Cecal diverticulitis is an unusual disease entity. There are some difficulities in making an accurate preoperative diagnosis as well as in the proper surgical treatment. This study is a retrospective, clinical analysis of 75 cases of cecal
diverticulitis treated in the department of Surgery, Catholic University Medical College from January `986 to January 1995.
@ES The following results were obtained:
@EN 1) The highest incidence was noted in the fourth decade. median age was 427 years and the male to female ratio was 3.4:1.
2) The main symptoms were abdominal pain, fever, nausea and vomiting. Most patients (64 cases, 85.3%) had right lower quadrant abdominal pain which was easily confused with that of appendicitis.
3) The duration of symptoms, prior to operation, was less 3 days in 49 cases (65.3%), 3 to 6 days in 8 cases (10.8%) and more than 7 days in 18 cases (24%).
4) The preoperative radiologic work-up was often not conclusive. Barium enema or colonofibroscopy may be more accurate than ultrasound or CT.
5) Fifty patients (66.7%) showed leukocytosis.
6) The correct preoperative diagnosis was made only in 12 cases (16%) and the remaining misdiagnoses were appendicitis for 46 cases (61.3%) and periappendiceal abscess for 13 cases(17.3%).
7) Among the 75 cases, had multiple diverticulitis, perforation occurred in 20 cases, abscess formation in 5 cases and mass formation in 3 cases.
8) The operative procedure varied markedly based on the multiplicity, extent of inflammation and complications such as perforation or abscess formation; right hemicolectomy for 36 cases(48%),diverticulectomy and appendectomy for 30 cases(40%),
ileocecetomy for 4 cases (5.3%) and invagination of the diverticulum for 5 cases (6.7%).
9) Postoperative complications included wound infection, ileus, atelectasis, leakage at the anastomotic site and wound dehiscense, especially in cases with colonic resection.
10) The average hospital stay was 11 days.
The authors suggest that one should suspect cecal diveticulitis in cases where the patient is in the fourth decade and shows right lower quadrant pain with unusual clinical finding. The diagnostic work-up can be started using a barium enema or
colonofiberscopy in cases without complications or in non-emergent situations. The operative modalities should be selected based on the extent of the disease.
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