Acute terminal ileal diverticulitis

Case contributed by Dr Chris O'Donnell

Presentation

9 days of pain in the right iliac fossa, nausea and fever ? appendicitis

Patient Data

Age: 75
Gender: Male

Small diverticulum just proximal to the ileo-caecal valve with a calcified faecolith at its neck showing thickening of surrounding fat indicative of inflammation.

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 ie 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 recognised 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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Case information

rID: 29567
Case created: 5th Jun 2014
Last edited: 12th Aug 2016
Inclusion in quiz mode: Included

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