Management of Cecal Diverticulitis That's Misdiagnosed as Acute Appendicitis

ABSTRACT

PURPOSE: Because of the difficulties in making the preoperative diagnosis of diverticulitis, most patients with cecal diverticulitis have been operated on under the preoperative diagnosis of acute appendicitis. However, controversy about the treatment exists when physicians are confronted with a cecal diverticulitis. The purpose of this study is to investigate the proper treatment of cecal diverticulitis that's misdiagnosed as acute appendicitis. METHODS: We reviewed 58 cases of cecal diverticulitis that underwent emergency operation as acute appendicitis, according to classified option of treatment. RESULTS: Of the 58 patients (82.8%), 48 were treated by appendectomy without manipulation of the cecal diverticulitis (conservative treatment, CT group), and 10 cases (17.2%) were treated by surgical resection (diverticulectomy or segmental resection of bowel) of the cecal diverticulitis (operative treatment, OT group). The difference of demographic figures was not significant between the CT and OT groups (P>0.05). However, the length of the postoperative hospital stay and the rate of complications were statistically superior for the CT group (mean hospital stay 7.5+/-2.1 days; rate of complications n=2/48; 4.2%) compared to the OT group (mean hospital stay 14.0+/-7.5 days, rate of complication n= 3/10; 30.0%) (P0.05). CONCLUSION: Given the above clinical results, we could suggest that appendectomy with postoperative antibiotic therapy is an effective management strategy for cecal diverticulitis that's misdiagnosed as acute appendicitis.