What is the global incidence of cecal diverticulitis?

Global Incidence of Cecal Diverticulitis

Cecal diverticulitis is a rare condition in Western populations but demonstrates significantly higher incidence in Asian populations, with marked geographic variation that fundamentally shapes its epidemiologic profile globally.

Geographic Distribution and Prevalence

Western Countries

• Right-sided (cecal) diverticulitis is uncommon in Western populations, where left-sided colonic diverticulitis predominates in approximately 90% of cases 1
• In the United States mainland, cecal diverticulitis remains rare enough that single-institution series of 49 patients over 22 years represented the largest reported cohort as of 1999 2
• The condition is sufficiently uncommon that it continues to present as a diagnostic dilemma, with preoperative misdiagnosis rates of 70-88% (most commonly mistaken for acute appendicitis) 3, 4

Asian and Pacific Populations

• Asian populations demonstrate dramatically higher incidence of right-sided diverticulitis, with 70-74% of diverticular disease affecting the right colon 1
• In Hawaii, where 78% of surgical cecal diverticulitis patients were of Asian descent, the condition was more frequently encountered, with 90 surgical cases over 11 years 5
• The mean age of presentation in Asian populations is notably younger (approximately 33-42 years) compared to the typical elderly presentation of left-sided disease 5, 4

African Populations

• Diverticulosis overall remains uncommon in Africa, with early studies showing prevalence as low as 1.85% in 1989 1
• However, emerging data suggest increasing prevalence (up to 10.6% by 2016), likely related to adoption of Western dietary patterns low in fiber 1
• Specific data on cecal versus left-sided distribution in African populations is limited in the available evidence

Contrast with Left-Sided Diverticulitis Incidence

To contextualize the rarity of cecal diverticulitis:

• Left-sided colonic diverticulitis affects approximately 180 cases per 100,000 persons per year in Western populations 1
• Among patients with diverticulosis, only 4-10% develop acute diverticulitis over their lifetime 1
• The prevalence of diverticulosis itself increases dramatically with age, from 32.6% in patients aged 50-59 years to 71.4% in those aged 80 years in Western countries 1

Clinical Implications of Geographic Variation

The striking geographic variation has critical diagnostic implications:

• In Western settings, cecal diverticulitis should be considered a rare differential diagnosis for right lower quadrant pain, with acute appendicitis remaining far more likely 2, 3
• In Asian populations, cecal diverticulitis represents a more common etiology and should be higher on the differential diagnosis for right lower quadrant pathology 1, 5
• CT imaging remains essential for accurate preoperative diagnosis regardless of geographic location, given the high rate of clinical misdiagnosis 6, 3

Data Limitations

Precise global incidence rates for cecal diverticulitis are not well-established in the available literature, with most evidence consisting of single-institution surgical series rather than population-based epidemiologic studies 2, 3, 5, 4. The condition's rarity in Western populations and variable presentation make accurate incidence determination challenging.