Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

Abstract Background In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis. Methods A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared. Results 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis (P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment. Conclusions In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.

Download Full-text

Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

10.21203/rs.3.rs-32188/v2 ◽

2020 ◽

Author(s):

Zhi Chen ◽

Bing Zhang ◽

Dan Wu ◽

Ye Jin

Keyword(s):

Hospital Stay ◽

Recurrence Rate ◽

Sigmoid Diverticulitis ◽

Colonic Diverticulitis ◽

Abdominal Drainage ◽

Female Ratio ◽

Uncomplicated Diverticulitis ◽

Significant Difference ◽

Male To Female ◽

Acute Colonic Diverticulitis

Abstract Background: In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared.Results: 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis ( P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment.Conclusions: In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.

Download Full-text

Clinical Analysis of 123 Cases of Acute Colonic Diverticulitis

10.21203/rs.3.rs-32188/v1 ◽

2020 ◽

Author(s):

Zhi Chen ◽

Bing Zhang ◽

dan wu ◽

Ye Jin

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Recurrence Rate ◽

Sigmoid Diverticulitis ◽

Colonic Diverticulitis ◽

Abdominal Drainage ◽

Significant Difference ◽

Operation Group ◽

Length Of Hospitalization ◽

Acute Colonic Diverticulitis

Abstract Objective: To study the characteristics of acute colonic diverticulitis and the differences between different treatment options.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including operation group (n = 30) and non-operation group (n = 93). The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of acute colonic diverticulitis were compared between the operation group and the non-operation group.Results:111 cases of Caecal and ascending colonic diverticulitis (proportion 90.2%, male to female ratio 2.26: 1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%); 3 cases of transverse colonic diverticulitis; 3 cases of descending colonic diverticulitis; 6 cases of Sigmoid diverticulitis (proportion 4.9%, male: female 1: 1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 Days, recurrence rate 0%).30 patients received surgical treatment, including 15 cases of abdominal drainage, 14 cases of colonic diverticulectomy and repair, and 1 case of sigmoidectomy. There was a statistically significant difference in the length of hospitalization between the operative group and the non- operative group (P = 0.018), and the length of hospitalization was longer in the operative group. There was no significant difference in the recurrence rate between the operative group and the non-operative group of colonic diverticulitis (P = 0.595). Colonic diverticulitis usually relapsed within 1 year. The total recurrence rate was 4.1%.Conclusions: The right-sided colonic diverticulitis is more common in young and middle-aged. There is a higher incidence in males. The effect of non-operative treatment of acute diverticulitis is better than that of surgical treatment. Resection and repair of the diverticulum or abdominal drainage can be used in patients with acute uncomplicated diverticulitis.

Download Full-text

EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis

British Journal of Surgery ◽

10.1093/bjs/znab312.004 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

Neil J Smart ◽

Andrew Maw

Keyword(s):

Hospital Stay ◽

Conservative Management ◽

Emergency Surgery ◽

Lower Risk ◽

Length Of Hospital Stay ◽

Colonic Diverticulitis ◽

Co Morbidity ◽

Male Patients ◽

The Right ◽

Acute Colonic Diverticulitis

Abstract Aims To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis Methods We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data. Results Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P<0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P<0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P<0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P<0.0001) while more patients in the left-sided group had stage II (OR:0.19,P<0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P<0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,<0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02). Conclusions Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.

Download Full-text

Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211056037 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110560

Author(s):

Krystian Kazubski ◽

Łukasz Tomczyk ◽

Piotr Morasiewicz

Keyword(s):

Hospital Stay ◽

Shoulder Arthroscopy ◽

Demographic Data ◽

Epidemiological Data ◽

University Hospital ◽

Female Ratio ◽

Duration Of Hospital Stay ◽

The Mean ◽

Orthopedic Patients ◽

Male To Female

The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.

