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Clinically distinguishing between appendicitis and right-sided colonic diverticulitis at initial presentation.
Jun-Ho Shin1, Byung-Ho Son, Hungdai Kim
1Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul 110-746, Korea.
Yonsei Medical Journal
|June 28, 2007
Summary
Right-sided colonic diverticulitis can mimic appendicitis, causing unnecessary surgery. Differentiating factors include fewer prodromal symptoms, tenderness lateral to McBurney's point, and distinct white blood cell counts.
Area of Science:
- Gastroenterology
- Surgical Diagnosis
Background:
- Right lower quadrant pain is often misdiagnosed as appendicitis.
- Right-sided colonic diverticulitis presents similarly to appendicitis, leading to potential diagnostic challenges.
Purpose of the Study:
- To differentiate right-sided colonic diverticulitis from appendicitis based on initial emergency department presentation.
- To reduce unnecessary emergency surgeries for misdiagnosed conditions.
Main Methods:
- Retrospective review of 450 patient records from January 1997 to July 2003.
- Categorization of patients into three groups: right-sided colonic diverticulitis (n=92), simple appendicitis (n=268), and perforated appendicitis (n=90).
Main Results:
- Right-sided colonic diverticulitis patients had fewer prodromal symptoms (p < 0.05).
- Maximal tenderness lateral to McBurney's point was more frequent in diverticulitis cases (19.6%, p=0.002).
- Diverticulitis group showed lower leukocytosis, a smaller percentage of segmented neutrophils, and a higher proportion of lymphocytes compared to appendicitis groups.
Conclusions:
- Consider right-sided colonic diverticulitis in patients with right lower quadrant pain, especially with absent prodromal symptoms.
- Tenderness lateral to McBurney's point and specific white blood cell patterns (mild leukocytosis, low segmented neutrophils, high lymphocytes) suggest diverticulitis.
- These findings aid in avoiding unnecessary emergency operations for appendicitis.
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