Presentation
9 days of pain in the right iliac fossa, nausea and fever ? appendicitis
Patient Data
Small diverticulum just proximal to the ileocecal valve arising from the mesenteric aspect of the terminal ileum. A calcified fecolith lies at the neck of the diverticulum and there is stranding of surrounding fat indicative of inflammation. Appearances consistent with terminal ileal diverticulitis. No evidence of complications (e.g. abscess, perforation etc.).
Case Discussion
Terminal ileum diverticulitis is a rare disease that may lead to an acute abdomen mimicking appendicitis. It is not Meckel diverticulitis nor other true diverticulum rather an acquired condition possibly due to the same causes as colonic diverticular disease i.e. pseudodiverticula.
These diverticula are usually multiple and occur at the mesenteric border, sometimes hidden in the mesentery and overlooked during surgery. Most patients are asymptomatic and diagnosis is made on routine imaging studies or at autopsy. The acute complications of ileal diverticula including inflammation are very rare.
The management of ileal diverticulitis is similar to that of colonic diverticulitis, i.e. treated conservatively if recognized on imaging prior to laparotomy. For those who present with complications such as bleeding, obstruction or perforation, surgical intervention is required.
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