Download Full-text

Conventional incision and drainage versus incision and drainage with primary closure in acute abscess: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20175911 ◽

2017 ◽

Vol 5 (1) ◽

pp. 281

Author(s):

Amandeep Singh ◽

Gurdhian Singh ◽

Darsshan Singh Sidhu ◽

Mohit Bhalla

Keyword(s):

Wound Healing ◽

Hospital Stay ◽

Recurrence Rate ◽

Conventional Method ◽

Primary Closure ◽

The Body ◽

P Value ◽

Incision And Drainage ◽

Significant Difference ◽

A Prospective Study

Background: An abscess is a common surgical condition. Abscesses may occur anywhere in the body. Surgical treatment of subcutaneous and soft tissue abscesses includes percutaneous aspiration, incision and drainage without primary closure, incision and drainage with primary closure with drain. The present study was planned to compare conventional method of incision and drainage with incision and drainage with primary closure in cases of acute -abscesses.Methods: A total of 100 patients with acute abscesses were included in the study and randomized into 2 groups with 50 patients in each group. The present study was carried out to compare the conventional method of incision and drainage with incision and drainage with primary closure of the wounds in acute abscesses with regards to wound healing, post- operative pain, duration of hospital stays and recurrence rates.Results: Wound healing was significantly faster in incision and drainage with primary closure (9.18±0.941days) as compared to conventional method of incision and drainage (16.66±1.944 days) [p <0.05]. Mean hospital stay with convention method of incision and drainage was 7.12±0.718 days and with primary closure was 4.0±0.728days (p <0.05). Mean VAS was significantly less in primary closure as compared with conventional method. Decreasing trend in VAS was observed on day 3, day 5 and day 7 (p value 0.000). Recurrence rate of an abscess was seen in 5 cases in conventional method and 2 cases in primary closure (p >0.05).Conclusions: Author have observed a significant difference noted in time taken for wound healing, postoperative pain, hospital stay and recurrence rate between two groups.

Download Full-text

Intranasal Splint in Nasal Septal Surgery: Is It Necessary?

Medicine Today ◽

10.3329/medtoday.v32i2.48835 ◽

2020 ◽

Vol 32 (2) ◽

pp. 126-129

Author(s):

Jahangir Alam Mazumder ◽

Md Golam Mustafa ◽

AHM Delwar ◽

Shazibur Rashid ◽

Md Mostafizur Rahaman ◽

...

Keyword(s):

Complete Healing ◽

College Hospital ◽

Female Ratio ◽

Medical College ◽

Septal Surgery ◽

Significant Difference ◽

Group A ◽

Medicine Today ◽

Group B ◽

Male To Female

Introduction: After SMR/septoplasty with or without turbinate surgery, it needs to keep apart the septum and turbinates upto their complete healing otherwise there is a chance of adhesion (synechia) formation. To prevent this there are variousprocedures. To place an intranasal splint in one or both sides of the septum is one of them. Nowadays there raised thequestion of whether the splinting is necessary or not. There is no significant difference in result with or without anintranasal splint. Weighing against the co-morbidities the routine use of an intranasal splint can no longer be justified. Materials and Methods: This is a randomized control study of 200 patients of SMR/septoplasty, done for nasal septaldeviation causing symptoms in Cumilla Medical College Hospital in the period of January 2016 to December 2019. Theywere equally divided into two groups, group-A were operated placing an intranasal splint and group-B with no intranasalsplint. They were followed up for 6 weeks to detect any synechia and co-morbidities. Result: The age of our patients wasranged from 13-49 years with a mean age of 22.45 years. The male to female ratio is 1.78:1. Synechia was found in 4% ofthe splinted group and 6 of the nonsplinted groups. Co-morbidities were detected more in the splinted group than that ofnon-splinted. In INS group these were found as follows: pain in the nose, face and head (26%), faint during removal ofnasal splint (6%), nasal obstruction (38%), the anxiety of splint removal in the postoperative period (35%) and vestibulitisdue to persistent irritation by a splint (17%). Conclusion: There is little significant advantage of using intranasal splintroutinely in septal surgery to prevent synechia formation. Medicine Today 2020 Vol.32(2): 126-129

