Brief Article
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World J Gastroenterol. Oct 14, 2010; 16(38): 4854-4857
Published online Oct 14, 2010. doi: 10.3748/wjg.v16.i38.4854
Suspected uncomplicated cecal diverticulitis diagnosed by imaging: Initial antibiotics vs laparoscopic treatment
Hyoung-Chul Park, Bong Hwa Lee
Hyoung-Chul Park, Bong Hwa Lee, Department of Surgery, Hallym University College of Medicine, Anyang 431-070, South Korea
Author contributions: Park HC contributed to the study design, analysis of data and drafting of the article; Lee BH contributed to analysis of data, revising the article and final approval.
Correspondence to: Hyoung-Chul Park, MD, Department of Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea.
Telephone: +82-31-3803772 Fax: +82-31-3804118
Received: April 30, 2010
Revised: June 7, 2010
Accepted: June 14, 2010
Published online: October 14, 2010

AIM: To compare the recurrence rate following initial antibiotic management to that following laparoscopic treatment for suspected uncomplicated cecal diverticulitis.

METHODS: We examined the records of 132 patients who were diagnosed with uncomplicated cecal diverticulitis and a first attack during an 8-year period. The diagnosis of uncomplicated diverticulitis was made based on imaging findings, such as inflamed diverticulum or a phlegmon with cecal wall thickening. Concurrent appendiceal dilatation from 8 to 12 mm was observed in 36 patients (27%). One hundred and two patients were treated initially with antibiotics only, whereas 30 underwent laparoscopic treatment, including partial cecectomy (n = 8) or appendectomy with diverticulectomy (n = 9) or appendectomy alone (n = 13). We compared clinical outcomes in both groups over a median follow-up period of 46 mo.

RESULTS: All patients were successfully treated with initial therapy. Of the 102 patients who initially received only antibiotic treatment, 6 (6%) had a recurrence (3 in the cecum and 3 in the ascending colon or transverse colon) during the follow-up period. Five of these patients were managed with repeated antibiotic treatment and 1 underwent ileocolic resection for perforation. Of the 30 patients treated by the laparoscopic approach, 2 (7%) had a recurrence (ascending colon) which was treated with antibiotics.

CONCLUSION: Initial antibiotic management for suspected uncomplicated cecal diverticulitis showed comparable efficacy to laparoscopic treatment in the prevention of recurrence.

Keywords: Antibiotics, Cecal diverticulitis, Laparoscopy, Radiological imaging