1
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Ma Z, Liu W, Zhou J, Yao L, Xie W, Su M, Yang J, Shao J, Chen J. Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence. BMC Surg 2022; 22:132. [PMID: 35392887 PMCID: PMC8991946 DOI: 10.1186/s12893-022-01578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD. Methods We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment. Results A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis. Conclusions Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.
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Affiliation(s)
- Zhilong Ma
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Weiwei Liu
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Jia Zhou
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Le Yao
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Wangcheng Xie
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Mingqi Su
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Jin Yang
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Jun Shao
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Ji Chen
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Epifani AG, Cassini D, Cirocchi R, Accardo C, Di Candido F, Ardu M, Baldazzi G. Right sided diverticulitis in western countries: A review. World J Gastrointest Surg 2021; 13:1721-1735. [PMID: 35070076 PMCID: PMC8727183 DOI: 10.4240/wjgs.v13.i12.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/28/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.
AIM To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.
METHODS MEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021.
RESULTS A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.
CONCLUSION The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.
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Affiliation(s)
- Angelo Gabriele Epifani
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Diletta Cassini
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Perugia 06123, Italy
| | - Caterina Accardo
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, University of Milan, Sesto San Giovanni 20099, Italy
| | - Francesca Di Candido
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Massimiliano Ardu
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
| | - Gianandrea Baldazzi
- Complex Unit of General, Minimally Invasive and Emergency Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni 20099, Italy
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3
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Kalcan S, Başak F, Hasbahçeci M, Kılıç A, Canbak T, Kudaş İ, Baş G, Alimoğlu O. Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series. ULUSAL CERRAHI DERGISI 2016; 32:54-7. [PMID: 26985160 DOI: 10.5152/ucd.2015.2765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/28/2014] [Indexed: 12/30/2022]
Abstract
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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Affiliation(s)
- Süleyman Kalcan
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Fatih Başak
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Hasbahçeci
- Department of General Surgery, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Ali Kılıç
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Tolga Canbak
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - İlyas Kudaş
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Gürhan Baş
- Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Orhan Alimoğlu
- Department of General Surgery, Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey
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4
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Kyziridis DS, Parpoudi SN, Antoniou ND, Konstantaras DC, Moysidis MG, Christoforidis EC, Tsalis KG. Cecal diverticulitis is a challenging diagnosis: a report of 3 cases. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:206-10. [PMID: 25851946 PMCID: PMC4395017 DOI: 10.12659/ajcr.892848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Case series Patient: Male, 44 • Female, 73 • Male, 63 Final Diagnosis: Cecal diverticulitis Symptoms: Abdominal pain Medication: — Clinical Procedure: Right hemicolectomy Specialty: Surgery
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Affiliation(s)
- Dimitrios S Kyziridis
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Styliani N Parpoudi
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos D Antoniou
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ch Konstantaras
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Moysis G Moysidis
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Ch Christoforidis
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos G Tsalis
- 4th Department of Surgery, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Colorectal emergencies and related complications: a comprehensive imaging review--imaging of colitis and complications. AJR Am J Roentgenol 2015; 203:1205-16. [PMID: 25415697 DOI: 10.2214/ajr.13.12250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Colorectal emergencies are a common presentation in the emergency medicine setting and their timely diagnosis plays a crucial role in avoiding dreaded complications. The quintessential role of a radiologist lies in identifying the cause, narrowing the differential diagnosis according to imaging features, and, most importantly, identifying the associated complications. CONCLUSION This review focuses on imaging features of the spectrum of colitides and the complications related to colitides.
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6
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Solitary cecal diverticulitis: an unusual cause of acute right iliac fossa pain-a case report and review of the literature. Case Rep Surg 2014; 2014:131452. [PMID: 25506025 PMCID: PMC4258334 DOI: 10.1155/2014/131452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Solitary cecal diverticulitis is a rare cause of acute abdominal pain in the Western world. Its clinical presentation, in most cases, mimics acute appendicitis. A 38-year-old Caucasian man presented with acute abdomen and clinical signs of acute appendicitis. Laparotomy was performed and revealed an inflammatory, solitary diverticulum of the cecum. A typical appendectomy was performed and a catheter was inserted for draining percutaneously the inflamed diverticulum of the cecum. The patient had an uneventful recovery and was discharged on the 4th postoperative day. This frequently misdiagnosed condition, in most cases, is being suspected and identified intraoperatively as acute appendicitis. The aim of this study is to review the available different surgical management options and to present an alternative therapeutic approach that may be valuable under specific circumstances.
