Benign Headache in the Elderly – A Case Report of Hypnic Headache

Solitary caecal diverticulitis Editor, I have had recent experience of three cases of solitary caecal diverticulitis which presented over an 18 month period to Causeway Hospital 1 and wished to add to the case by Abogunrin et al. 2 There have been over 1000 cases of caecal diverticulitis reported in the literature. A review of 881 cases showed that the average age was 43.6 years (range 7 to 87 years) with a 3:2 male to female ratio. 3 85% present with symptoms similar to appendicitis. 3 Cutajar 4 suggested clinical features which could help differentiate caecal diverticulitis from appendicitis. There is a relatively long history of abdominal pain with lack of toxicity. Tenderness is not as marked and only elicited on deep palpation, and vomiting is less frequent. Abogunrin et al 2 suggested that CT scanning was the most useful pre-operative investigation as ultrasound was not sensitive. However, Chou 5 proved the accuracy of ultrasound in diagnosing caecal diverticulitis. In a prospective study of 934 men with indeterminate right lower abdominal pain, ultrasound had a sensitivity of 91.3% and a specificity of 99.5% in differentiating right sided diverticulitis from appendicitis. Ultrasound also has the advantage of avoiding radiation exposure and being generally more accessible. Given the low incidence and difficulties with diagnosis, there have been no randomised trials comparing conservative with aggressive treatment. Most studies are retrospective note reviews comparing outcomes in those treated with antibiotics alone to diverticulectomy or hemicolectomy, and also tend to be from mainly Asian populations, which may not be truly representative of the UK. Lane et al 6 in a study of 49 patients with 78% of non-Asian descent, found that 40% of those treated with diverticulectomy or antibiotics alone required subsequent hemicolectomy due to an ongoing inflammatory process. In a US population, they recommended diverticulectomy in cases of a solitary inflamed diverticulum. Our cases, treated with diverticulectomy or inversion of the diverticulum had no postoperative complications or recurrence of symptoms. We agree with Abogunrin et al 2 that surgery should be conservative when carcinoma is excluded and there is not extensive inflammation. Letters 2. Abogunrin fA, Arya n, Somerville JE, Refsum S. Solitary caecal diverticulitis – a rare cause of right iliac fossa pain. Sonography of acute right side colonic diverticulitis. Editor, new headaches in the elderly raise the suspicion of serious pathology such as space occupying lesions, temporal arteritis, or cerebrovascular disease. Alternatively …