Diverticulitis cecal: un complejo desafío médico / Cecal diverticulitis: a complex medical challenge

Antecedentes: la diverticulitis cecal es una patología poco común en los países occidentales. Clínicamente es indistinguible de una apendicitis aguda. Objetivos: exhibir los resultados de acuerdo con diferentes abordajes terapéuticos. Material y métodos: se presentan cinco casos de diverticulitis cecal tratados en nuestra institución entre enero de 2013 y diciembre de 2015. Revisión retrospectiva de historias clínicas e imágenes. Revisión de la literatura. Resultados: fueron incluidos cinco pacientes. En cuatro hubo resolución quirúrgica y uno tuvo buena evolución con tratamiento médico. Conclusiones: si bien es poco frecuente, la diverticulitis cecal debe considerarse dentro de los diagnósticos diferenciales frente a un cuadro de dolor abdominal localizado en fosa ilíaca derecha acompañado de estudios por imágenes no categóricos de apendicitis aguda.

Background: cecal diverticulitis is a rare disease in western countries. It is clinically indistinguishable from acute appendicitis. Objetive: to show outcome with different therapeutic approaches. Material and methods: we present five cases of cecal diverticulitis treated at our institution between January 2013 and December 2015. Retrospective review of medical records and images. Review of the literature. Results: five patients were included. Four cases required surgical treatment while one patient resolved with medical treatment. Conclusions: Although it is rare, cecal diverticulitis must be considered within the differential diagnoses in the face of abdominal pain located in the right iliac fossa and non-categorical imaging of acute appendicitis.

Divertículo cecal solitario perforado: presentación de un caso y revisión de la literatura / Cecal solitary perforated diverticulum: case report and literature review

El objetivo de este artículo es relatar un caso de divertículo cecal solitario perforado, observado en el Hospital Municipal Los Pinos de La Paz Bolivia, en un paciente masculino de 72 años diagnosticado con abdomen agudo quirúrgico y la presencia de una masa en ciego cuyo estudio histopatológico informo divertículo perforado. La diverticulitis cecal es una entidad poco frecuente y se presenta en la mayoría de los casos como diagnostico secundario o incidental durante una laparatomía por apendicitis aguda. Además se expondrá no solo los medios diagnósticos, sino su clasificación y la terapéutica actualizada y/o estandarizada, que implica tomar en cuenta en esta patología una vez diagnosticada.

The aim of this article is to describe a case of solitary cecal diverticulum drilled, observed in the Hospital Municipal Los Pinos of the peace Bolivia, in a 72-year-old male patient diagnosed with surgical acute abdomen and the presence of a mass in blind whose histological study reported perforated diverticulum. Cecal diverticulitis is a rare entity and occurs in the majority of cases as diagnosis secondary or incidental damages during a laparotomy for acute appendicitis. In addition will be exposed not only the Diagnostics, but classification and therapeutic updated and/or standardized, which entails taking into account in this condition once diagnosed.

Diverticulitis exclusiva de ciego / Unique diverticulitis of the cecum

La diverticulitis cecal es una rara entidad de difícil diagnóstico que con frecuencia se confunde con un proceso apendicular agudo. Los divertículos primarios o de origen congénito, generalmente son únicos, suelen presentarse en una edad más temprana que la enfermedad diverticular cólica (divertículos secundarios). La presencia de estos en el colon derecho se reporta con menor frecuencia, su diagnóstico es en muchas ocasiones indistinguible de la apendicitis aguda y se realiza en la mayoría de los casos durante la laparotomía, el tratamiento es variable, según la literatura abarca desde la resección del divertículo hasta la hemicolectomía derecha. El objetivo de esta presentación es referir la dificultad diagnostica y la alta frecuencia de error diagnóstico que presenta esta entidad

The cecal diverticulitis is a strange disease, difficult to be diagnosed, frequently confused with acute appendicular process. The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula). Their presence in the right colon is less frequently reported, the diagnosis is often confused with that of acute appendicitis and most of cases undergo laparatomy. According to the scientific literature, the treatment is variable, ranging from diverticular resection to right hemi-cholectomy. The objective of this paper was to present the difficulties and the high frequency of errors in diagnosing this disease

