IS case 524: Cecal diverticulitis

Charles Hubeny, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-09-10

History

Patient is a 30-year-old female with right lower quadrant pain with suspicion for appendicitis.

Findings

Inflammatory changes surrounding diverticula in the right lower quadrant. The appendix is normal.

Diagnosis

Cecal diverticulitis

Discussion

Right colon diverticulitis is a relatively rare disease more commonly seen in the Asian or African population. Clinically, the entity resembles left colon diverticulitis with symptoms on the right and is a great mimicker of acute appendicitis. Right colon diverticula are congenital, more commonly in the cecum, and usually solitary in contrast to left colon diverticula which develop and increase in number with age and are associated with certain risk factors such as low fiber intake.

Image findings on CT include right lower quadrant infiltrative changes surrounding the inflamed diverticula with or without colon wall thickening or adjacent abscess. The diagnosis is difficult to make as diverticula may be obscured by adjacent inflammatory changes and the entity may be indistinguishable from colon cancer in an older population. Also, since appendicitis more commonly causes right lower quadrant inflammatory changes visualization of a normal appendix is essential for CT diagnosis. Other than appendicitis and colon cancer the differential diagnosis includes Crohn’s disease and epiploic appendigitis.

Initial treatment for right colon diverticulitis is usually antibiotic therapy. Surgery is reserved for severe or recurrent disease.

References

  1. Jang HJ, Lim HK, Lee SJ, et al. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol. 2000 May;174(5):1397-402. PMID: 10789802
  2. Scatarige JC, Fishman EK, Crist DW, Cameron JL, Siegelman SS. Diverticulitis of the right colon: CT observations. AJR Am J Roentgenol. 1987 Apr;148(4):737-9. PMID: 3493656

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