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Background
RSD, defined as diverticulitis involving the colon proximal to the splenic flexure, is uncommon in western countries. A low index of suspicion could affect the diagnosis and management of these patients. The purpose of this study was to examine presentation, treatment and outcome of patients admitted with RSD in a large urban area.
Methods
The health records of all patients admitted with diverticulitis between January 2007 and March 2010 were reviewed and the subset of patients admitted with RSD was identified. Records were reviewed looking at demographic, clinical, radiologic, treatment and outcome factors.
Results
715 patients presented with acute diverticulitis, 68 had RSD (9.5%). Median age was 45 years (range 19 to 92yrs), 58.8% were female, median follow up 29.5 months (range 12 to 50). 60 patients (88.2%) presented with uncomplicated and 8 (11.8%) with complicated diverticulitis.
59 patients (86.7%) had a CT scan. 10 of these (14.7%) required surgery due to diagnostic uncertainty (2 incidental appendectomies, 8 segmental resections). 49 patients (83.1%) had CT diagnosis of RSD and were successfully treated non-operatively.
9 patients (13.2%) had surgery without imaging for presumed appendicitis (4 incidental appendectomies, 5 segmental resections). Post-operative morbidity was only 2.8%.
Of the 55 patients whose RSD was treated without segmental resection, 1 was readmitted with recurrent diverticulitis at 2 weeks and underwent elective resection.
33 patients (60%) underwent subsequent colonoscopy at a mean of 3.5 months from admission, no alternate diagnoses found.
Conclusions
CT scan is accurate at diagnosing RSD. Once diagnosed, it can be successfully treated non-operatively. Risk of recurrent RSD following non operative management is very low.