Cecal diverticulitis: a diagnostic challenge.

BACKGROUND: Cecal diverticulitis is frequently indistinguishable from acute appendicitis preoperatively and is sometimes mistaken for carcinoma at laparotomy. The surgeon must be aware of the possibility of diverticulitis of the cecum in the operating room and choose the appropriate treatment. PURPOSE: Because there is no universal therapeutic approach to these patients, we decided to assess the presenting symptoms, clinical findings, preoperative diagnosis, operative findings determining the proper management of these patients. METHODS: A retrospective chart review of 13 patients with pathologically confirmed cecal diverticulitis, who underwent surgery in our department from 1984 to 1998, was undertaken. RESULTS: The mean age of patients was 43.5 years. Right lower quadrant pain and local tenderness were the only clinical findings in 92.3%, with preoperative diagnosis of acute appendicitis in 84.6% of patients. The operative finding in most cases was inflammatory mass of the cecum; in 6 cases it was indistinguishable from perforated cecal carcinoma. Six patients underwent right hemicolectomy, 5 had ileocecectomy, 1 patient was treated by tube cecostomy, and 1 had diverticulectomy. There were three minor postoperative complications: pneumonia, wound infection and lower limb superficial thrombophlebitis. CONCLUSIONS: Cecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. We suggest that the operative therapy should be ileocecectomy. The surgical specimen should be examined during surgery and only if carcinoma is found should the patient have a formal colectomy.

Tangential low-velocity missile wound of the head with acute subdural hematoma: case report.

Tangential missile wounds of the head without skull fracture are a known entity. Usually, references in the literature indicate that this type of injury results from a high-velocity missile impact. We present a case of a tangential missile head wound caused by a low-velocity missile. As the range of fire was short, the quantity of energy that might be released could be equated with that released by a high-velocity missile fired from a much longer range. This possibility should be brought to the attention of clinicians as an essential element in this pre-treatment clinical evaluation. We propose a pathomechanical explanation for the development of the clinical state.

Chlamydia trachomatis and inflammatory bowel disease--a coincidence?

Serological tests of 35 patients suffering from inflammatory bowel disease were compared to those of 35 healthy controls. The tests were performed using the indirect immunoperoxidase assay. Ninety-three per cent of 15 patients with Crohn's disease had IgG antibodies against Chlamydia, compared to 26% in the control group. In the 20 patients with ulcerative colitis, 45% had IgG antibodies against Chlamydia, compared to 10% in the control group. High serum titres of IgG antibodies were found in most of the patients with inflammatory bowel disease, mainly with Crohn's disease, while weak reactions appeared in most of the controls in which antibodies were detected. These results suggest a high incidence of Chlamydia infection in the studied patients with inflammatory bowel disease, especially in those with Crohn's disease. The possible association between Chlamydia trachomatis and inflammatory bowel disease is discussed.

Perforated diverticulitis of the transverse colon.

A case of localized, perforated diverticulitis of the transverse colon in a 45-year-old woman is presented. Preoperatively, this rare disease is indistinguishable from other acute surgical conditions, and often is mistaken for carcinoma at laparotomy. This report increases awareness of this unusual condition, and emphasizes the clinical, diagnostic, and therapeutic implications. Case reports described in the literature are reviewed.

Familial retrocaecal appendicitis.

Four members of the same family operated on for acute retrocaecal appendicitis are reported. It is suggested that they provide further support for the hypothesis that an hereditary factor might be involved in the pathogenesis of acute appendicitis.

The role of the spermatic cord layers in the development of varicoceles.

The theory that insufficiency of the spermatic cord layers could be the etiological factor in the development of varicocele is reviewed critically. A prospective study of 40 patients operated upon for a left indirect inguinal hernia was done. The spermatic cord layers were excised as a routine part of the operation but combined manual and Doppler examinations revealed no postoperative reflux into the pampiniform plexus. We conclude that the spermatic cord layers probably do not have a major role in the pathogenesis of varicocele.

Splenogonadal relation.

The gonad-related accessory spleen is a rare anomaly. We report an unusual variant of this condition, featuring two accessory spleens - inguinal and scrotal. This anomaly is important in the differential diagnosis of mass lesions, and the surgical implications are discussed.