Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series
Süleyman Kalcan1, Fatih Başak1, Mustafa Hasbahçeci2, Ali Kılıç1, Tolga Canbak1, İlyas Kudaş1, Gürhan Baş1, Orhan Alimoğlu3
1Clinic of General Surgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
2Department of General Surgery, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
3Department of General Surgery, Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey
Abstract
Objective: Cecal diverticulum may lead to acute abdomen as either diverticulitis or perforation. In this study, we aimed to analyze patients with cecal diverticulitis who presented with acute abdomen.
Material and Methods: Patients who were admitted to our emergency clinic between 2009-2012 for acute abdomen, and intraoperatively diagnosed with cecal diverticulitis were retrospectively evaluated.
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/mm3 (5850-17.400/mm3), 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. Four 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.
This study was accepted as a poster presentation at the 14th National Congress of Colon & Rectum Surgery (May 19, 2013, Antalya, Turkey).
Keywords: Cecum, diverticulitis, acute abdomen, acute appendicitis
Ethics committee approval was not received due to the retrospective nature of the study.
Written informed consent was not obtained due to the retrospective nature of the study.
Externally peer-reviewed.
Concept - S.K., F.B., M.H.; Design - S.K., F.B., M.H.; Supervision - S.K., F.B., M.H., G.B., O.A.; Data Collection and/or Processing - A.K., T.C., İ.K.; Analysis and/or Interpretation - S.K., F.B., M.H., G.B., O.A.; Literature Review - A.K., T.C., İ.K.; Writer - S.K., F.B., M.H., A.K., T.C., İ.K.; Critical Review - F.B., M.H., G.B., O.A.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.