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Management of solitary cecum diverticulitis - Single-Center Experience
Emre Gonullu1, Merve Yigit1, Baris Mantoglu2
1General Surgery Department, Sakarya University Training and Research Hospital, Sakarya, Turkey.
Insights
Distinguishing cecal diverticulitis from acute appendicitis is vital for appropriate patient management. Cecal diverticulitis often requires conservative treatment, avoiding unnecessary surgeries.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Diagnostic Imaging
Background:
- Cecal diverticulitis is an infrequent cause of appendectomy findings.
- Accurate differentiation between acute appendicitis and cecal diverticulitis is critical due to distinct management strategies.
Purpose of the Study:
- To underscore the significance of differentiating cecal diverticulitis from acute appendicitis.
- To highlight the implications for surgical intervention and patient care.
Main Methods:
- Retrospective analysis of patient data from 2015-2019.
- Inclusion criteria: abdominal pain, diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis.
- Review of surgical and clinical/radiological evaluations.
Main Results:
- Cecal diverticulitis identified in 5 out of 1247 appendectomies (0.4%).
- Among 119 colonic diverticulitis patients, 14 had solitary cecal diverticulitis.
- Most solitary cecal diverticulitis cases were managed conservatively, with one exception (Hinchey 3).
Conclusions:
- Accurate differential diagnosis between cecal diverticulitis and acute appendicitis is crucial.
- Conservative management is feasible for most cecal diverticulitis cases, preventing unnecessary surgery.
- This distinction is particularly important in resource-limited situations, such as during the COVID-19 pandemic.
Abstract:
<b> Objective: </b> Cecal diverticulitis may be encountered as a real etiological factor in 1/300 appendectomies. Differential diagnosis of acute appendicitis and cecal diverticulitis is crucial because of the different treatment methods. Our aim is to reveal the importance of distinguishing acute appendicitis from cecal diverticulitis. <p> <b>Methods: </b> The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively. <p><b>Results: </b> A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis.<p><b> Conclusion: </b> Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.
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