Cecum diverticulosis is a benign, rare and generally asymptomatic disease that can manifest with acute diverticulitis or bleeding, thus complicating the differential diagnosis of the right iliac fossa pathology. The optimal management of this disease does not have a well-established treatment plan, as it may vary in some centers from conservative treatment, consisting of only antibiotics, to segmental colectomy or even right hemicolectomy. We present the case of a 45-year-old patient, prior diagnosed with chronic pain in the right iliac fossa after appendectomy, who was diagnosed with a single cecum diverticulum.
Key words: cecum diverticulosis, appendectomy, right iliac fossa.
Cecum diverticulitis of the right colon is a rare disease, with a reported incidence of 0.04%1 of all cases of colon diverticulitis discovered intraoperatively or by imaging investigations. In Europe and in the United States, right side colon diverticulitis remains a rare and uncommon pathological finding, while in Coreea, China and Japan the incidence is ten times higher1. Cecum diverticula that have all the digestive layers are considered to be congenital2. Clinical symptoms may vary depending on the location of the diverticulum, usually it mimics acute appendicitis, but when it’s located at a distance from the ileocecal valve in the proximity of the colon, the differential diagnosis becomes difficult, mimicking a large right illiac fossa and right upper quadrant symptomatology. Controversies exist regarding the optimal management in non perforated cecum diverticulitis, ranging from conservative approach with intravenous antibiotics, to surgical procedures such as diverticulectomy and right hemicolectomy3. The management approach should be based on the clinical presentation of the patient, the intraoperative findings, and the surgeon’s experience.