Caecal diverticulitis mimicking acute appendicitis

Abstract

Solitary caecal diverticulitis is a rare cause of abdominal pain in Western patients and is more common in the Oriental population (1). In this paper, we describe a patient who was thought to have acute appendicitis or pelvic inflammatory disease preoperatively. At operation, inflamed solitary caecal diverticulum was detected.A 56-year-old man was admitted to our hospital with two-day history of abdominal pain in the right lower quadrant. He had no nausea or vomiting. His past medical history was unremarkable. Physical examination revealed a temperature of 37.8°C, heart rate -80 beats/min, and blood pressure of 128/75 mmHg. Physical examination was unremarkable other than right iliac fossa tenderness and rebound. Rectal digital examination was normal. Apart from the increase in WBC to 12.9 and CRP to 42, laboratory investigations including urinalysis were within normal limits. Computed tomography (CT) scan showed a tumor in the cecum surrounded by inflammatory plate (Figure 1). At operation, there was a small amount of clear free fluid. The appendix was normal, as was the terminal ileum. There was a solitary diverticulum projecting from the medial aspect of the caecum and forming an inflammatory mass with the omentum (Figure 2). Diverticulectomy and incidental appendectomy were performed. His postoperative course was uneventful, and he was discharged home after a week of admission.The true prevalence of colonic diverticulosis is difficult to ascertain, however, it appears that about 8.5% of people in Western countries are afflicted (2). In Western countries, 85% of all diverticula occur in the descending and sigmoid colon. The reported frequency of caecal diverticulum in the literature has been estimated to be 1 in 300 appendicectomies (3). Nausea and vomiting are less frequent, abdominal pain typically starts and remains in the right iliac fossa rather than beginning in the central abdomen and shifting to the right iliac fossa. Right iliac fossa tenderness is not usually as marked as in acute appendicitis. Intravenous contrast-enhanced CT scanning can accurately demonstrate the features of acute right-sided diverticulitis (4). The features of caecal diverticulum include colonic wall thickening, pericolic fat infiltration, associated abscess formation, and extraluminal air denoting perforation. In our case, CT indicated diverticulum without abscess formation in the caecal wall. In patients with preoperative di-

Cecal diverticulitis mimicking acute appendicitis: Management and short-term results of surgery

“…In our study, nine patients were treated surgically, and only five patients were treated non-operatively. Different surgical approaches are defined but a right hemicolectomy is recommended in the presence of an inflammatory mass and when a carcinoma cannot be excluded [17,18]. Moreover, if surgery is needed, elective laparoscopic surgery is preferred to minimize complications and morbidity [19,20].…”