title: Toward therapeutic guidelines for patients with acute right colonic diverticulitis.
abstract: BACKGROUND
  At present, little information is available on the outcome of medical therapy for patients with acute right colonic diverticulitis, and this has meant a gap in constructing guidelines for its treatment.
  
  
  METHODS
  The records of patients with acute right colonic diverticulitis at Nagasaki University Graduate School and affiliated hospitals were reviewed and analyzed with the goal of establishing therapeutic guidelines. The time frame of the data analyzed was from 1984 to 2002.
  
  
  RESULTS
  Of the 81 patients included in the data, 80 patients who were suffering a first attack were successfully treated with bowel rest and antibiotics. Two of these 80 patients underwent an elective operation at the surgeon's discretion during the original hospitalization and 1 (1.2%) needed an urgent operation. Of the 78 patients who responded to medical therapy, 16 (20.5%) developed recurrent right colonic diverticulitis. All 16 patients who had a second attack were successfully treated with medical therapy. Three of the 16 patients underwent an elective operation during this rehospitalization period. Of the 13 patients who had had a second attack and had responded to medical therapy, there was a third attack in 2 patients (15.4%). Both of these patients were again successfully treated with medical therapy. There has been no morbidity and no mortality related to recurrence to date. The average time from the first attack to us contacting the patient was 35.2 months.
  
  
  CONCLUSIONS
  Unlike acute uncomplicated left colonic diverticulitis, our findings indicate that after two documented episodes, medical treatment alone rather than elective surgery may be considered as an effective guideline for the treatment of acute uncomplicated right colonic diverticulitis.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Ngasaki 852-8102, Japan. komuta@net.negasaki-u.ac.jp
authors.forename: Ko
authors.initials: K
authors.lastname: Komuta
authors.forename: Shizuo
authors.initials: S
authors.lastname: Yamanaka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Okada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kamohara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueda
authors.forename: Noriaki
authors.initials: N
authors.lastname: Makimoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shiogama
authors.forename: Junichiro
authors.initials: J
authors.lastname: Furui
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004239:Diverticulitis, Colonic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome