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Huang CH, Liu KL, Lim ZJ, Sung CW, Wang HP, Chen IC, Lien WC, Huang CH. Colonic Diverticulitis Location Affects the Diagnostic Accuracy of Point-of-Care Ultrasound: A Multicenter, 10-Year Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1611-1615. [PMID: 37032239 DOI: 10.1016/j.ultrasmedbio.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (PoCUS) has high sensitivity and specificity in diagnosing uncomplicated colonic diverticulitis in Western patients. Evidence regarding the accuracy of PoCUS in Asian patients in which diverticulitis frequently occurs in the right-side colon is lacking. This multicenter, 10-y study was aimed at evaluating the diagnostic accuracy of PoCUS in various locations of uncomplicated diverticulitis among Asians. METHODS A convenience sample of patients with suspected colonic diverticulitis who had undergone computed tomography (CT) were eligible. Patients undergoing PoCUS before CT were included. The primary outcome was the diagnostic accuracy of PoCUS in the various locations, compared with the final diagnosis made by the expert physicians. The sensitivity, specificity, positive predictive value and negative predictive value were computed. The logistic regression model was used to investigate the possible factors related to the accuracy of PoCUS. RESULTS A total of 326 patients were included. The overall accuracy of PoCUS was 92% (95% confidence interval [CI]: 89.1%-95.0%) and was lower in the cecum (84.3%, 95% CI: 77.8%-90.8%), compared with other locations (p < 0.0001). Nine of 10 false positives had the final diagnosis of appendicitis: 5 had an outpouching structure whose origin in the cecum could not be traced and 4 had elongated "diverticula." Moreover, body mass index was negatively associated with the accuracy of PoCUS in cecal diverticulitis (odds ratio: 0.79, 95% CI: 0.64-0.97) after adjusting for other covariates. CONCLUSION Point-of-care ultrasound exhibits high diagnostic accuracy in diagnosing uncomplicated diverticulitis in the Asian population. However, the accuracy varies according to location, and was relatively low in the cecum.
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Affiliation(s)
- Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zi-Jiang Lim
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Torres US, Caiado AH, Tiferes DA, Bretas EA, Ueda SK, Chamié LP, Fong MS, Silva LL, Ottaiano AC, D'Ippolito G. The Cecum Revisited: A Multimodality Imaging Case-based Review of Common and Uncommon Cecal Diseases. Semin Ultrasound CT MR 2022; 43:455-465. [DOI: 10.1053/j.sult.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Uhe I, Meyer J, Viviano M, Naiken S, Toso C, Ris F, Buchs NC. Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature. Colorectal Dis 2021; 23:2515-2526. [PMID: 34272795 PMCID: PMC9292704 DOI: 10.1111/codi.15818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
AIM Caecal diverticulitis (CD) is an uncommon condition which can be misdiagnosed as acute appendicitis due to similar clinical presentations. Further, its management varies among medical centres. The aim of this study was to review cases of patients with CD, to identify the factors differentiating CD from acute appendicitis and to provide a summary of existing diagnostic methods and therapeutic alternatives regarding its management. METHODS This systematic review was conducted in accordance with the PRISMA guidelines and the AMSTAR2 checklist. We searched MEDLINE and Embase from inception until 1 October 2018 for original publications reporting cases of CD. RESULTS Out of the 560 identified studies, 146 publications (988 patients) were included in the qualitative synthesis. Most frequent symptoms of CD were right iliac fossa pain (93.2%), nausea and/or vomiting (35.4%) and fever (26.9%). A total of 443 patients (44.8%) underwent radiological imaging, which reported CD in 225 patients (22.8%). For the other patients, the diagnosis was obtained by surgical exploration (73.9%). Among patients diagnosed with CD by imaging, 67 (29.8%) underwent surgery and 158 (70.2%) were treated conservatively. Among patients who underwent surgical exploration, treatment consisted most frequently of right hemi-colectomy (33%), appendectomy (18.8%) and diverticulectomy with appendectomy (16.3%). CONCLUSION CD can be misdiagnosed as acute appendicitis, therefore resulting in unnecessary surgical exploration. The review of the literature starting from 1930 highlights the critical role of medical imaging in supporting the clinician to diagnose this condition and administer adequate treatment.
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Affiliation(s)
- Isabelle Uhe
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Jeremy Meyer
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Manuela Viviano
- Division of Gynaecology and ObstetricsOspedale Regionale di LuganoLuganoSwitzerland
| | - Surrennaidoo Naiken
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
- Pôle santé Vallée de JouxLe ChenitSwitzerland
| | - Christian Toso
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
- Unit of Surgical ResearchUniversity of GenevaGenèveSwitzerland
| | - Frédéric Ris
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
| | - Nicolas C. Buchs
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenèveSwitzerland
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Clinical Difference between Acute Appendicitis and Acute Right-Sided Colonic Diverticulitis. Emerg Med Int 2020; 2020:4947192. [PMID: 32953179 PMCID: PMC7481953 DOI: 10.1155/2020/4947192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
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.
