Terminal ileal diverticulitis

Case contributed by Yaïr Glick
Diagnosis almost certain

Presentation

Lower abdominal pain, more on right. Raised inflammatory markers despite having been on cefuroxime for several days for a urinary tract infection. No fever or shivers.

Patient Data

Age: 25 years
Gender: Female

The cecum curves upward, wherefore the appendix originates cranial to the ileocecal valve.
Normal-appearing mediocecal appendix, its distal part bordering the liver.
Single diverticulum on the mesenteric border of the terminal ileum, approximately 2 cm from the ileocecal valve, surrounded by mesenteric fat stranding which contains a couple of tiny gas bubbles. Several reactive mesenteric lymph nodes nearby. The terminal ileum is thickened.

Case Discussion

Ileal diverticulitis with perforation in a young woman, a very rare diagnosis. It is quite possible that had she undergone ultrasound imaging, the diagnosis would have been delayed.
She received antibiotic treatment and recovered uneventfully.

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