ORIGINAL ARTICLES   

Chirurgia 2001 December;14(6):211-4

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: Italian

Solitary diverticulum of the cecum. A case report

Bentivegna F., Bonaccorso A., Viola F., Caragliano P.

Background. Solitary diverticuli of the cecum are rare and just over 500 cases have been reported in the literature. They are congenital in origin and real diverticuli, contrary to those found in other tracts of the colon, and they only become clinically manifest when complicated by inflammation, leading to perforation or causing a pseudotumoral mass to form.
Methods. Of 130 cases of complicated colic diverticuli examined in the past 15 years, the authors report 3 clinical cases (4.3%) of complicated solitary diverticuli of the cecum referred to their attention. They highlight both the pre- and intraoperative diagnostic difficulties, given that they are often mistaken for appendicular phlogosis or perforated carcinoma of the cecum, which affects surgery.
Results. The authors showed an eclectic approach to the treatment of this pathology. In cases where the diagnosis was certain, they suggest using a conservative approach as the treatment of choice, namely simple resection of the diverticulum. On the contrary, in cases with a doubtful interpretation, like those observed, or when diverticolectomy or invagination could jeopardise the patency of the ileocecal valve or intestinal vascularisation, they used demolitive surgery such as right hemicolectomy. This enabled excellent results to be achieved with zero mortality and acceptable morbidity.
Conclusions. Although they recognise that the advent of image diagnostics, like ultrasonography and CAT, has been particularly important for a clearer definition of complicated cases of diverticulitis of the right colon, the diagnosis is frequently made following the histological analysis of the surgically removed biopsy and, as a result, surgery is almost always demolitive.