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Lewis A, Mahendiran S, Hochsztein J, Alterman D, Guelfguat M. An organized approach to imaging of benign cecal pathologies. BJR Open 2020; 2:20190043. [PMID: 33178964 PMCID: PMC7594902 DOI: 10.1259/bjro.20190043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 11/05/2022] Open
Abstract
Unique problems in cecal embryogenesis and cecal pathology can result in characteristic imaging findings. Familiarity with these findings and utilization of an organized approach help to define the cecum's role in acute abdominal symptoms. Clinical symptoms associated with cecal diseases can be diverse and misleading. This pictorial essay should provide a framework for an understanding of anatomical, infectious, and inflammatory cecal diseases. Knowledge of a broad spectrum of cecal pathologies contributing to these disorders and their corresponding imaging findings can help a radiologist define the diagnosis and guide proper management.
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Affiliation(s)
- Ariel Lewis
- Albert Einstein College of Medicine 1300 Morris Park Avenue Bronx, NY 10461, United States
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Pulzato I, Boero E, Shaipi E, Cardinale L. "Sigmoid diverticulitis mimicking cholecystitis" a clinical challenge. Ultrasound J 2019; 11:14. [PMID: 31359166 PMCID: PMC6638605 DOI: 10.1186/s13089-019-0127-6] [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: 11/14/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Diverticular disease is a common disorder and its incidence increases with ageing. Pathophysiology is multifactorial. Lifestyle, including smoking, alcohol intake, decreased dietary fibres and lack of physical activity, plays a predominant role. Genetics seems also to contribute specifically for right-sided diverticular disease (RSD). The majority of the patients with diverticular disease are asymptomatic. Diverticulitis is the inflammation of the diverticula usually presenting with abdominal pain associated to nausea, vomiting, rectal bleeding, diarrhoea and fever. When the inflammation process affects the diverticula in the ascending colon, the condition represents a clinical challenge as it can be easily misdiagnosed with other acute abdominal emergencies. We reported a case of a 70-year-old female who presented to our Emergency Department (ED) with right upper quadrant pain and an initial clinical suspicion of cholecystitis. Ultrasound (US) and Computed Tomography (CT) demonstrated an anatomical variation of the sigmoid colon diverticulitis. This clinical report demonstrates that ultrasound plays a relevant part as first-step approach to the acute abdominal conditions and its accuracy increases together with other diagnostic tools such as Computer Tomography.
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Affiliation(s)
- Ilaria Pulzato
- Dipartimento di Medicina interna e Specialità mediche, Di.M.I. Università degli Studi di Geniva, Viale Benedetto XV, 10, 16132, Genoa, GE, Italy.
| | - Enrico Boero
- Dipartimento di scienze Chirurgiche, Università degli Studi di Torino, Turin, Italy
| | - Elona Shaipi
- SCDU Radiodiagnostica e Medicina Nucleare, Azienda Ospedaliero-Universitaria S.Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Luciano Cardinale
- SCDU Radiodiagnostica e Medicina Nucleare, Azienda Ospedaliero-Universitaria S.Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, TO, Italy
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Medical Approach to Right Colon Diverticulitis with Perforation. Case Rep Emerg Med 2017; 2017:2563218. [PMID: 29098095 PMCID: PMC5643097 DOI: 10.1155/2017/2563218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022] Open
Abstract
We report a case of a 71-year-old female who presented with right lower quadrant (RLQ) abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast. Right-sided diverticulitis often presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department (ED). The aim of this case report is to increase awareness of the incidence, pathophysiology, presentation, work-up (laboratory studies and imaging), and management (medical and surgical) of right-sided diverticulitis among emergency physicians.
