CASE 2728 Published on 29.02.2004

Diverticulum of the cecum


Abdominal imaging

Case Type

Clinical Cases


Kapanadze I, Kintcurashvili G, Kvatadze M, Chankvetadze L, Tcilosani M.


33 years, male

Clinical History
Acute appendicitis
Imaging Findings
The patient was admitted to the surgical department due to right lower quadrant pain of 3 days duration. White blood cell count was 10,2X10&sup9;/ L. Physical examination revealed tenderness in the left lower quadrant. Surgery for acute appendicitis was performed. During the operation the diagnosis of acute phlegmonous appendicitis was confirmed, and, laterally to appendix a 5cm size tumourous formation was revealed.
Histological diagnosis was of perityphlitis.
15 days after operation contrast enema was performed, wich revealed a 6 X 7 mm contrast shadow on the front side of the caecum. Ultrasonography did not reveal any changes.
True diverticulum containing the three layers of the bowel wall: mucosa, submucosa and muscularis mucosa and arising in the cecum or the ascending colon. The acquired type of diverticulum of the ascending colon and the caecum is less common than that of the left colon. It is discussed under diverticular disease, diverticulosis and diverticulitis of the colon. The true diverticula of the ascending colon are mostly solitary and may contain a faecalith. Complications such as inflammation and perforation with peridiverticulitis are not uncommon. The inflamed diverticula is difficult to distinguish preoperatively from that of appendicitis and may be difficult to distinguish intraoperatively from carcinoma of the caecum. The diagnosis at operation in some cases is difficult because the inflammatory reaction may simulate a malignant process.
Radiological imaging is important to distinguish this condition from acute appendicitis, which may cause similar clinical symptoms. The inflammatory changes are best visible on CT as increased attenuation in the mesenteric lipomatous tissue, adjacent to the colon due to strand-like linear structures and/or the presence of extraluminal air. Contrast enemas with water soluble contrast medium can be used to visualize the diverticulum and sometimes the extravasation at the site of the perforation.
Differential Diagnosis List
Acute appendicitis, Diverticulum of the caecum
Final Diagnosis
Acute appendicitis, Diverticulum of the caecum
Case information
DOI: 10.1594/EURORAD/CASE.2728
ISSN: 1563-4086