Right sided colonic diverticulitis

Case contributed by Sami Elhinnawi
Diagnosis almost certain

Presentation

Acute abdomen, right iliac fossa pain, tenderness, rebound tenderness and fever.

Patient Data

Age: 60 years
Gender: Male

Mural thickening of the cecum with surrounding fat stranding.

There are multiple colonic diverticula, one of them arising from the anterior aspect of the cecum which shows prominent mural thickening and surrounding fat stranding as well as multiple enlarged lymph nodes. It also contains an internal gas lucency. 

The appendix appears normal with no evidence of inflammation.

There is evidence of left colonic diverticulosis.

Other incidental findings are multiple simple renal cysts and a retro-aortic left renal vein.

Findings are pathognomonic of right sided non-complicated diverticulitis.

 

Annotated image

Annotated images of the inflamed diverticulum and the normal appendix

Case Discussion

The patient was clinically diagnosed as acute appendicitis although initial ultrasound examination was in favor of right sided diverticulitis rather than appendicitis (ultrasound images not available).

CT was done to prevent unnecessary surgery, and confirmed the right sided diverticulitis.

The patient received antibiotics and symptoms resolved without complication.

Right sided diverticulitis typically follows a more benign course when compared to left sided diverticulitis owing to the fact that it is a true diverticulum, as one of the annotated images demonstrates.

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