Perforated Cecal Diverticulitis with Right Mesocolic Hernia

Mesocolic hernias are rare congenital anormalies resulting from abnormalities in the intestinal rotation during embryonic development, and comprise approximately 53% of all congenital internal hernias. A right mesocolic hernia is formed by the arrest of further rotation of the prearterial segment of gut in the right side of the abdomen, with continued rotation of the postarterial segment, during the second stage of embryonic intestinal rotation, leading to the entrapment of almost the entire small bowel behind the right colonic mesentery. The condition may be discovered incidentally during at laparotomy, or may be the cause of an acute small bowel obstruction. Cecal diverticulitis is a rare disease, whose symptoms are similar to acute appendicitis. It is difficult to diagnose the two diseases accurately prior to operation. We report on a 48-year old man, who had perforated cecal diverticulitis and an incidental right mesocolic hernia, with a review of the literature.

Cecal Diverticulitis

PURPOSE: Cecal diverticulitis is rare but relatively common in Asians including Koreans. Furthermore, most case of cecal diverticulitis can be diagnosed as an acute appendicitis preoperatively. The purpose of this study was to evaluate antibiotic treatment for cecal diverticulitis, identified during laparotomy under the diagnosis of acute appendicitis. METHODS: From January 1995 to June 2001, we reviewed 52 patients with cecal diverticulitis, who were diagnosed as having acute appendicitis preoperatively and treated by conservative treatment, i.e. appendectomy only and postoperative antibiotics. RESULTS: The results were as follows. The male to female ratio and mean age was 1.2:1 and 33.4 respectively. The mean operative time was 55.4 minutes. The mean hospital stay was 5.9 days. The site of the diverticulitis was mostly located at the cecum (92.3%). Other sites of diverticulitis were the ascending colon in 2 patients, and the cecum and ascending colon in another 2 patients. The number of diverticulitis found was one in 44 patients (84.6%) and multiple in 8 patients (15.4%). Postoperative complications occurred in 6 patients (11.5%). The most common postoperative complication was wound infection, which occurred in 4 patients. There was no recurrence during follow-up. CONCLUSION: When cecal diverticulitis is found incidentally at the time of an emergency operation for acute appendicitis, we conclude that an appendectomy only combined with postoperative antibiotics is a safe, effective, cost-efficient and cosmetic method.

Surgical Management of Cecal Diverticulitis Detected during Appendectomy

PURPOSE: Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease. METHODS: Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998. RESULTS: There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage. CONCLUSION: We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.

Cecal Diverticulitis and its Managements

Cecal Diverticulitis(CD) is a rare condition with a higher incidence in Oriental populations, which symptoms and signs are closely simulate acute appendicitis. The present study was designed to resume the optimal therapeutic modalities. A retrospective review was conducted between 1991 and 1996 on 28 surgically treated patients(18 men, 10 women ; mean age 45 years) with documented CD in Kon-Kuk University Hospital. Most patients presented with right lower quadrant pain and tenderness. Acute appendicitis was the preoperative diagnosis in 89.2%(25/28) of the patients. The CD patients were divided into three groups : CD-RC(right hemicolectomy group; n=4), CD-DV(diverticulectomy group; n=5), and CD-AP(appendectomy only group; n=19) by operative options. Information on patient demographics, duration of symptom, white blood cell count, radiologic studies, operative procedure, operation time, hospital days, duration of intravenous antibiotics administration, complications and recurrent symptoms were reviewed and analyzed. CD-RC and CD-DV patients required more hospital days than CD-AP(mean 20.6 days, 9.6 days versus 8.4 days, respectively) and more complications(50%, 60% versus 26%). There was no recurrent patient in this series and also there were no reoperated cases. But there was one death in CD-RC group. Of the 4 patients who had right hemicolectomy, one was expired by sepsis and one had minor wound infection. Minor wound infections are the most common complications : 5 in CD-AP, 3 in CD-DV group. Conclusively, if CD could be diagnosed preoperatively, surgical management should be reserved and initial medical treatment with intravenous antibiotics should be considered, and in those patient who underwent emergency operation presumed acute appendicitis, right hemicolectomy with primary ileocolic anastomosis is recommended with acceptable low morbidity. But alternatively appendectomy only is a safe and effective procedure for the treatment of CD if there is no evidence of free perforation, abscess formation or strongly suggested cecal carcinoma.