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7
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Salemis NS, Grapatsas K, Matzoukas I, Lagoudianakis E. Perforated posterior cecal diverticulum: challenges in establishing an accurate preoperative diagnosis of a rare emergency. Am J Emerg Med 2014; 33:475.e7-9. [PMID: 25245284 DOI: 10.1016/j.ajem.2014.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022] Open
Abstract
Solitary cecal diverticulitis is a rare cause of abdominal pain in Western countries. The preoperative diagnosis is very difficult to establish and most patients are operated on with a presumptive diagnosis of acute appendicitis based on clinical grounds. We describe a very rare case of perforated posterior cecal diverticulum and discuss the challenges in establishing a correct preoperative diagnosis. We conclude that although very rare, the possibility of perforated posteriorcecal diverticulum should always be considered in the differential diagnosis of patients presenting with atypical clinical manifestations of acute appendicitis. A perforation of a posterior cecal diverticulum maybe associated with a mild clinical course without signs of peritonitis. Athorough preoperative evaluation including a computed tomography scan is essential in order to establish a correct preoperative diagnosis which is of utmost importance for treatment planning in the emergency setting. Simple diverticulectomy is an effective surgical treatment in the absence of extensive inflammatory changes and when a colonic tumor can be ruled out.
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Affiliation(s)
- Nikolaos S Salemis
- Second Department of Surgery, 401 Army General Hospital, Athens, Greece.
| | | | - Ioannis Matzoukas
- Second Department of Surgery, 401 Army General Hospital, Athens, Greece
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8
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Issa N, Paran H, Yasin M, Neufeld D. Conservative treatment of right-sided colonic diverticulitis. Eur J Gastroenterol Hepatol 2012; 24:1254-8. [PMID: 22872077 DOI: 10.1097/meg.0b013e328357e672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diverticulosis of the right colon occurs in a small percentage of patients in Western countries. Clinical presentation of right-sided colon diverticulitis is indistinguishable from that of acute appendicitis, and the majority of patients undergo surgical intervention for presumed appendicitis. The liberal use of diagnostic radiological modalities whenever appendicitis was suspected led to correct diagnosis and also to more preoperative diagnosis of right-sided diverticulitis, which consented conservative medical therapy in cases of uncomplicated right-sided diverticulitis. The aim of the study was to report the outcome in patients with right-sided diverticulitis diagnosed nonoperatively using computed tomography scanning and treated conservatively. METHODS Patients with clinical and radiological diagnosis of cecal or right colon diverticulitis treated conservatively between January 2005 and December 2007 were included. The demographic and clinical data were retrospectively analyzed. RESULTS Fifteen patients were included in this study. The median age was 52 years (range, 34-72 years) and the duration of symptoms was 4 days (range, 1-9 days) before the diagnosis. The median hospital stay was 5 days (range, 1-9 days). All patients were successfully treated with medical therapy. During a median follow-up of 32 months (range, 24-52 months) only one patient (6.6%) had a recurrent attack, and he was successfully treated again with medical therapy. CONCLUSION The routine use of the computed tomography scan for abdominal pain in the right lower quadrant, and whenever right-sided diverticulitis is suspected, improves diagnosis and reduces surgical interventions. The current study provides additional data in support of conservative therapy as the initial treatment in acute right-sided diverticulitis, even in cases of recurrence.
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Affiliation(s)
- Nidal Issa
- Hasharon Hospital Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Petah-Tikva, Israel.
