[Acute appendicitis or diverticulitis of the right colon? Diagnostic dilemma in emergency surgery]

Diverticulitis of the right colon is a rare disease in the Western countries, so that the diagnosis still remains very difficult and frequently indistinguishable from acute appendicitis preoperatively. In presence of acute abdominal discomfort with pain referred to the right lower quadrant region, fever and hyperleukocytosis, nausea and vomiting, surgeons operate with a margin of uncertainty, because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation of acute appendicitis. Moreover the unexpected inflammatory colonic mass of uncertain etiology is sometimes mistaken for carcinoma at laparotomy and consequently a right hemicolectomy is performed. In these cases it should be better that right-sided colonic diverticulitis should be taken into account allowing a more correct surgical approach and even conservative treatment alone. Therefore, in case of suspected appendicitis, since our experience and literature data indicate that the mean age for right diverticulitis is over 40 years, also in presence of a significative Alvarado's score, computed tomography is strongly recommended, if the age is over 40 years.