Renol Mathew Koshy, MS, DNB, Abdulrehman Abusabeib, FRCS, Mohammed Rizwan, MS, Mohammed Khairat, FRCS
HAMAD GENERAL HOSPITAL, DOHA, QATAR.
Right iliac fossa (RIF) pain is a common surgical emergency. Acute appendicitis is the most common clinical diagnosis, and unless there are other confounding factors, no further investigations are required. Solitary caecal diverticulitis (SCD) is mostly an intra-operative surprise or an accidental radiological finding.
We report a series of seven patients with SCD seen over one year that presented with RIF pain. The only patient diagnosed pre-operatively by CT scan, due to a previous appendectomy, was managed conservatively. The six other patients that were diagnosed intra-operatively were managed surgically. Of these, the first four patients had ileo-caecectomy; two of which were perforated and the following two had appendectomy alone. The aggressiveness of our management seemed to decrease as the cases of SCD increased!
The pre-operative diagnosis of SCD depends on a high index of suspicion, supported by-
- Male of median age 30 years
- Asian or Oriental race
- History of appendectomy
- Subtle recurrent symptoms and absence of shifting pain
- Signs localized to the RIF for a longer duration
Pre-operatively, CT scan of the abdomen is both sensitive and specific to diagnose SCD. A diagnostic laparoscopy is of value, where the diagnostic accuracy improves up to 60%, based on the gross appearance of the caecum, in the presence of a normal looking appendix. The histopathology is confirmatory.
The surgical options for SCD include diverticulectomy, appendectomy alone, ileo-caecal resection or right hemi-colectomy. An appendectomy should suffice, unless there is a diagnostic dilemma or a complication of perforation, when an ileo-caecectomy is required.
SCD when managed conservatively has a chance of recurrence in about 30%. This outcome is comparable with the conservative regimen for appendicitis, where we look at the larger 70% which don’t recur. Hence, considering the importance of preserving the ileo-caecal junction, the young age of patients and low recurrence rates, we propose a conservative approach to SCD.
Session: Poster Presentation
Program Number: P044