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Related Experiment Videos

Surgical approach to cecal diverticulitis.

J S Lane1, R Sarkar, P J Schmit

  • 1Department of Surgery, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.

Journal of the American College of Surgeons
|June 8, 1999
PubMed
Summary

Cecal diverticulitis, though rare in the West, often mimics appendicitis. An aggressive surgical approach, including right hemicolectomy, is recommended for effective management and to prevent recurrence.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Cecal diverticulitis is uncommon in Western populations, with higher prevalence in individuals of Asian descent.
  • Treatment strategies vary from conservative medical management to surgical resection, such as right hemicolectomy.

Purpose of the Study:

  • To review the largest single-institution experience with cecal diverticulitis in the mainland US.
  • To evaluate treatment outcomes and recurrence rates for cecal diverticulitis.

Main Methods:

  • Retrospective chart review of 49 patients treated for cecal diverticulitis between 1976 and 1998.
  • Analysis of clinical presentation, surgical procedures, and patient outcomes.

Main Results:

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  • Clinical presentation commonly mimicked acute appendicitis, with symptoms including abdominal pain, fever, nausea, and leukocytosis.
  • Right hemicolectomy was performed in 80% of patients, diverticulectomy in 14%, and appendectomy with drainage in 6%.
  • Complications occurred in 18% of immediate hemicolectomy patients, with no mortality; however, some patients undergoing diverticulectomy or appendectomy required subsequent hemicolectomy.

Conclusions:

  • An aggressive operative approach is endorsed for cecal diverticulitis, involving resection of all apparent disease during the initial surgery.
  • Diverticulectomy is recommended for solitary diverticula when feasible; immediate right hemicolectomy is advocated for multiple diverticula, phlegmon, or when malignancy cannot be excluded.
  • Excisional treatment is effective in preventing symptom recurrence, which may be more prevalent in Western populations.