An Unusual Cause of Right Lower Quadrant Pain: The Caecum Diverticulitis (original) (raw)
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A case of appendiceal diverticulitis, and a review of the literature
Irish Journal of Medical Science, 2009
Appendiceal diverticulitis is a rare presentation, often presenting outside of the classical age grouping for appendicitis. We describe a case of appendiceal diverticulitis and issue a cautionary note in the management of patients with atypical features of right lower quadrant pain. In light of its clinical course the finding of a non-inflamed appendiceal diverticulum should prompt one to consider incidental appendicectomy. We also review the literature on appendiceal diverticulitis.
Presentation of the Diverticulum of the Caecum, Cause of the Acute Abdomen
Surgical Science, 2016
Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.
Caecal diverticulitis presenting as acute appendicitis: a case report
World Journal of Emergency Surgery, 2009
Solitary caecal diverticulum is an uncommon entity and therefore difficult to diagnose except at surgery. Caecal diverticulitis is an infrequent cause of acute abdomen and usually presents in a manner similar to acute appendicitis. It is extremely difficult to differentiate it preoperative from acute appendicitis and such distinction is usually made in the operating room. The optimal management of this
INTRODUCTION: Appendiceal diverticulitis is a rare pathology that mimics acute appendicitis. Appendiceal diverticula are classified into congenital and acquired with difference in incidence and pathogenesis. Appendiceal diverticulitis is often overlooked because of mildness of symptomatology with increasing risk of complications, such as perforation. Appendiceal diverticula are often associated to higher risk of neoplasm especially carcinoid tumors and mucinous adenomas. PRESENTATION OF CASE: A 40-year-old caucasic male presented into Emergency Room with right lower quadrant pain associated with vomit, abdominal tenderness, fever and moderate leukocytosis (11.93 × 10; neutrophils 78.5%). Acute appendicitis was suspected and a surgical approach was chosen with a McBurney access. The removed specimen (Figs. 1 and 2) was 11 cm long with multiple hyper-aemic and oedematous diverticular protrusions. The postoperative course was regular. Discharging was on 4th postoperative day in optimal clinical conditions. The histological examination (Fig. 3) showed acute inflammation of appendiceal pseudodiverticula with acute peridiverticulitis and abscess. DISCUSSION: Currently, appendiceal diverticulitis is often overlooked with high risk of complications, above all perforation. Attention should be kept during the surgical procedure and the patholological examination in order to identify any associated neoplasm. CONCLUSION: Appendiceal diverticulitis should be considered in adult male patients with right lower quadrant pain or tenderness. Accurate appendectomy should be performed in order to permit an appropriate pathological examination and possible associate neoplasm should always be searched through. Prophylactic appendectomy should be performed in case of incidental finding of appendiceal diverticula in asymptomatic patients in order to avoid the high perforation risk.
Techniques in …, 2011
Caecal diverticula are rare, representing the 3.6% of colonic diverticula. They may have congenital origin and remain asymptomatic, presenting as an accidental finding. We present a case of a 42-year-old Caucasian woman, admitted with a 12-h history of sudden onset of sharp right iliac fossa pain, anorexia, and nausea. There was leukocytosis (23.49 9 10 3 /ll) and increased C-reactive protein (11.76 mg/dl). CT scan showed an inflamed appendix. At laparotomy, a diffuse caecal phlegmon with an inflammatory solitary caecal diverticula was found. A limited right hemicolectomy was performed. Histological examination confirmed the caecal diverticulitis without malignancy. Post-operative period was uneventful. Three months later, endoscopy showed no diverticula or other pathologies. Solitary caecal diverticulum is very rare, but surgeons must bear this in mind in case of pain in right iliac fossa.
Diverticulitis and Diverticulosis of the Appendix: A Case Series
Cureus, 2022
Introduction Diverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung's disease, cystic fibrosis and adult age, where some reports claim that they are also associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitis and one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methods A total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied. The demographic details and clinical data including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. Results The study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptoms were right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. Conclusion Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula-this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.
Cecal diverticulitis mimicking acute appendicitis: Management and short-term results of surgery
Annals of Clinical and Analytical Medicine, 2018
Aim: Cecal diverticulum is an infrequent cause of acute abdomen, and cecal diverticulitis usually presents in a behavior similar to acute appendicitis. This study aims to review our experience with surgical or nonsurgical management of cecal diverticulitis mimicking acute appendicitis in our department. Material and Method: From January 2012 to April 2017, fourteen patients were treated for cecal diverticulitis at our clinic. We retrospectively reviewed the patients' records, imaging modalities, and operative findings.Results: Nine men and five women with a mean age 43.93 ± 8.95 (range 32 to 65) years were evaluated. Total of nine (64.2%) patients were managed operatively. All patients were urgently operated. The mean hospital stay was 6.11 ± 1.61 days. In the postoperative period, two patients had wound infection, and postoperative mortality was not observed. Nonoperative management was used for the treatment in five (35.7%) patients who were preoperatively diagnosed with cecal diverticulitis, Hinchey stage I or II.Conclusion: Inflammation of the diverticulum of the cecum is an uncommon disease, but should be kept in mind in the differential diagnosis of pain in the right lower quadrant. Diagnostic laparoscopy can be used in patients and especially in women with atypical presentations of acute appendicitis. Preoperative diagnosis of cecal diverticulitis is very important in order to decide how to manage this condition.
Laparoscopic treatment of caecal diverticulitis
Chirurgia italiana
Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain and, in particular, is frequently indistinguishable from acute appendicitis preoperatively. Because of the problems concerning preoperative diagnosis and controversies in the management, the choice of the best therapy on the surgeon's part is still open. A total of 1150 patients with a clinical diagnosis of right acute abdomen observed in our surgical department from 1995 to 2003 was analysed. Three patients had a pathologically confirmed diagnosis of caecal diverticulitis. The mean age of the patients was 37 years. Right lower quadrant pain and local tenderness were the only clinical findings in 95.3% of the cases, with a preoperative diagnosis of acute appendicitis in 2 of 3 patients. The operative findings were an inflammatory mass in the caecum and the presence of a minimal amount of free peritoneal fluid. Two patients underwent laparoscopic ileocecectomy and one had a div...