Giant sigmoid diverticulitis mimicking acute appendicitis

Abstract

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients. case history A 70-year-old man presented to the acute general surgical take with a 24-hour history of worsening right iliac fossa pain. On examination he was found to have guarding and percussion tenderness in the right iliac fossa with pyrexia and tachycardia. A laboratory blood analysis showed a leukocytosis and an elevated C-reactive protein level. A diagnosis of acute appendicitis was suspected but in view of the age of the patient and his co-morbidity (ischaemic heart disease and type 2 diabetes) an urgent computed tomography (CT) of the abdomen and pelvis with oral contrast was arranged (Fig 1). The scan showed a 6.5cm-diameter giant sigmoid diverticulum in the mid-sigmoid to the right of the midline within an area of moderate diverticulosis. The giant diverticulum showed contrast enhancement indicating active inflammation. There was no evidence of a paracolic abscess, perforation or appendicitis and a diagnosis of acute giant sigmoid diverticulitis was made. Our patient was assessed as being at high risk for a laparotomy and was treated with intravenous broad-spectrum antibiotics with anaerobic cover. After 72 hours his symptoms had settled and he was well enough to be discharged. Ann R Coll Surg Engl

Uncommon Diverticular Disease

“…Nonsurgical treatments have also been reported, including percutaneous drainage, stent placement, and antibiotics, but these options should be limited to those refusing surgery and in prohibitively high-risk patients who may be candidates for elective partial colectomy after any acute inflammatory process has resolved. 21,36,37 Small Bowel Diverticula…”

Apendicitis Crónica Como Causa Del Dolor Crónico en Fosa Iliaca Derecha

“…Como parte de la valoración complementaria, el examen de laboratorio que se solicitó primordialmente fue el hemo-leucograma, del cual solo el 45% mostró datos sugestivos de un cuadro inflamatorio abdominal (véase gráfico # 1). 2,3,6,12,22,23,27,29,31,33,35,36,41,47,48].…”

“…Al 85% de los pacientes (17 casos) se les realizó apendicectomía como tratamiento definitivo, ya sea terapéutica o profiláctica, demostrando eficacia en ambos casos. El 15% restante de los pacientes (3 casos FUENTE: [2,3,6,12,22,23,27,29,31,33,35,36,41,47,48].…”

“…Sin embargo hay otros autores que sugieren la existencia de apendicitis crónicas. Esto conlleva a que actualmente varios autores se planten la aceptación del término de: apendicitis crónica en dolor abdominal crónico en el cuadrante inferior derecho y la indicación de apendicectomía en estos casos [31,32,33]…”

“…BAAR: bacilo alcohol ácido resistente. 2,3,6,12,22,23,27,29,31,33,35,36,41,47,48] De la búsqueda se encontró una totalidad de 127 artículos disponibles para la lectura de cualquier usuario sin necesidad de asociarse a páginas web o revistas específicas.…”