Cecal Diverticulitis and its Managements

Oh, Jae Pil; Kim, Bo Gyoon

Abstract

Cecal Diverticulitis(CD) is a rare condition with a higher incidence in Oriental populations, which symptoms and signs are closely simulate acute appendicitis. The present study was designed to resume the optimal therapeutic modalities. A retrospective review was conducted between 1991 and 1996 on 28 surgically treated patients(18 men, 10 women ; mean age 45 years) with documented CD in Kon-Kuk University Hospital. Most patients presented with right lower quadrant pain and tenderness. Acute appendicitis was the preoperative diagnosis in 89.2%(25/28) of the patients. The CD patients were divided into three groups : CD-RC(right hemicolectomy group; n=4), CD-DV(diverticulectomy group; n=5), and CD-AP(appendectomy only group; n=19) by operative options. Information on patient demographics, duration of symptom, white blood cell count, radiologic studies, operative procedure, operation time, hospital days, duration of intravenous antibiotics administration, complications and recurrent symptoms were reviewed and analyzed. CD-RC and CD-DV patients required more hospital days than CD-AP(mean 20.6 days, 9.6 days versus 8.4 days, respectively) and more complications(50%, 60% versus 26%). There was no recurrent patient in this series and also there were no reoperated cases. But there was one death in CD-RC group. Of the 4 patients who had right hemicolectomy, one was expired by sepsis and one had minor wound infection. Minor wound infections are the most common complications : 5 in CD-AP, 3 in CD-DV group. Conclusively, if CD could be diagnosed preoperatively, surgical management should be reserved and initial medical treatment with intravenous antibiotics should be considered, and in those patient who underwent emergency operation presumed acute appendicitis, right hemicolectomy with primary ileocolic anastomosis is recommended with acceptable low morbidity. But alternatively appendectomy only is a safe and effective procedure for the treatment of CD if there is no evidence of free perforation, abscess formation or strongly suggested cecal carcinoma.