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Perforation of the sigmoid colon simulating acute appendicitis
Israel Journal of Medical Sciences
|September 1, 1980
Summary
Misdiagnosing sigmoid colon issues like diverticulitis or carcinoma as appendicitis is common in elderly patients. Recognizing age-related changes and sigmoid colon anatomy is key to accurate diagnosis and treatment.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Acute appendicitis incidence declines with age, while diverticular disease and colorectal cancer prevalence increases.
- The sigmoid colon's redundancy and potential for right-sided migration can mimic right lower quadrant pathology.
Observation:
- Nine patients were misdiagnosed with acute appendicitis over five years.
- Inflammatory processes in the right lower quadrant, stemming from sigmoid colon issues, were the cause.
Findings:
- Diverticulitis and carcinoma with abscess formation due to sigmoid colon perforation were misdiagnosed.
- Age-related prevalence shifts and anatomical variations contribute to diagnostic challenges.
Implications:
- Consider sigmoid colon pathology in elderly patients presenting with acute right abdominal symptoms.
- Transrectal or paramedian incisions and two-stage operations are recommended for suspected sigmoid colon perforations.