Presentation
Right lower abdominal pain.
Patient Data
Few diverticulae are noted in the mesenteric border of the distal ilium and cecum, the largest one seen at the cecal pole contains fecal material with relative wall thickening and peridiverticular infiltration. Several reactive lymph nodes were seen along the congested mesentery with no drainable collection. Noticeable cecal wall thickening with preservation of layered enhancement. The terminal ileum (apart from diverticulosis), and the appendix are unremarkable.
Incidental note of hepatic hemangioma at segment VIII.
Thin green arrows in the first three images: terminal ilium and cecal diverticula.
Purple arrow: the largest inflammed cecal diverticulum and peridiverticular infiltration.
Thick green arrow: small lymph nodes along the congested mesentery.
Thick red arrow: layered enhancement of the cecal wall (outer and inner hyperattenuating layer, and thickened middle layer of low attenuation).
Blue arrow: terminal ileum diverticulosis.
Case Discussion
The patient presented with acute right lower abdominal pain and elevated inflammatory markers, with tenderness noted on clinical examination. Ultrasound raised the suspicion of a cecal mass lesion and thus perforated cecal carcinoma was suspected given the patient's age. CT scan is important to differentiate colon carcinoma from a complicated diverticular disease since the management differs. The patient's condition markedly improves on conservative treatment.
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