Caecal diverticulitis: Presentation and management

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Left-sided colonic diverticular disease is common in Western populations.
• Right-sided diverticular disease, particularly caecal diverticulitis, is increasingly diagnosed due to Asian migration.
• Caecal diverticulitis often presents with atypical symptoms, mimicking appendicitis.

Purpose of the Study:

• To determine the incidence of caecal diverticulitis in patients with colonic diverticulitis.
• To identify clinical features aiding pre-operative diagnosis of caecal diverticulitis.

Main Methods:

• Retrospective analysis of medical records from January 2007 to December 2013.
• Inclusion criteria: confirmed caecal diverticulitis on imaging or laparoscopy during first admission.
• Data collected on patient demographics, symptoms, diagnostic methods, and treatment outcomes.

Main Results:

• 13 cases of caecal diverticulitis (2.06%) identified among 632 colonic diverticulitis patients.
• Most affected patients were of Asian background (12/13) and young (10/13, ≤50 years).
• Common symptoms included right-sided abdominal pain (84.6%) and diarrhea (38.5%). Computed tomography diagnosed 90% of cases.

Conclusions:

• Caecal diverticulitis incidence is rising in Western countries.
• A high index of suspicion is needed for Asian patients presenting with appendicitis-like symptoms, especially diarrhea.
• Prompt diagnosis can be achieved through computed tomography and prompt management.