Download Full-text

Clinical Statistical Analysis with Comparison between Pelvic and Non-pelvic Chondrosarcoma

Oman Medical Journal ◽

10.5001/omj.2021.65 ◽

2021 ◽

Vol 36 (3) ◽

pp. e271-e271

Author(s):

Sayed Abdulla Jami1, ◽

Shi Jiandang ◽

Brotendu Shekhar Roy ◽

Zhanwen Zhou ◽

Liu Chang Hao

Keyword(s):

Prognostic Factors ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Survival Rates ◽

Significant Difference ◽

Grade Ii ◽

The Difference ◽

Early Local Recurrence ◽

Male To Female

Objectives: Chondrosarcomas are rare tumors with a variable biological characteristic. Their treatment clinically and surgically is controversial. Analysis of the clinical statistics and prognostic factors of pelvic chondrosarcoma provides a reference for clinical diagnosis and treatment. Methods: A total of 73 cases of chondrosarcoma were collected, including 24 pelvic samples, from 2008 to 2017 from the hospital database and divided into two groups: pelvic chondrosarcoma and non-pelvic chondrosarcoma. The clinical characteristics and prognostic factors of pelvic chondrosarcoma were analyzed using different statistical methods. Results: Among the 24 pelvic chondrosarcoma patients, the ratio of male to female was 1.4:1, and the median age was 43.5 years. According to the classification proposed by Enneking, there were five grade I, 14 grade II, and five grade III. Histological grading of chondrosarcoma was grade I in one case, II in 15 cases, and III in eight cases. The histological type was 17 conventional, three dedifferentiated, two secondary, one myxoid, and one mesenchymal. The overall survival rates for 24 cases at three, five, and 10 years were 82.2±8.1%, 77.3±8.9%, and 52.4±12.1%, respectively. The local recurrence rate of pelvic chondrosarcoma after surgical resection (83.3%) was significantly higher than that of other sites (34.7%), and the difference was statistically significant (p < 0.001). The final proportion of amputation rate (50.0%) was also higher than other parts (20.4%), with a statistically significant difference (p =0.010). The total survival of the two groups was not significantly different (p =0.216). Conclusions: Chondrosarcoma of bone generally has an excellent prognosis when optimally diagnosed and treated by an experienced team of specialists. Pelvic chondrosarcoma has a higher local recurrence rate than the other sites and tends to result in amputation. Early local recurrence after surgery indicates a poor prognosis.

Download Full-text

Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals

Annals of Coloproctology ◽

10.3393/ac.2020.01.19.2 ◽

2020 ◽

Vol 36 (5) ◽

pp. 323-329 ◽

Cited By ~ 1

Author(s):

Soo Min Lee ◽

Jun Sang Shin

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Univariate Analysis ◽

Survival Rates ◽

The Elderly ◽

Clinicopathological Parameters ◽

Female Ratio ◽

Significant Difference ◽

Differentiation Stage ◽

Male To Female

Purpose: Elderly population will comprise a substantial proportion of colorectal cancer (CRC) patients. We examined patients older than 80 years according to their clinical and pathological characteristics to fully understand the elderly patients.Methods: CRC patients, 60 years or older at diagnosis, admitted between 2009 and 2014 at our hospital were enrolled. The patients were divided into 2 groups: elderly (aged > 80 years, n = 133), and controls (aged 60 to 79 years, n = 596). Patient’s demographics, risk factors for prognosis of CRC, Clinicopathological parameters, treatment, and survival rates were compared.Results: The mean ages were 83.9 and 64.8 years, respectively. Male-to-female ratio and tumor sidedness were comparable in both groups. Prognostic factors found in univariate analysis; differentiation, stage, lymphovascular invasion, and carcinoembryonic antigen showed no statistical difference. The microsatellite instability status and number of retrieved lymph nodes were also similar (17.2 vs 21.6, P = 0.505). A significant difference was found in the treatment approach for chemotherapy as the elderly patients with stage III and IV tend to have omitted adjuvant (43.6% vs. 92.8%, P < 0.001) or palliative (35.8% vs. 89.4%, P = 0.016) chemotherapy. Except in stage I, elderly patients showed significantly lower overall survival rates.Conclusion: Current study shows far-elderly patients with CRC were less likely to receive standard treatments, which might have resulted in an inferior outcome. As the number of elderly patients with CRC increase, our results provide a basis for further clinical and molecular investigations of elderly CRC patients.

