A rare nosological entity The perforated solitary cecal diverticulum

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COD: 15_2145_397-404 Categorie: ,

Carlo Boselli, Gloria Burini, Piero Covarelli, Francesco Barberini, Alessandro Gemini, Elisa Castellani, Giuseppe Noya, Roberto Cirocchi

Ann. Ital. Chir., 2014 85: 397-403

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AIM: To describe three cases of solitary cecal diverticulum, and trying to evaluate the better method of diagnosis and
treatment with analysis of the literature.
MATERIAL OF STUDY: Description of three cases of solitary cecal diverticulum’s perforation admitted in the Department
of General and Oncologic Surgery, Santa Maria della Misericordia Hospital, Perugia, during the period January 2011
– January 2012.
RESULTS: In all patients the clinical presentation was very similar to that of acute appendicitis. Preoperative diagnosis
was achieved in one case through abdominal CT scan, other two cases were identified at final pathology. At one year
from the treatment all patient are still alive.
DISCUSSION: Cecal diverticulum is a rare condition, often diagnosed either casually or because of inflammatory or perforative
complications. The highest incidence is found in Western population. Because of the clinical presentation, very
similar to the appendicitis, and the inflammatory reaction involving the colon and its surrounding tissues, the pre- and
intra-operative diagnosis are very difficult. The diagnosis is almost always histological. The treatment may vary from
simple expectant medical management, carried out with bowel rest, parenteral support and antibiotics as for left-sided
diverticulitis, to surgical approach, performed through simple diverticulectomy or by classical right hemicolectomy.
CONCLUSION: Pre-surgical and, also intra-operative, diagnosis of perforated solitary cecal diverticulum is clearly difficult.
CT scan represents the gold standard for the differential diagnosis. Right hemicolectomy is an effective and safe approach,
allowing accurate control, preventing complications and recurrences, and it represents the optimal management of the disease.

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