Year 2025 / Volume 117 / Number 7
Letter
Right-side diverticulitis

403-404

DOI: 10.17235/reed.2024.10418/2024

Víctor Blázquez Ávila, Sandra Borrego Rivas, Marcos Jiménez Palacios, Juan Sebastián Baldi Borelli, César Álvarez Fernández,

Abstract
Colonic diverticula develop at specific weak spots, where the vasa recta enter the colonic circular smooth muscle layer.1 They are usually seen in the left colon. Their most common complication is diverticulitis, with mild cases resolving even without antibiotic therapy.2 Right-side diverticulitis develops in only 1.5% of cases, primarily on the anterior aspect of the cecum, proximal to the ileocecal valve (80%).4 Given its low incidence, location, and the fact that it involves younger patients, a differential diagnosis is needed to rule out abdominal inflammatory conditions such as appendicitis or ileitis, as well as gynecological disorders. Diverticulitis is diagnosed using imaging modalities. Computed tomography (CT) is the modality of choice,5 and confirmation is required after clinical remission, primarily using colonoscopy. We studied a series of 3 cases of patients initially diagnosed with acute, uncomplicated right-side diverticulitis who were admitted to the Gastroenterology Department, Hospital de León, from January to December 2023. Our goal was to confirm a presumptive diagnosis of right-side diverticulitis using delayed endoscopy or barium enema to ascertain the presence of right-side diverticulosis and rule out other conditions manifesting with abdominal pain in the right iliac fossa. Cases 1 and 3 were admitted with an accurate diagnosis of right-side diverticulitis. Case 1 was confirmed by ambulatory colonoscopy, and case 3 was confirmed by barium enema because of a history of previous colonoscopy without findings. All three patients required surgical assessment to rule out appendicular involvement. The imaging technique of choice was CT, using the WSES scale for severity grading. Case 2 was diagnosed with right-side diverticulitis by means of ultrasonography, and its origin was later confirmed to be in the sigmoid colon. The remaining clinical, laboratory, and diagnostic characteristics are listed in Table 1.
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References
1- Meyers, M. A., Alonso, D. R., Gray, G. F., & Baer, J. W. (1976). Pathogenesis of bleeding colonic diverticulosis. Gastroenterology, 71(4), 577–583.
2- Serrano González J, Román García de León L, Galindo Jara P, Lucena de la Poza JL, Sánchez Movilla A, Colao García L, García Schiever JG, Varillas Delgado D. Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study. Rev Esp Enferm Dig. 2024;116:140-147
3- Reichert, M. C., & Lammert, F. (2015). The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence. United European gastroenterology journal, 3(5), 409–418. https://doi.org/10.1177/2050640615576676.
4- Fischer, M. G., & Farkas, A. M. (1984). Diverticulitis of the cecum and ascending colon. Diseases of the colon and rectum, 27(7), 454–458. https://doi.org/10.1007/BF02555537
5- Sartelli, M., Weber, D.G., Kluger, Y. et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 15, 32 (2020). https://doi.org/10.1186/s13017-020-00313-4
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Blázquez Ávila V, Borrego Rivas S, Jiménez Palacios M, Baldi Borelli J, Álvarez Fernández C. Right-side diverticulitis. 10418/2024


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Publication history

Received: 22/03/2024

Accepted: 28/03/2024

Online First: 30/04/2024

Published: 08/07/2025

Article Online First time: 39 days

Article editing time: 473 days


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