EP2031 - Is it Left- or Right- Sided Diverticulitis? A Retrospective Study from the Middle East

Purpose/Background: Diverticular disease demonstrates distinct anatomical and clinical patterns across global populations, with left-sided disease predominating in Western populations and right-sided disease more common in East Asia. Data specific to Arab and Middle Eastern populations are sparse. This study aims to characterize and compare the clinical presentations and outcomes of left- versus right-sided diverticulitis in a cohort from the Middle East.

Methods/Interventions: A retrospective study was conducted on all adult patients admitted with acute diverticulitis to a single academic institution between 2010 and 2025. Demographic data, comorbidities, disease severity (Hinchey classification), treatment modality, length of stay (LOS), and recurrence patterns were extracted from hospital medical records. The primary outcome was to delineate differences in clinical presentation and outcomes between left- and right-sided diverticulitis in a cohort from the Middle East.

Results/Outcomes: Among the 300 patients who met the inclusion criteria during the study period, there were 252 patients (84.0%) with left-sided diverticulitis and 48 patients (16.0%) with right-sided diverticulitis. Table 1 summarizes patient characteristics and outcomes. There were no differences in age and comorbidities between the two groups; however, left-sided disease patients were predominantly males, of Arabic ethnicity, and exhibited higher rates of complicated disease (Hinchey class 3 and 4). Management of the index episode was predominantly non-operative across both groups, with no difference between left- and right-sided diverticulitis.

Persistent disease occurred in 19 patients (7.5%) with left-sided disease; including 16 treated with antibiotics alone, 2 with percutaneous abscess drainage, and 1 with surgery. In comparison 3 patients (6.3%) with right-sided disease had persistent disease and were treated with antibiotics alone. During the study period, first disease recurrence occurred in 47 patients (18.7%) with left-sided disease; 36 received antibiotics alone, 10 underwent percutaneous abscess drainage, and 1 required surgery. Four patients (8.3%) with right-sided disease experienced a first recurrence, 2 treated with antibiotics and 2 with percutaneous abscess drainage.

Second recurrence occurred in 18 patients (7.1%) with left-sided disease; 13 were treated with antibiotics, 3 with percutaneous drainage and 2 required surgery. Only one patient (2.1%) with right-sided disease developed a second recurrence and was managed with antibiotics alone. A third recurrence was observed in 5 patients (1.9%) with left-sided disease; 4 were treated with antibiotics and 1 with percutaneous drainage. No third recurrence occurred with right-sided disease.

Conclusion/Discussion: Diverticulitis in this cohort from the Middle East was predominantly left-sided, uncomplicated, and managed non-operatively. Recurrent disease was also mostly left sided and primarily managed non-operatively.

Table 1 compares characteristics and outcomes of left- and right-sided diverticulitis