ORiginal Article : Visceral Obesity as a Risk Factor for Left-Sided Diverticulitis in Japan: A Multicenter Retrospective Study

( Eiji Yamada ),( Hidenori Ohkubo ),( Takuma Higurashi ),( Eiji Sakai ),( Hiroki Endo ),( Hirokazu Takahashi ),( Eri Uchida ),( Emi Tanida ),( Nobuyoshi Izumi ),( Akira Kanesaki ),( Yasuo Hata ),( Tet The Editorial Office of Gut and Liver 2013 Gut and Liver Vol.7 No.5

Background/Aims: Left-sided diverticulitis is increasing in Japan, and many studies report that left-sided diverticulitis is more likely to be severe. Therefore, it is important to identify the features and risk factors for left-sided diverticulitis. We hypothesized that left-sided diverticulitis in Japan is related to obesity and conducted a study of the features and risk factors for this disorder in Japan. Methods: Right-sided di-verticulitis and left-sided diverticulitis patients (total of 215) were compared with respect to background, particularly obesity-related factors to identify risk factors for diverticulitis. Results: There were 166 (77.2%) right-sided diverticulitis patients and 49 (22.8%) left-sided diverticulitis patients. The proportions of obese patients (body mass index ≥25 kg/m2, p=0.0349), viscerally obese patients (visceral fat area ≥100 cm2, p=0.0019), patients of mean age (p=0.0003), and el-derly patients (age ≥65 years, p=0.0177) were significantly higher in the left-sided-diverticulitis group than in the right-sided-diverticulitis group. The proportion of viscerally obese patients was significantly higher in the left-sided-diverticulitis group than in the left-sided-diverticulosis group (p=0.0390). Conclusions: This study showed that obesity, particularly visceral obesity, was a risk factor for left-sided diverticulitis in Japan. (Gut Liver 2013;7:532-538)

Risk Factors for Severe Diverticulitis in Computed Tomography-Confirmed Acute Diverticulitis in Korea

( Nark Soon Park ),( Yoon Tae Jeen ),( Hyuk Soon Choi ),( Eun Sun Kim ),( Young Jin Kim ),( Bora Keum ),( Yeon Seok Seo ),( Hoon Jai Chun ),( Hong Sik Lee ),( Soon Ho Um ),( Chang Duck Kim ),( Ho Sang 대한소화기학회 2013 Gut and Liver Vol.7 No.4

Background/Aims: Acute complicated diverticulitis can be subdivided into moderate diverticulitis and severe diverticulitis. Although there have been numerous studies on the risk factors for complicated diverticulitis, little research has focused on severe diverticulitis. This study was designed to identify the risk factors for severe diverticulitis in an acute diverticulitis attack using the modified Hinchey classification. Methods: Patients were included if they had any evidence of acute diverticulitis detected by computed tomography. The patients were subdivided into severe diverticulitis (Hinchey class Ib; abscesses or peritonitis) and moderate diverticulitis (Hinchey class Ia; pericolic inflammation) groups. Results: Of the 128 patients, 25 exhibited severe diverticulitis, and 103 exhibited moderate diverticulitis. In a multivariate analysis, age >50 years (odds ratio [OR], 5.27; p=0.017), smoking (OR, 3.61; p=0.044), comorbidity (OR, 4.98; p=0.045), leukocytosis (OR, 7.70; p=0.003), recurrence (OR, 4.95; p=0.032), and left-sided diverticulitis (OR, 6.92; p=0.006) were significantly associated with severe diverticulitis. Conclusions: This study suggests that the risk factors for severe diverticulitis are age >50 years, smoking, comorbidity, leukocytosis, recurrent episodes, and left-sided diverticulitis. (Gut Liver 2013; 7:443-449)

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

정병훈,하기원,이민로,김종훈 대한대장항문학회 2016 Annals of Coloproctolgy Vol.32 No.6

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.

Clinical characteristics of acute appendiceal diverticulitis

Tae Joon Sohn,Yeon Soo Chang,Jae Hee Kang,Dong Hee Kim,Tae Seok Lee,Joon Kil Han,Seong Hwan Kim,Young Ok Hong 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.1

Purpose: Diverticulitis of vermiform appendix is known as a rare cause of acute appendicitis, most of which are diagnosed after surgery. We compared appendiceal diverticulitis with acute appendicitis to study the clinical characteristics of appendiceal diverticulitis. Methods: Among 1,029 patients who received appendectomy from January 2009 to May 2011, 38 patients with appendiceal diverticulitis (diverticulitis group) were compared with 98 randomly collected patients with acute appendicitis (appendicitis group) during the same period. Patients’" characteristics, clinical features, laboratory findings, operative findings, and postoperative course were compared between the two groups. Results: Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 ± 15.2 years vs. 25.4 ± 14.2 years, P 〈0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 ± 3.8 days vs. 1.8 ± 3.2 days, P 〈0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groups. Twenty-five patients (65.8%) of the diverticulitis group and 10 patients (10.2%) of the appendicitis group showed perforation of appendix (P 〈 0.05). Mean operating time and postoperative hospital stay were longer in the diverticulitis group (55.3 ± 28.8 minutes vs. 41.4 ± 17.8 minutes, 6.8 ± 3.4 days vs. 4.9 ± 1.5 days, P 〈 0.05). Conclusion: Acute diverticulitis of the appendix can be classified into quite different disease entities compared with acute appendicitis. Regarding high rates of perforation, immediate surgical treatment is needed for patients with a high index of suspicion of acute diverticulitis of the appendix.

