Cecal Diverticulitis: A Diagnostic Challenge

Abstract

Background: Cecal diverticulitis is frequently indistinguishable from acute appendicitis preoperatively and is sometimes mistaken for carcinoma at laparotomy. The surgeon must be aware of the possibility of diverticulitis of the cecum in the operating room and choose the appropriate treatment. Purpose: Because there is no universal therapeutic approach to these patients, we decided to assess the presenting symptoms, clinical findings, preoperative diagnosis, operative findings determining the proper management of these patients. Methods: A retrospective chart review of 13 patients with pathologically confirmed cecal diverticulitis, who underwent surgery in our department from 1984 to 1998, was undertaken. Results: The mean age of patients was 43.5 years. Right lower quadrant pain and local tenderness were the only clinical findings in 92.3%, with preoperative diagnosis of acute appendicitis in 84.6% of patients. The operative finding in most cases was inflammatory mass of the cecum; in 6 cases it was indistinguishable from perforated cecal carcinoma. Six patients underwent right hemicolectomy, 5 had ileocecectomy, 1 patient was treated by tube cecostomy, and 1 had diverticulectomy. There were three minor postoperative complications: pneumonia, wound infection and lower limb superficial thrombophlebitis. Conclusions: Cecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. We suggest that the operative therapy should be ileocecectomy. The surgical specimen should be examined during surgery and only if carcinoma is found should the patient have a formal colectomy.

Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period

“…While in other reports the age of patients with right-sided diverticulitis is lower compared to left-sided diverticulitis [2,4,6,9,10,13,19], no significant difference was observed in this study (60.9 years for right-sided vs 63.1 years for sigmoid diverticulitis, p>0.05). The diagnostics for right-sided diverticulitis are similar to those for diverticular disease of the left colon: abdominal ultrasound and CT scan with intravenous contrast medium or colon contrast enema with water-soluble contrast medium will lead to the correct diagnosis in up to 90% [20].…”

An Uncommon Cause of Acute Abdomen in a Pediatric Patient: Caecal Diverticulitis

“…Some studies in the literature also demonstrated that right colonic diverticulitis can be correctly diagnosed using radiologic evaluation [15,16]. Without any further imaging modalities such as CT, right-sided diverticulitis, in particular cecal diverticulitis is quite difficult to distinguish from acute appendicitis before surgery based only on clinical presentations, and the percentage of misdiagnosis is over 90% [17,18]. Therefore CT should be considered the diagnostic tool of choice in patients with suspected acute diverticulitis of the colon [8].…”

Perforated caecal diverticulum as a content of inguinal hernia — report of a rare case

“…Solitary diverticulum of the caecum is a rare and congenital entity [2] and perforation of such a diverticulum was fi rst described by Potiers in 1992. Since then there have been reports from different parts of the world [3][4][5][6][7]. Though perforated appendix in a hernial sac has been reported [8], there has been no report of a perforated caecal diverticulum in a hernial sac.…”