Solitary Cecal Diverticulitis During Surgery for Acute Appendicitis.

Abstract

Background: Caecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases, it is usually made at laparotomy. The aim of the present study is to retrospectively report our personal experience with solitary caecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of caecal diverticulitis not requiring surgery.
 Materials and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Center "Mother Teresa" of Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of allpatients affected by solitary caecal diverticulitis were reviewed.
 Results: In the study period, 15 patients presented with a solitary caecal diverticulitis. Most of patients had pain in the right iliac fossa, with a duration of 2–6 days. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocaecal resection, and right hemicolectomy.
 Conclusions: Cecal diverticulitis should be included in the differen­tial diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of caecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is impor­tant in order to decide how to manage this condition.Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.