Download Full-text

Familial spontaneous pneumothorax: importance of screening for Birt–Hogg–Dubé syndrome

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz171 ◽

2019 ◽

Vol 57 (1) ◽

pp. 39-45 ◽

Cited By ~ 3

Author(s):

Yanguo Liu ◽

Huajie Xing ◽

Yu Huang ◽

Shushi Meng ◽

Jun Wang

Keyword(s):

Recurrence Rate ◽

Spontaneous Pneumothorax ◽

Clinical Characteristics ◽

Primary Spontaneous Pneumothorax ◽

Treatment Modalities ◽

Onset Age ◽

Female Ratio ◽

The Mean ◽

Male To Female ◽

Bhd Syndrome

Abstract OBJECTIVES The goal of this study was to investigate the prevalence of Birt–Hogg–Dubé (BHD) syndrome in patients with familial spontaneous pneumothorax (FSP) and the clinical characteristics of pneumothorax related to BHD syndrome compared with those of primary spontaneous pneumothorax. METHODS A total of 37 families diagnosed with FSP from 2007 to 2017 were enrolled in this study. The FLCN gene, which is responsible for BHD syndrome, was sequenced using the Sanger method in 25 probands. For the patients with confirmed BHD syndrome-related pneumothorax, clinical characteristics including the median onset age of pneumothorax, the male-to-female ratio, the mean height and body mass index (BMI) and the recurrence rate after different treatment modalities were obtained and compared with those of patients with primary spontaneous pneumothorax. RESULTS Of the 25 probands with FSP, 16 [64.0%, 95% confidence interval (CI) 43.8–84.2%] harboured FLCN germline mutations. In the patients with BHD syndrome-related pneumothorax, the median onset age of pneumothorax was 34 years; the male-to-female ratio was 1.3:1; and the mean height and BMI were 167.0 ± 8.6 cm and 23.6 ± 3.4 kg/m2, respectively. These characteristics were significantly different from those in patients with primary spontaneous pneumothorax from the same centre. The recurrence rate of BHD syndrome-related pneumothorax after conservative therapy was 53.1% (95% CI 38.6–67.5%) compared with 9.1% (95% CI 0–19.4%) after surgical treatment. CONCLUSIONS BHD syndrome is one of the most common causes of FSP. Patients with FSP should be recommended for mutation screening for the FLCN gene to facilitate early diagnosis and proper intervention.

Download Full-text

Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy Procedures in a University Hospital Department in Poland

10.21203/rs.3.rs-146656/v1 ◽

2021 ◽

Author(s):

Krystian Kazubski ◽

Łukasz Tomczyk ◽

Piotr Morasiewicz

Keyword(s):

Hospital Stay ◽

Shoulder Arthroscopy ◽

Demographic Data ◽

Epidemiological Data ◽

University Hospital ◽

Female Ratio ◽

Duration Of Hospital Stay ◽

The Mean ◽

Orthopedic Patients ◽

Male To Female

Abstract Background: The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopies performed in an orthopedic department of a university hospital in Poland.Methods: This study compared the data on shoulder and knee arthroscopy procedures performed in two different periods: the period of the COVID-19 pandemic in Poland (from March 4, 2020 to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019–October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration.Results: The total number of arthroscopy procedures conducted in the evaluated period in 2020was approximately 8.6% higher than that in the corresponding 2019 period.The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019.The male-to-female ratio was shown to be lower at 0.85 during the pandemic, having decreased from 1.5 in 2019Conclusions: The COVID-19 pandemic did not reduce the number of arthroscopies performed at our center and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.

Download Full-text