Cecal Diverticulitis
نویسندگان
چکیده
A 56-year-old Hispanic male presented to the emergency department (ED) complaining of right lower quadrant abdominal pain for two days. The pain was gradual in onset with a throbbing, burning quality, and 10 out of 10 severity. He reported diarrhea but denied fever, chills, nausea or vomiting. In the ED the patient was afebrile with normal vital signs, and his abdomen was soft and mildly tender in the right lower quadrant with normal bowel sounds. Computed Tomography (CT) of the pelvis with oral and intravenous contrast showed a thickened cecal wall with radiographic findings consistent with appendicitis (Figure 1). The patient went to the operating room for laparoscopic appendectomy and was found to have right-sided colonic diverticulitis involving the cecum, as well as a normal appendix. Right-sided colonic diverticulitis was first described in 1912 by Potier.1 Right-sided diverticulae are true, involving all layers of the intestinal wall, in contrast to left-sided which are false, only involving the mucosa and submucosa; however, the pathological mechanism that leads to diverticulitis is the same throughout the colon.2 In a majority of cases the underlying cause is secondary to obstruction by a faecolith.3 This pathologic mechanism mimics appendicitis and as such, the clinical presentation of right-sided diverticulitis is identical.4 Diverticulitis is initially managed non-operatively with antibiotics, unlike appendicitis which mandates surgical intervention. This difference underscores the importance of radiographic evidence along with a high index of suspicion for correctly identifying this uncommon diagnosis. Despite its low incidence, right-sided colonic diverticulitis remains an important differential diagnosis to consider in the presentation of an older patient with acute right lower quadrant pain. CT for acute appendicitis is good but not perfect. A systematic review showed CT to be 94 percent sensitive and 95 percent specific.5 Therefore, correct radiographic diagnosis, coupled with astute clinical judgment, may avoid unnecessary laparotomy.
منابع مشابه
Conservative Management of Cecal Diverticulitis Mimicking Acute Appendicitis in a Pregnant Woman
A 24-year-old pregnant woman was referred for further evaluation and treatment of the right lower quadrant pain at 19 weeks gestational age. The patient was diagnosed to be acute appendicitis and underwent laparoscopic surgery. However, an inflamed solitary cecal diverticulum was found during surgery. After a routine appendectomy, cecal diverticulitis was conservatively treated with postoperati...
متن کاملCecal Diverticulitis is a Challenging Diagnosis: A Report of 3 Cases
BACKGROUND Cecal diverticulitis is an uncommon cause of acute abdominal pain and presents clinically similar to acute appendicitis. There are many perspectives concerning the management of this condition, ranging from different types of surgical resections to conservative treatment with antibiotics. CASE REPORT We present 3 cases of cecal diverticulitis. One of the patients was treated conser...
متن کاملDiverticulitis of Cecum Mimicking Plastron Appendicitis: A Diagnostic and Therapeutic Dilemma
Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. Although it is usually asymptomatic, it may cause inflammation, bleeding, or perforation. The diagnosis is not always easy and in the majority of cases, the diagnosis is usually made at laparotomy. There have been various controversies in the literature regarding the optimal management of cecal divert...
متن کاملCecal diverticulitis or appendicitis. When should I suspect? A case report
The objective of this article was to report a case of cecal diverticulitis and point out the differential diagnosis of acute appendicitis. The clinical manifestations of these pathological conditions are similar, and the accurate diagnosis of cecal diverticulitis before the surgery is difficult. Therefore, most diagnoses are made during the surgery. Moreover, cecal diverticulum is uncommon in w...
متن کاملCecal Diverticulitis: A Diagnostic Conundrum
Section Editor: Sean O. Henderson, MD Submission history: Submitted December 17, 2014; Accepted January 13, 2015 Electronically published March 6, 2015 Full text available through open access at http://escholarship.org/uc/uciem_westjem DOI: 10.5811/westjem.2015.1.25119 [West J Emerg Med. 2015;16(2):316–317.] St. George’s Hospital, Department of Surgery, London, England, United Kingdom Royal Gwe...
متن کامل