Surgical management of cecal diverticulitis

Harada, Russell N.; Whelan, Thomas J.

doi:10.1016/s0002-9610(05)80676-2

Cited by 56 publications

(55 citation statements)

References 10 publications

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“…If recurrence is high and complications frequent, surgical resection is essentially required. However, after successful conservative treatment, a recurrence rate of 3.6% to 23.8% has been reported in the literature [5,7,8,20,21,30] . Ngoi et al [31] reported a recurrence rate of 1.5%, but 38% of their patients underwent diverticulectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Ngoi et al [31] reported a recurrence rate of 1.5%, but 38% of their patients underwent diverticulectomy. It is interesting to note that in these studies, there was little complicated diverticulitis in recurrent cases: Fang et al [5] reported three complicated cases in 10 recurrences in 42 patients receiving conservative treatments, and Harada et al [30] reported one complicated case in four recurrences in 29 patients. The other authors reported that all of the recurrent cases were uncomplicated diverticulitis, which responded well to medical therapy.…”

Section: Discussionmentioning

confidence: 99%

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Image-guided conservative management of right colonicdiverticulitis

Park¹,

Choi²,

Lee³

et al. 2009

WJG

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AIM:To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS:The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS:Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION:Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Image-guided conservative management of right colonicdiverticulitis

Park¹,

Choi²,

Lee³

et al. 2009

WJG

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“…Daniels and Wood [10]reported cecal diverticulum in only 0.2% of 5,000 barium enema studies. Other studies demonstrated a higher incidence of the disease (range 2.5–5%), and that 14% of cecal diverticulae would ultimately develop diverticulitis [2, 4, 11, 12, 13]. This disease was encountered especially in patients of Asian ancestry.…”

Section: Discussionmentioning

confidence: 99%

Cecal Diverticulitis: A Diagnostic Challenge

Keidar¹,

Pappo²,

Shperber³

et al. 2000

Dig Surg

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Background: Cecal diverticulitis is frequently indistinguishable from acute appendicitis preoperatively and is sometimes mistaken for carcinoma at laparotomy. The surgeon must be aware of the possibility of diverticulitis of the cecum in the operating room and choose the appropriate treatment. Purpose: Because there is no universal therapeutic approach to these patients, we decided to assess the presenting symptoms, clinical findings, preoperative diagnosis, operative findings determining the proper management of these patients. Methods: A retrospective chart review of 13 patients with pathologically confirmed cecal diverticulitis, who underwent surgery in our department from 1984 to 1998, was undertaken. Results: The mean age of patients was 43.5 years. Right lower quadrant pain and local tenderness were the only clinical findings in 92.3%, with preoperative diagnosis of acute appendicitis in 84.6% of patients. The operative finding in most cases was inflammatory mass of the cecum; in 6 cases it was indistinguishable from perforated cecal carcinoma. Six patients underwent right hemicolectomy, 5 had ileocecectomy, 1 patient was treated by tube cecostomy, and 1 had diverticulectomy. There were three minor postoperative complications: pneumonia, wound infection and lower limb superficial thrombophlebitis. Conclusions: Cecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. We suggest that the operative therapy should be ileocecectomy. The surgical specimen should be examined during surgery and only if carcinoma is found should the patient have a formal colectomy.

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“…Grade 1 refers to inflamed diverticulitis, Grade 2 to inflamed cecal mass, Grade 3 to localized abscess and fistula, Grade 4 to diffuse peritonitis or free perforation. While diverticulectomy is sufficient for Grade 1 and 2 disease, right hemicolectomy is recommended for Grade 3 and 4 (10,11).…”

Section: Colonoscopy Findings Biopsymentioning

confidence: 99%

Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series

Kalcan

Başak

Hasbahçeci

et al. 2016

UCD

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Objective: Cecal diverticulum is a rare entity, and can cause acute abdomen by the way of diverticulitis and perforation of diverticulitis. In this study, we aimed to perform an analysis of patients that have cecal diverticulitis, and presented with acute abdomen. Material and Methods: Patients who were admitted to emergency clinic between 2009-2012 and had acute abdomen due to cecal diverticulitis were included into study retrospectively. Results: Six patients were included in the study with a mean age of 34 years (range 24-43). Four patients were male and two were female (male/female: 2). All six patients presented with abdominal pain, additional symptoms were nausea in five patients, and vomiting in one patient. The mean white blood cell count was 11.900/mm 3 (5850-17.400/mm 3 ), while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. The surgical exploration revealed an inflamed cecal diverticulitis and normal appendix in all patients. Five patients underwent appendectomy and diverticulectomy. Right hemicolectomy was performed in one patient due to suspicion of malignancy. The early postoperative period was uneventful in all patients. The mean length of hospital stay was 4.5 days with a range of 2-6 days. Histopathological examination showed acute perforated diverticulitis with underlying true diverticulum in three patients, and true diverticulum with acute diverticulitis in the remaining three patients. Conclusion: Pre-operative diagnosis of cecal diverticulitis is challenging due to symptoms and signs that resemble acute appendicitis. Diverticulectomy and incidental appendectomy is the treatment of choice in uncomplicated cases.

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Surgical management of cecal diverticulitis

Cited by 56 publications

References 10 publications

Image-guided conservative management of right colonicdiverticulitis

Image-guided conservative management of right colonicdiverticulitis

Cecal Diverticulitis: A Diagnostic Challenge

Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series

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