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Monari F, Cervellera M, Pirrera B, D'Errico U, Vaccari S, Alberici L, Tonini V. Right-sided acute diverticulitis: A single Western center experience. Int J Surg 2017. [PMID: 28627445 DOI: 10.1016/j.ijsu.2017.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Right sided diverticular disease is a rare condition in Western countries whereas is common amongst Asian population. The aim of this study is to evaluate options and outcomes for the treatment of right colonic diverticulitis. METHOD We included only patients undergoing surgery with right colon diverticulitis (RCD) proven at histological specimen examination from September 2011 to December 2016. RESULTS We performed 18 operations for RCD. Age was lower compared to left sided disease (49 ± 16 vs 67 ± 14; P < 0.001). Three patients were Asian (16.7%). RCD was diagnosed preoperatively in 8 cases (44.4%), whereas appendicitis was suspected in 9 cases (50%) and neoplasm in one (5.6%). We performed resection with anastomosis in 13 patients (72.2%) and in 5 cases we performed a diverticulectomy. Laparoscopy was performed in 14 cases (77.8%). Postoperative morbidity occurred in 3 patients (16.7%; grade 2 or 3a according to Clavien-Dindo) with no mortality. No postoperative events occured after diverticulectomy with shorter hospital stay (4 ± 1.5 vs 11 ± 13; P = 0.022), as no recurrence or need for elective surgery after a mean follow-up of 20 months. CONCLUSION RCD is a rare but not irrelevant condition. Minimally invasive surgery is often feasible and complication rate is low. In selected patients, diverticulectomy can be a valid alternative to treat this condition providing improved postoperative results.
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Affiliation(s)
- Francesco Monari
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Maurizio Cervellera
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Basilio Pirrera
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy.
| | - Umberto D'Errico
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Samuele Vaccari
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Laura Alberici
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
| | - Valeria Tonini
- Unit of Emergency Surgery, Emergency Department, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
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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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Koshy RM, Abusabeib A, Al-Mudares S, Khairat M, Toro A, Di Carlo I. Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated? World J Emerg Surg 2016; 11:1. [PMID: 26734068 PMCID: PMC4700755 DOI: 10.1186/s13017-015-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/30/2015] [Indexed: 12/30/2022] Open
Abstract
Aim To compare experience with solitary cecal diverticulum (SCD) with literature on the indication for appendectomy in cases of solitary cecal diverticulitis. Methods We retrospectively reviewed all cases of SCD in our institution from September 2011 to March 2013. Data on sex, age, ethnic origin, presence of pain in the right iliac fossa, duration of symptoms, diagnosis, management, intraoperative findings, histologic examination, hospital stay, complications, and follow-up were reviewed and analyzed. We compared this to related literature reported between 2000 and 2015. Results In the study period, 10 patients presented with an SCD. Male sex and Asian origin were predominant. All patients had pain in the right iliac fossa, with a duration of 2–5 days. In nine cases the diagnosis was made by clinical examination and laboratory testing. One patient who had undergone a previous appendectomy was diagnosed with SCD by computed tomography. This last patient was treated conservatively, four patients were treated with resection of the cecum “en bloc” with the last jejunal loop and appendix, and the other five patients were treated with appendectomies. Two patients had minor complications. All patients were followed up for a minimum of 12 to a maximum of 24 months. No recurrence was recorded in either the case treated conservatively or the cases treated by appendectomies. Conclusions In cases of operative but conservative treatment for SCD, appendectomy could be justified to avoid misdiagnosis in case of future episodes of solitary cecal diverticulitis.
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Affiliation(s)
- Renol M Koshy
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | | | - Saif Al-Mudares
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | - Mohamed Khairat
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar
| | - Adriana Toro
- Department of Surgery, Patti Hospital, Patti (ME), Italy
| | - Isidoro Di Carlo
- Department of General Surgery, Hamad General Hospital, 3050 Doha, Qatar ; Department of Surgical Sciences and Advanced Technologies, "G.F. Ingrassia" University of Catania, Catania, Italy
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Huntington JT, Brigode W, Thakkar RK, Raval MV, Teich S. A case of pediatric cecal diverticulitis mimicking acute appendicitis. Int J Colorectal Dis 2016; 31:147-8. [PMID: 25728830 DOI: 10.1007/s00384-015-2171-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Justin T Huntington
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - William Brigode
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rajan K Thakkar
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Steven Teich
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
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12
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Hayes C, Coombs P, Ptasznik R. Acute right upper quadrant diverticulitis: an unusual sonographic finding in a young adult patient. SONOGRAPHY 2015. [DOI: 10.1002/sono.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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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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14
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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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15
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White EK, MacDonald L, Johnson G, Rudralingham V. Seeing past the appendix: the role of ultrasound in right iliac fossa pain. ULTRASOUND (LEEDS, ENGLAND) 2014; 22:104-12. [PMID: 27433203 DOI: 10.1177/1742271x13514385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.
