Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

GASTROINTESTINAL
Year
: 2006  |  Volume : 16  |  Issue : 4  |  Page : 451--452

CT diagnosis of cecal diverticulitis


N Sreenivasan, A Kalyanpur, A Bhat, PG Sridhar, J Singh 
 Teleradiology solutions, Bangalore, India

Correspondence Address:
N Sreenivasan
Consultant Radiologist, Teleradiology solutions, Bangalore
India




How to cite this article:
Sreenivasan N, Kalyanpur A, Bhat A, Sridhar P G, Singh J. CT diagnosis of cecal diverticulitis.Indian J Radiol Imaging 2006;16:451-452


How to cite this URL:
Sreenivasan N, Kalyanpur A, Bhat A, Sridhar P G, Singh J. CT diagnosis of cecal diverticulitis. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Feb 19 ];16:451-452
Available from: http://www.ijri.org/text.asp?2006/16/4/451/32244


Full Text

 Introduction



Cecal diverticulitis has a high incidence among Asians, but is a rare condition in the western world. Cecal diverticulitis is not a common disease, becoming clinically evident between the second and the fourth decade. The diagnosis of cecal diverticulitis is often controversial since the signs and symptoms simulate an acute appendicitis or an appendicular abscess. Moreover, during surgery, sometimes it appears like carcinoma of the cecum. CT scanning is a sensitive means by which to detect cecal diverticulitis. We are presenting the CT findings of a case of cecal diverticulitis.

 Case report



CLINICAL HISTORY: A 15-year-old Cambodian female presented with a one-day history of right lower quadrant (RLQ) pain as well as low-grade fever and anorexia. The patient denied nausea, vomiting, or diarrhea. On clinical examination the patient was tender over the RLQ however not exhibit peritoneal signs did. Labs: CBC: WBC=11.1, Hgb=14.6, Diff: 69% neutrophils, 25% lymphocytes, 6% monocytes.

 Imaging and Surgical Findings



CT of the abdomen and pelvis with oral and intravenous was performed, demonstrating a thickened and inflamed diverticulum in the cecum with surrounding fat stranding. The appendix was contrast filled and normal in caliber. Multiple enlarged mesenteric lymph nodes were also noted. The terminal ileum was normal without evidence of wall thickening. A differential diagnosis of cecal diverticulitis, infectious colitis and less likely neoplastic process was given with the former being the favored diagnosis.

The patient was admitted for observation, pain control and intravenous antibiotic therapy. The patient's abdominal pain worsened over the next 12 hours therefore the decision was made to take the patient to the operating room for exploration. An inflammatory mass was found in the right lower quadrant, suspicious grossly for a neoplastic process and therefore an ileocecal resection was performed. On histopathological examination a diagnosis of cecal diverticulitis was made. The patient did well post-operatively and went home on post-op day 5.

 Discussion



Cecal Diverticulitis is a benign and primarily non-surgical disease that must be differentiated preoperatively from colonic carcinoma [1].Several groups of researchers have reported that accurate distinction between these two diseases is not possible with CT and further investigation should be performed to exclude carcinoma [2],[3].

Right-sided colonic diverticulitis is considered to be a rare condition in the Western population [4] and radiologic studies of acute colonic diverticulitis have usually been limited to the sigmoid colon [2]. Recently, owing to the liberal use of sonography and CT in patients with abdominal pain, right-sided colonic diverticulitis has been reported to be more common [1] than was previously estimated .The correct preoperative diagnosis of right-sided colonic diverticulitis has rarely been made; instead, the diverticulitis is usually discovered unexpectedly at surgery for suspected appendicitis [1],[4].

Clinically, right-sided colonic diverticulitis has been one of the greatest mimics of acute appendicitis; however, with current thin-section helical CT, most healthy appendixes can be revealed [5] and the differentiation of colonic carcinoma from acute appendicitis is not difficult. In approximately 10% of patients, diverticulitis is reported to be indistinguishable from carcinoma on CT [2]. The CT findings of diverticulitis are linear densities in the pericecal fat consistent with pericecal inflammation, intramural abscess, thickening of the cecal wall, and cecal diverticulum. [6].

The two CT findings of right-sided colonic diverticulitis that most distinguished it from colonic carcinoma were inflamed diverticula and the preservation of an enhancement pattern of the involved colonic wall.

References

1Oudenhoven LFIJ, Koumans RKJ, Puylaert JBCM. Right colonic diverticulitis: US and CT findings-new insights about frequency and natural history. Radiology 1998;208:611 -618
2Balthazar EJ, Megibow A, Schinella RA, Gordon R. Limitation in the CT diagnosis of acute diverticulitis: comparison of CT, contrast enema, and pathologic findings in 16 patients. AJR 1990;154:281 -285
3Pradel JA, Adell J-F, Taourel P, Djafari M, Monnin-Delhom E, Bruel J-M. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 1997;205:503 -512
4Balthazar EJ, Megibow AJ, Gordon RB, Hulnick D. Cecal diverticulitis: evaluation with CT. Radiology 1987;162:79 -81
5Jang H-J, Lim HK, Lee SJ, Choi SH, Lee MH, Choi MH. Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings. AJR 1999;172:601 -604
6Cho KC, Morehouse HT, Alterman DD, Thornhill BA. Sigmoid diverticulitis: diagnostic role of CT-comparison with barium enema studies. Radiology 1990;176:111 -115