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Rare cecum diverticulitis misleading to false appendicitis diagnosis

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Introduction: Diverticulum of the cecum is a very rare cause of acute abdomen and can be very hard to tell apart from appendicitis prior to surgical intervention. Indication for surgery is taken on the presumptive diagnosis of appendicitis. The incidence of diverticular disease is increasing worldwide due to the aging trend of the general population.

Case report: We are presenting a case of a 47 years old adult with cecal diverticulitis, in which case acute appendicitis was the most obvious diagnostic before surgery. Appendectomy and diverticulectomy were performed, followed by a double layer cecoraphy and peritoneal drainage. The macroscopic aspect of the resected diverticulum is consistent with extended parietal necrosis involving all of its layers. In the histopathological examination of the resected diverticulum, findings of distinct acute necrosis, vascular thrombosis, and presence of muscular layer were determined into the diverticular wall.

Discussion: Most of the patients with cecal diverticulitis are misdiagnosed on admission as appendicitis due to symptoms of acute abdomen; thus, they undergo surgery without any further investigation. This is mostly because of the rare incidence of the disease, and to the fact that it mimics the symptoms of an acute appendicitis.

Conclusion: The preoperative diagnosis of cecum diverticulitis is hard to be made only relying on clinical symptoms. Radiological imaging is the only investigation able to point the diagnosis in the right direction. Histopathology is the ultimate investigation for the diagnosis of this illness. Ultrasonography, CT scan and colonoscopy can make the difference by pointing to the real diagnosis and thus preventing the intraoperative surprise. There is a debate on what kind of surgical treatment should undergo these patients, with a large spectrum of choices like appendectomy, diverticulectomy up to right hemicolectomy, correlated with intraoperative findings.

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Cristian Balalau, Nicolae Bacalbasa, Ion Motofei, Petru Tonu, Petrisor Banu, Razvan Valentin Scaunasu, Bogdan Popescu and Vlad Denis Constantin

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