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9
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Wong CS, Naqvi SA. Appendicular perforation at the base of the caecum, a rare operative challenge in acute appendicitis, a literature review. World J Emerg Surg 2011; 6:36. [PMID: 22053953 PMCID: PMC3253676 DOI: 10.1186/1749-7922-6-36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022] Open
Abstract
Background Acute appendicitis is the most common acute surgical condition of the abdomen. Diagnosis is made based on full clinical history and examination as well as supported by a routine blood investigation and urine test. Prompt diagnosis and surgical referral may reduce the risk of perforation and prevent complications. The mortality rate of non-perforated appendicitis is less than 1 percent. Perforated appendicitis is associated with a higher mortality rate - as high as five percent and may be particularly more in extreme of age group attributed to delay in clinical presentation or diagnosis in the younger group and multiple co-morbidities in the elderly group. The aetiology is unknown. It may be linked with lack of fibre, familial tendency, or viral infection. It may be precipitated by faecaliths. The commonest site of the appendix is retrocaecal. Case Report We report a case of a 46 year old male who was admitted under the surgical service in Mid-Western Regional Hospital, Limerick with suspected appendicitis which turned out to be a perforated caecum, a rare complication of an acute appendicitis. We performed a literature review comparing two main approaches - right hemicolectomy and primary closure with omental patch - discuss and highlight their differences as well as a guide to its management. Conclusion There are limited studies to compare these two surgical options in the literature. A larger prospective study is needed to compare both approaches and long term outcome.
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Affiliation(s)
- Chee Siong Wong
- Department of Surgery, Mid Western Regional Hospital, Dooradoyle, Co, Limerick, Ireland.
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10
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Radhi JM, Ramsay JA, Boutross-Tadross O. Diverticular disease of the right colon. BMC Res Notes 2011; 4:383. [PMID: 21978459 PMCID: PMC3206858 DOI: 10.1186/1756-0500-4-383] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/06/2011] [Indexed: 01/19/2023] Open
Abstract
Background The incidence of colonic diverticular disease varies with national origin, cultural background and diet. The frequency of this disease increases with advancing age. Right-sided diverticular disease is uncommon and reported to occur in 1-2% of surgical specimens in European and American series. In contrast the disease is more prevalent and reported in 43-50% of specimens in Asian series. Various lines of evidence suggest this variation may represent hereditary differences. The aim of the study is to report all cases of right sided diverticular disease underwent surgical resection or identified during pathological examination of right hemicoloectomy specimens Methods A retrospective review of all surgical specimens with right sided colonic diverticular disease selected from a larger database of all colonic diverticulosis and diverticulitis surgical specimen reported between January 1993 and December 2010 at the Pathology Department McMaster University Medical Centre Canada. The clinical and pathological features of these cases were reviewed Results The review identified 15 cases of right colon diverticulosis. The clinical diagnoses of these cases were appendicitis, diverticulitis or adenocarcinoma. Eight cases of single congenital perforated diverticuli were identified and seven cases were incidental multiple acquired diverticuli found in specimen resected for right side colonic carcinomas/large adenomas. Laparotomy or laparoscopic assisted haemicolectomies were done for all cases. Pathological examination showed caecal wall thickening with inflammation associated with perforated diverticuli. Histology confirmed true solitary diverticuli that exhibited in two cases thick walled vessels in the submucosa and muscular layer indicating vascular malformation/angiodysplasia. Acquired diverticuli tend to be multiple and are mostly seen in specimens resected for neoplastic right colon diseases. Conclusion Single true diverticular disease of the right colon is usually of congenital type and affects younger age group and may be associated with angiodysplasia in some cases. Multiple false diverticuli are more seen in association with caecal carcinoma or large adenomas. These are usually asymptomatic and are more seen in older patients. However this study dose not reflects the true incidence of the disease in the general population.
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Affiliation(s)
- Jasim M Radhi
- Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
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11
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Inflammation of solitary caecal diverticula:a rare aetiology of acute abdominal pain [corrected]. Tech Coloproctol 2011; 15 Suppl 1:S43-5. [PMID: 21887576 DOI: 10.1007/s10151-011-0730-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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 × 10(3)/μl) 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.
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12
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Karaca G, Tekten G, Güler O, Kuşabbi R, Köklü S, Ustün H, Altunkaya C. Acute appendicitis and cecal diverticulitis in a young woman. Emerg Med Australas 2010; 22:192-3. [PMID: 20534057 DOI: 10.1111/j.1742-6723.2010.01277.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Cole M, Ayantunde AA, Payne J. Caecal diverticulitis presenting as acute appendicitis: a case report. World J Emerg Surg 2009; 4:29. [PMID: 19646252 PMCID: PMC2736155 DOI: 10.1186/1749-7922-4-29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 07/31/2009] [Indexed: 11/10/2022] Open
Abstract
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 clinical condition is still controversial, ranging from conservative treatment with antibiotics to aggressive surgical resections. We report a case of a 61 year old Caucasian who presented with acute onset right iliac fossa pain indistinguishable from acute appendicitis. The true diagnosis of a perforated acute caecal diverticulitis with an abscess mass was only made at operation in the presence of a macroscopically normal appendix. We reviewed the literature to highlight the difficulty of a preoperative diagnosis and the need for a high index of suspicion especially in the older age group presenting in manner similar to acute appendicitis.
