CLINICAL BEHAVIOR OF COMPLICATED RIGHT-SIDED AND LEFT-SIDED DIVERTICULOSIS

PURPOSE: The aim of the study was to characterize the clinical entity of multiple right-sided (RS) diverticular dis ease, which is uniquely common in Asians. METHODS: Patients hospitalized with proven diverticu lar disease from June 1989 to January 1996 were reviewed. Data were re trieved from a prospectively collected computerized database. RESULTS: One hundred eighty consecutive patients were admitted to the Departme nt of Colorectal Surgery, Singapore General Hospital, with multiple di verticular disease. Average age was 65.1 (standard error of the mean, 13.9) years. There were 96 men and 84 women. Women presented, on avera ge, 8.4 years later than men (P < 0.005). Eighty-five patients (47 per cent) had massive rectal bleeding, 65 (36 percent) had diverticulitis, 21 (12 percent) had obstructive symptoms, and 9 (15 percent) had ente ric fistulas. The diverticula were RS in 76 patients (42 percent), lef t-sided (LS) in 62 patients (34 percent), and on both sides in 42 pati ents (24 percent). RS diverticulosis tended to present with massive re ctal bleeding (42/76; 55 percent) more often than LS disease (14/62; 2 3 percent; P < 0.005). Surgery for bleeding was also required more oft en for RS (17/42; 41 percent) than for LS disease (1/14; 7 percent; P < 0.05); however, diverticulitis was more common on the left (RS. 25/7 6, 33 percent; LS, 32/62, 52 percent; P < 0.05). Seventy-eight patient s (43 percent) required surgery for these complications of diverticula r disease. At a mean follow-up of 15.2 (standard error of the mean 2) months, mortality was 2 in 78 patients who underwent surgery (3 percen t), and morbidity was 15 percent. CONCLUSIONS: In comparison with LS, RS diverticular disease tended to present more often with massive blee ding than with diverticulitis and fistulation. This bleeding was often more severe and required surgical intervention.