C Adam1, K Böttcher. 1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München.
Abstract
INTRODUCTION: Cecal diverticulitis is an important differential diagnosis to acute appendicitis. The diagnosis is often difficult to make and the therapeutic procedure is still a point of discussion. PATIENTS AND METHOD: Seven patients (24-77 years old) who underwent surgery for abdominal reasons were investigated retrospectively. RESULTS: Five patients who had not underwent appendectomy before were operated under the leading diagnosis of acute appendicitis. Despite further diagnostic measures, only in one case of the two patients who had already had an appendectomy before, the diagnosis cecal diverticulitis could be made preoperatively. DISCUSSION: Preoperative diagnostics, if conducted at all, only rarely lead to the diagnosis of cecal diverticulitis. In prolonged courses and in patients after appendectomy, laparoscopy can be of diagnostic and therapeutic value. If it is possible to diagnose cecal diverticulitis preoperatively, conservative treatment can be indicated. If the diagnosis is made intraoperatively and malignancy can be securely excluded, we recommend ileocecal resection, but not appendectomy and further conservative treatment. If a carcinoma can not be excluded definitively, a hemicolectomy must be performed.
INTRODUCTION: Cecal diverticulitis is an important differential diagnosis to acute appendicitis. The diagnosis is often difficult to make and the therapeutic procedure is still a point of discussion. PATIENTS AND METHOD: Seven patients (24-77 years old) who underwent surgery for abdominal reasons were investigated retrospectively. RESULTS: Five patients who had not underwent appendectomy before were operated under the leading diagnosis of acute appendicitis. Despite further diagnostic measures, only in one case of the two patients who had already had an appendectomy before, the diagnosis cecal diverticulitis could be made preoperatively. DISCUSSION: Preoperative diagnostics, if conducted at all, only rarely lead to the diagnosis of cecal diverticulitis. In prolonged courses and in patients after appendectomy, laparoscopy can be of diagnostic and therapeutic value. If it is possible to diagnose cecal diverticulitis preoperatively, conservative treatment can be indicated. If the diagnosis is made intraoperatively and malignancy can be securely excluded, we recommend ileocecal resection, but not appendectomy and further conservative treatment. If a carcinoma can not be excluded definitively, a hemicolectomy must be performed.
Authors: B Papaziogas; J Makris; I Koutelidakis; G Paraskevas; B Oikonomou; E Papadopoulos; K Atmatzidis Journal: Int J Colorectal Dis Date: 2004-09-04 Impact factor: 2.571