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Affiliation(s)
- E K White
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - L MacDonald
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - G Johnson
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - V Rudralingham
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
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Gallagher KL. Ischaemic diverticular disease may mimic acute appendicitis. BMJ Case Rep 2013; 2013:bcr-2013-008939. [PMID: 23893271 DOI: 10.1136/bcr-2013-008939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 81-year-old man with a medical history significant for diverticulosis and irritable bowel syndrome presented to the emergency department with a 1-day history of periumbilical pain that woke him from sleep and ultimately localised to his right lower quadrant. He reported nausea, anorexia and chills but denied vomiting, diarrhoea, melena, hematochezia or fever. His physical exam was notable for focal tenderness at McBurney's point. Diagnostic information included a normal white blood cell count and an abdominal CT scan that demonstrated a normal appendix with no other pathology noted. The patient opted to proceed with laparoscopy where a normal appendix was found. The caecum, however, contained a large ischaemic diverticulum not noted on CT scan. Following laparoscopic ileocecectomy, pathology demonstrated haemorrhage, inflammation, oedema and full thickness necrosis of the caecal wall. Recovery was uneventful; the patient was discharged from the hospital 3 days following surgery.
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Affiliation(s)
- Kara Lee Gallagher
- Department of Cabarrus Family Medicine, Carolinas Medical Center-Northeast, Concord, North Carolina, USA.
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An unusual cause of right lower quadrant pain: the caecum diverticulitis. Case Rep Surg 2012; 2012:789397. [PMID: 22606604 PMCID: PMC3349988 DOI: 10.1155/2012/789397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/13/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. In the study presented, preoperative examinations and surgical methods were discussed along with literature, regarding two cases who were operated with the prediagnosis of acute appendicitis and for whom caecum diverticulitis was determined. Case 1. 21 years old male patient who had applied to hospital with complaint of abdominal pain, underwent an operation with a prediagnosis of acute appendicitis. Right hemicolectomy was performed with mass perioperatively determined in caecum. Histopathological examination revealed necrosis and inflammation in diverticulum wall. Case 2. 36 years old female patient applied to emergency department with abdominal pain and underwent an operation with a prediagnosis of acute appendicitis. Appendectomy and diverticulectomy were performed for whom inflame diverticula in caecum was determined perioperatively. Histopathological examination was revealed acute inflammation in diverticulum wall. Conclusion. Although solitary caecum diverticulitis is a rarely encountered disease, it must be considered in the differential diagnosis of right lower abdomen pain.
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Cheng E, Cohen L, Gasinu S, Sy C, Beneck D, Spigland N. Cecal diverticulitis as a continuing diagnostic and management dilemma: a report of two cases in children. Pediatr Surg Int 2012; 28:99-102. [PMID: 22138978 DOI: 10.1007/s00383-011-3035-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 10/15/2022]
Abstract
Right-sided diverticulitis remains an exceedingly rare condition in the pediatric population. The clinical presentation mimics acute appendicitis, and the correct diagnosis is often difficult to make prior to operative exploration. We report two cases of cecal diverticulitis, and discuss the diagnosis and management of this disease, with a review of the literature.
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Affiliation(s)
- Elaine Cheng
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, USA
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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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Park HC, Lee BH. Suspected uncomplicated cecal diverticulitis diagnosed by imaging: Initial antibiotics vs laparoscopic treatment. World J Gastroenterol 2010; 16:4854-7. [PMID: 20939115 PMCID: PMC2955256 DOI: 10.3748/wjg.v16.i38.4854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the recurrence rate following initial antibiotic management to that following laparoscopic treatment for suspected uncomplicated cecal diverticulitis.
METHODS: We examined the records of 132 patients who were diagnosed with uncomplicated cecal diverticulitis and a first attack during an 8-year period. The diagnosis of uncomplicated diverticulitis was made based on imaging findings, such as inflamed diverticulum or a phlegmon with cecal wall thickening. Concurrent appendiceal dilatation from 8 to 12 mm was observed in 36 patients (27%). One hundred and two patients were treated initially with antibiotics only, whereas 30 underwent laparoscopic treatment, including partial cecectomy (n = 8) or appendectomy with diverticulectomy (n = 9) or appendectomy alone (n = 13). We compared clinical outcomes in both groups over a median follow-up period of 46 mo.
RESULTS: All patients were successfully treated with initial therapy. Of the 102 patients who initially received only antibiotic treatment, 6 (6%) had a recurrence (3 in the cecum and 3 in the ascending colon or transverse colon) during the follow-up period. Five of these patients were managed with repeated antibiotic treatment and 1 underwent ileocolic resection for perforation. Of the 30 patients treated by the laparoscopic approach, 2 (7%) had a recurrence (ascending colon) which was treated with antibiotics.
CONCLUSION: Initial antibiotic management for suspected uncomplicated cecal diverticulitis showed comparable efficacy to laparoscopic treatment in the prevention of recurrence.
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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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