Acute right‐sided colonic diverticulitis mimicking appendicitis: A report of two cases

Abstract

We describe two right-sided diverticulitis cases that presented with marked right iliac fossa tenderness with guarding and rebound and laboratory parameters resembling acute appendicitis. The imaging findings suggested diverticulitis in both cases. One of the patients underwent surgery and the other one was followed up with medical treatment. Awareness of these imaging findings may aid in the diagnosis of right-sided diverticulitis, which is frequently misdiagnosed and mistreated.

Medical Approach to Right Colon Diverticulitis with Perforation

“…As a general principle, diverticular disease increases with age. Diverticular disease is said to affect 50% of those aged 60 years and older and as many as 80% of the population aged 80 and older [ 4 ]. Many factors have been described as variables in the development, including dietary factors (such as decreased dietary fiber) as well as a lack of physical activity [ 5 ].…”

“…They conclude that right-sided diverticulitis should be considered in cases of atypical appendicitis presentations [ 11 ]. However, as well noted by Kahveci et al, the differential diagnosis of right lower quadrant pain “is vast” and includes not only acute appendicitis but also “ureteral colic, ectopic pregnancy, and a ruptured ovarian cyst.” [ 4 ]. Other forms of pathology may present with right lower quadrant pain and CT evidence of inflammation, including an inflammatory Crohn's mass, ileocecal tuberculosis, or a perforated foreign body reaction [ 1 ].…”

Acute right upper quadrant diverticulitis: an unusual sonographic finding in a young adult patient

“…Diverticulitis, as a differential for RUQ pain in a young patient, is the key learning from this case. Most patients with acute right sided diverticulitis present with right sided abdominal pain that is almost always mistaken for appendicitis or cholecystitis . A key sign of diverticulitis is that the patient is more likely to complain of dull pain, which is of longer duration.…”

“…Traditionally, CT has been the modality of choice where diverticulitis is suspected; however, diverticulitis predominantly manifests on the left side, accompanied by raised inflammatory markers (C‐reactive protein over 50 mg/L) and tenderness to ballottement in the left lower quadrant only . Right sided diverticulitis tend to be an incidental finding on imaging or diagnosed on laparoscopic examination during appendectomy subsequent to erroneous clinical diagnosis of appendicitis …”

“…Despite ultrasound being an accurate tool for identifying diverticulitis, the sonographic diagnosis (as in this case) of a young person in the right upper quadrant is rarely reported. There are only a range of sporadic case reports . These mostly report a clinical presentation mimicking other pathologies as previously described.…”