Diagnosis and management of acute colonic diverticulitis: results of a survey among Korean gastroenterologists

( Jae Gon Lee ),( Yong Eun Park ),( Ji Young Chang ),( Hyun Joo Song ),( Duk Hwan Kim ),( Young Joo Yang ),( Byung Chang Kim ),( Shin Hee Lee ),( Myung-won You ),( Seong-eun Kim ) 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.5

Background/Aims: Some management strategies for acute colonic diverticulitis remain controversial in Korean real-world practice because their clinical features differ from those in the West. This study aimed to investigate the opinions of Korean physicians regarding the diagnosis and treatment of acute diverticulitis. Methods: A web-based survey was conducted among gastroenterologists specializing on treating lower gastrointestinal disorders. The questionnaires concerned overall management strategies for colonic diverticulitis, including diagnosis, treatment, and follow-up. Results: In total, 209 gastroenterologists responded to the survey. Less than one-fourth of the respondents (23.6%) answered that left-sided colonic diverticulitis is more likely to be complicated than right-sided colonic diverticulitis. Most respondents agreed that immunocompromised patients with diverticulitis have worse clinical outcomes than immunocompetent patients (71.3%). Computed tomography was the most preferred tool for diagnosing diverticulitis (93.9%). Approximately 89% of the respondents answered that they believed antibiotic treatment is necessary to treat acute uncomplicated diverticulitis. Most respondents (92.6%) agreed that emergency surgery is not required for diverticulitis with an abscess or microperforation without panperitonitis. Further, 94.7% of the respondents agreed that colon cancer screening is necessary in patients aged ≥ 50 years with diverticulitis after they have recovered from acute illness. Many respondents (71.4%) agreed that surgery for recurrent diverticulitis should be individualized. Conclusions: Opinions regarding management strategies for colonic diverticulitis among Korean gastroenterologists were well agreed upon in some areas but did not agree well in other areas. Evidence-based guidelines that meet the practical needs of the Korean population should be developed.

한국인에서 대장게실염의 임상 양상

김흥업 ( Kim Heung Eob ),김영호 ( Kim Yeong Ho ),최원혁 ( Choe Won Hyeog ),김정환 ( Kim Jeong Hwan ),육청미 ( Yug Cheong Mi ),이재욱 ( Lee Jae Ug ),심상군 ( Sim Sang Gun ),손희정 ( Son Hui Jeong ),이풍렬 ( Lee Pung Lyeol ),김재준 대한소화기학회 2003 대한소화기학회지 Vol.42 No.5

In western countries, symptomatic diverticulitis develops in about 20% of the population with colonic diverticula, and it is mainly located at the left-sided colon. The clinical characteristics of diverticulitis have rarely been investigated although its incidence is increasing in Asia including Korea. The aim of this study was to compare diverticulitis with asymptomatic diverticulosis and to compare the clinical characteristics of right-sided diverticulitis with those of left-sided diverticulitis. Methods: We retrospectively investigated the medical records of the patients who had symptoms and signs of diverticulitis. Their diagnosis was confirmed with computed tomography, barium study, colonoscopy and/or operations at Samsung Medical Center from September 1998 to February 2002. The control cases of asymptomatic and incidental diverticulosis were randomly selected during routine health check-up after matching age and sex. Results: Twenty-seven patients with diverticulitis (male:female=14:13) were included. The mean age was 53 (27~86). The ratio of right and left diverticulitis was 20:7, which was similar to the ratio of diverticulosis. The complications, especially perforation, were more frequent in the patients with left-sided diverticulitis (p<0.05). Conclusions: Colonic diverticulitis is more prevalent at the right colon and left colonic diverticulitis has more complications than right colonic diverticulitis in Korea. (Korean J Gastroenterol 2003;42:363-368)

The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries

( Sun Young Kim ),( Tae Hoon Oh ),( Ji Young Seo ),( Tae Joo Jeon ),( Dong Dae Seo ),( Won Chang Shin ),( Won Choong Choi ),( Myeong Ja Jeong ) 대한소화기기능성질환·운동학회 2012 Gut and Liver Vol.6 No.1

