emergency operation under the impression of acute appendicitis during 10 years from January 1988 to December 1997. RESULTS: Of them, 38 cases were treated by diverticulectomy with appendectomy (Group I), and 7 cases were treated by resection (ileocecal resection or right hemicolectomy) (Group II). The male to female ratio was 4:1, and the mean age was 38.2 years. In Group I, all cases had a solitary inflamed cecal diverticulum. In group II, two cases had a solitary cecal diverticulitis, whereas five cases had multiple ones. Postoperative complications were found in 14 cases, but all of them were not significant. Postoperative Barium enema was performed in 22 cases of Group I, in two cases of Group II. In Group I, 8 cases had a residual diverticulum at postoperative Barium enema. In Group II, no residual diverticulum was shown. Follow-up study by Telephone was done at 16 cases, there were no symptomatic recurrences. CONCLUSIONS: In conclusion, when right colonic diverticulitis is found at the time of operation, surgical management is a safe treatment with low morbidity and low recurrence rate. Diverticulectomy with appendectomy is a safe surgical procedure for the uncomplicated diverticulitis. If diverticulitis is complicating, multiple or undistinguishable with malignancy, resection (ileocecal resection, right hemicolectomy) should be considered as a primary surgical treatment. Postoperative colon study is helpful, due to high incidence of residual diverticulum.