Clinical Difference between Acute Appendicitis and Acute Right-Sided Colonic Diverticulitis

Abstract

Background. Clinical presentations of acute appendicitis (AA) and acute right-sided colonic diverticulitis (ARCD) are similar. However, the usual treatment for each disease differs between surgical and conservative management. The aim of this study was to identify clinical differences between AA and ARCD. Method. We performed a single-center retrospective study on adult patients, with uncomplicated AA and ARCD confirmed by computed tomography, who visited an emergency department between March 2018 and August 2019. Clinical variables including past medical history, presented symptoms and signs, and laboratory findings were compared between the two groups. A logistic regression analysis was subsequently performed to differentiate ARCD from AA based on results of univariate analyses. Results. A total of 212 (79.1%) and 56 (20.9%) patients were enrolled in AA and ARSD groups, respectively. Logistic regression analysis revealed that a past history of diverticulitis [OR: 102.679 (95% CI: 9.964–1058.055), p<0.001] was associated with ARCD, while ketonuria [OR: 2.907 (95% CI: 1.091–7.745), p=0.033], anorexia [OR: 21.544 (95% CI: 3.905–118.868), p<0.001], and neutrophilia [OR: 3.406 (95% CI: 1.243–9.336), p=0.017] were associated with AA. Conclusion. Anorexia, neutrophilia, and ketonuria were predictors of AA while a history of diverticulitis was a predictor of ARCD.

Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life

“…Distinguishing acute appendicitis from right-sided diverticulitis often depends on prior diverticular disease, elevated WBC count, and increased CRP level. 10,11 In our research, 36.3% and 81.8% of patients presented high WBC and CRP levels respectively upon emergency department admission. Interestingly, severe cases didn't always correlate with higher inflammatory markers in blood tests.…”

“…It should be suspected in patients with a long history of abdominal pain in the right lower quadrant with atypical presentation. Distinguishing acute appendicitis from right‐sided diverticulitis often depends on prior diverticular disease, elevated WBC count, and increased CRP level 10,11 . In our research, 36.3% and 81.8% of patients presented high WBC and CRP levels respectively upon emergency department admission.…”

“…Right-sided diverticulitis, previously accounting for under 5% of cases, has slightly increased in Western societies. More recent data 9,10 reveal that it constitutes 15% of all diverticular disease cases 11 and its incidence increases with aging in patients who had concurrent or prior LCD. 6,[10][11][12] The diagnosis of RCD is challenging and is often missed preoperatively.…”

“…More recent data 9,10 reveal that it constitutes 15% of all diverticular disease cases 11 and its incidence increases with aging in patients who had concurrent or prior LCD. 6,[10][11][12] The diagnosis of RCD is challenging and is often missed preoperatively. This condition is often asymptomatic and comes to attention mostly in the presence of important symptoms, depending also on disease localization; such as peritonitis, perforation, or, rarely, bleeding.…”

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina

“…On a clinical basis, it is difficult to distinguish RD from appendicitis, due to the fact that signs and symptoms are similar at the moment of presentation, especially in young patients [ 16 ]; which requires a differential diagnosis between these 2 pathologies to determine a therapeutic plan and avoid unnecessary surgeries, due to a misdiagnosis of AA [ 17 ]. In this cohort, AA was suspected in 75% of the cases.…”