Background/Aims: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. Methods: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. Results: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38oC, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was signifi cantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. Conclusions: This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed. (Gut Liver 2012;6:78-85)

대장 게실염: 임상 양상과 재발의 관점에서

최귀숙 ( Kwi Sook Choi ),변정식 ( Jeong Sik Byeon ),윤순만 ( Soon Man Yoon ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: There are a limited number of studies concerning the outcomes of diverticulitis in the Oriental population. We sought to evaluate the clinical features and the long-term outcomes of diverticulitis in Korean patients. Methods: We retrospectively reviewed the clinical courses of 104 patients (59 men, 45 women; median age 48.5 years [range: 24-83 years]) hospitalized for their first episode of diverticulitis between 1989 and 2005. Results: Right-sided diverticulitis was more common (71/104, 68%). However, the proportion of left-sided diverticulitis increased as age increased. Thirty-two patients underwent operations: 30 because of complications and 2 because of presumed appendicitis. Left-sided diverticulitis was an independent risk factor for complications (OR=7.6, p< 0.001), and it required surgical treatment more often than right-sided diverticulitis did (61% vs. 17%, p<0.001). Eighty-five patients were followed for a median of 36 months. Four of the 62 medically treated patients developed recurrence of diverticulitis, with a 3-year cumulative recurrence rate of 4.8%. None of the 4 recurrences showed complications, and all were successfully managed using conservative treatment. No predictive factors for the recurrence of diverticulitis could be determined. Conclusions: The recurrence rate and risk of complications associated with recurrence are low in patients treated conservatively for the first episode of diverticulitis. Therefore, elective surgery to prevent recurrence and complications should be utilized sparingly in patients with diverticulitis. (Intest Res 2008;6:37-44)

Assessment of clinical and laboratory parameters for the severity of acute diverticulitis in a Korean emergency department

이경원,이휘재,신종환,유경민 대한응급의학회 2020 대한응급의학회지 Vol.31 No.2

Objective: Practice guidelines for diverticulitis have been developed in countries where left-colon diverticulitis is dominant, but there is limited information on right-colon diverticulitis. This study examined the clinical characteristics and risk factors of clinically severe right-colon diverticulitis. Methods: A retrospective chart review of patients diagnosed with diverticulitis in an emergency department in Korea between 2013 and 2017 was performed. Clinically severe diverticulitis was defined as any cause of death, intensive care unit admission, surgery, or invasive intervention due to diverticulitis, and admission for seven or more hospital days. Multivariable logistic regression was used to identify the risk factors for clinically severe diverticulitis. Results: This study analyzed 302 patients. Patients with older age (odds ratio [OR], 1.044; 95% confidence interval [CI], 1.009-1.080; P=0.013), complications observed on computed tomography (CT) (OR, 6.906; 95% CI, 2.514-18.968; P<0.001), rebound tenderness on a physical examination (OR, 2.542; 95% CI, 1.041-6.218; P=0.041), high alkaline phosphatase (ALP) levels (OR, 1.014; 95% CI, 1.002-1.026; P=0.026), and high C-reactive protein (CRP) levels (OR, 1.095; 95% CI, 1.017-1.178; P=0.013) were at higher risk of clinically severe diverticulitis. Conclusion: Among patients diagnosed with right-colon diverticulitis in the emergency department, those of older age, distinct complications on CT, rebound tenderness on physical examination, high ALP, and high CRP levels are related to clinically severe disease.

The Relationship of Central Obesity to the Risk of Complicated Diverticulitis

이성연,한지숙,김율빈,김호중,유성훈,김철식,이성진,임성희,박충기,유교상,김민정,강준구 대한비만학회 2012 The Korean journal of obesity Vol.21 No.4

Background: Predictive factors of severe diverticulitis are known to be sex, obesity, immunodeficiency and old age. However, the association between obesity and complicated diverticulitis is yet to be defined. We conducted the present study to clarify the association of central obesity with the risk of complicated diverticulitis. Methods: A total of 117 patients were selected, who were diagnosed with colonic diverticulitis by abdominal CT from January 2005 to May 2007 at the authors’ institution. For measuring obesity, body mass index (BMI) was calculated and the visceral fat area (VFA), subcutaneous fat area (SFA), total fat area (TFA) and abdominal circumference (AC) were determined from CT images. All parameters were analyzed using univariate statistics and multivariate logistic regression models. Results: Out of the 117 patients with colonic diverticulitis,111 (94.9%) cases involved the proximal colon. In 30patients with complicated diverticulitis, 21 cases involved abscess formations and 9 cases showed perforated diverticulitis. Univariate analysis identified age, male sex, VFA, VFA/TFA and AC as risk factors associated with complicated diverticulitis (P < 0.05). However, after adjusting for age and sex, none of the parameters showed increased risk for complicated diverticulitis. Conclusions: Central obesity may not be a risk factor for increasing the risk of complicated colon diverticulitis in the Korean population.