Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated?

Renol M Koshy,Mohamed Khairat,Abdelrahman Abusabeib,Isidoro Di Carlo,Adriana Toro,Saif Al-Mudares

doi:10.1186/s13017-015-0057-y

Renol M Koshy, Mohamed Khairat + Show 4 more

Open Access

https://doi.org/10.1186/s13017-015-0057-y

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Abstract

AimTo compare experience with solitary cecal diverticulum (SCD) with literature on the indication for appendectomy in cases of solitary cecal diverticulitis.MethodsWe 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.ResultsIn 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.ConclusionsIn cases of operative but conservative treatment for SCD, appendectomy could be justified to avoid misdiagnosis in case of future episodes of solitary cecal diverticulitis.

Highlights

The cecal diverticula described for the first time by Potier in 1912 [1] remain a rare entity, especially if solitary, with an incidence between 1:50 and 1:300 of that of appendicitis [2]
One patient who had undergone a previous appendectomy was diagnosed with solitary cecal diverticulum (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

Summary

Introduction

The cecal diverticula described for the first time by Potier in 1912 [1] remain a rare entity, especially if solitary, with an incidence between 1:50 and 1:300 of that of appendicitis [2]. The incidence of solitary cecal diverticulum (SCD) in North America is low at about 1–2 %; in contrast, SCD is more common in the Orient, accounting for 43–50 % of all cases of colonic diverticulosis [3]. The most common clinical misdiagnosis of diverticular disease of the right colon is acute appendicitis [4], and it is on the operating table that we are faced with the reality of the actual diagnosis. The correct diagnosis is very important because acute diverticulitis of the right colon without complications can be treated medically [8]

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