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Affiliation(s)
- Michelle Cole
- Department of Surgery, Queen Mary's Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT, UK.
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14
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Kumar S, Fitzmaurice GJ, O'Donnell ME, Brown R. Acute right iliac fossa pain: not always appendicitis or a caecal tumour: two case reports. CASES JOURNAL 2009; 2:88. [PMID: 19173712 PMCID: PMC2637256 DOI: 10.1186/1757-1626-2-88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 01/27/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND A solitary diverticulum of the caecum is a rare benign condition which was first described by Potier in 1912 1. Clinical symptoms are usually a manifestation of complications arising from inflammation, perforation or haemorrhage. Despite radiological imaging, a pre-operative diagnosis is infrequent. CASE PRESENTATION We report two cases of right iliac fossa pain associated with a solitary caecal diverticulum. We discuss the clinical presentation, investigative modalities, and current therapeutic guidelines associated with this rare condition and highlight the difference from the more common conditions of appendicitis in the young and caecal neoplasms in the older patient. CONCLUSION Complications of a solitary caecal diverticulum should be considered in the differential diagnosis of acute right lower quadrant pain. Mild caecal diverticulitis verified pre-operatively by radiological imaging or laparoscopically can be ameliorated by antibiotics alone. However, severe inflammation, perforation, haemorrhage or torsion necessitates a localised or radical resection. The presence of multiple diverticula, caecal phlegmon, or the inability to rule out an underlying caecal neoplasm warrants a right hemicolectomy.
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Affiliation(s)
- Susim Kumar
- Department of General Surgery, Daisy Hill Hospital, Newry BT35 8DR, Northern Ireland, UK.
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15
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Karatepe O, Gulcicek OB, Adas G, Battal M, Ozdenkaya Y, Kurtulus I, Altiok M, Karahan S. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases. World J Emerg Surg 2008; 3:16. [PMID: 18426572 PMCID: PMC2365938 DOI: 10.1186/1749-7922-3-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 04/21/2008] [Indexed: 11/14/2022] Open
Abstract
Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.
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Affiliation(s)
- Oguzhan Karatepe
- Department of General Surgery, Okmeydaný Training and Research Hospital, Istanbul, Turkey.
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16
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Griffiths EA, Date RS. Acute presentation of a solitary caecal diverticulum: a case report. J Med Case Rep 2007; 1:129. [PMID: 17996100 PMCID: PMC2174501 DOI: 10.1186/1752-1947-1-129] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 11/09/2007] [Indexed: 11/28/2022] Open
Abstract
Introduction Solitary caecal diverticulitis is a rare cause of abdominal pain in Caucasian patients. The condition is often misdiagnosed and only correctly identified on exploration for suspected acute appendicitis. Our aim is to improve awareness of this condition amongst surgical trainees to ensure that its first encounter is not in the operating theatre. We review the role of pre-operative radiological imaging in this condition and the wide and controversial management options are also discussed. Case presentation A 67 years old man was admitted with a 24 hour history of pain in right iliac fossa. A pre-operative diagnosis of acute appendicitis was made but at operation a 2.5 cm inflamed and gangrenous solitary diverticulum of caecum was found. This was treated by right hemicolectomy as there was the suspicion of underlying malignancy. Conclusion Caecal diverticulitis, although rare in the Western population, should be considered in the differential diagnosis of patients complaining of right iliac fossa pain. The surgical approach should be tailored to the clinical scenario but may include conservative management, diverticulectomy, limited ileocaecal resection or right hemicoloectomy.
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Affiliation(s)
- Ewen A Griffiths
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool Fylde and Wyre NHS Trust, Blackpool, FY2 8NR, UK.
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