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Abdomen » Gastrointestinal
Right sided diverticulitis
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Author(s) :
Taco Geertsma, MD
 
Presentation 59 year old Caucasian male with pain in the right lower abdomen, raised infection parameters and signs of a peritonitis
 
 
 
Caption: Transverse image through the right cecal area
Description: There is a large hyperechoic strcture in continuation with the cecum that causes acoustic shadowing
 
 
 
Caption: transverse image of the hyperechoic structure medial to the cecum
Description: There is a rounded hyperechoic structure causing acoustic shadowing surrounded by hperechoic mesenteric fat
 
 
 
Caption: Longitudinal image of the same structure medial to the cecum
Description: Hyperechoic structure with acoustic shadowing surrounded by hyperechoic mesenteric fat
 
 
 
Caption: Color doppler image of the cecal wall and base of the hyperechoic structure
Description: There is increased vascularity
 
 
 
Caption: Image of the cecal wall
Description: The cecal wall is slightly thickened but the layers are intact. There are no signs indicating a tumor
 
 
 
Caption: CT image of the lower abdomen
Description: There is a large right sided cecal diverticulum filled with feces and inflammatory changes in the surrounding mesenteric fat
 
Differential Diagnosis The clinical symptoms are that of an acute appendicitis. The ultrasound examination was also requested to confirm an acute appendicitis. The ultrasound findings however are not consistent with an appendicitis but with a diverticulitis.
In some cases of a right sided or cecal diverticulitis it can be difficult to differentiate from a perforated colon tumor.
 
Final Diagnosis

Cecal diverticulitis

 
Discussion

The cecal diverticulitis was first described by Portier in 1912. A right sided diverticulitis can be located in the cecum or the ascending colon. A right sided or cecal diverticulitis is fairly uncommon especially in the Caucasian population. In the Asian population it is more common. The right sided diverticulitis is less frequent than the left sided divericulitis. Males are slightly more affected than females. In the case presented there was a solitary diverticulum. These solitary diverticula are usually true diverticula and the diverticulum involves all layers of the colon wall. They are considered congenital diverticula. The left sided diverticula are considered false diverticula and do not contain a muscle layer. These diverticula are considered to be acquired. In severe cases of acquired diverticulitis the right side of the colon can also be involved. That was not the case in this patient. Because the right sided diverticulum is a true diverticulum which involves all the layers of the wall they do not perforate as easily as the left sided diverticulitis.

The typical sonographic feature of a right sided diverticulitis is a rounded or oval-shaped hypoechoic or nearly anechoic structure protruding out from the segmentally thickened colon wall. Some of them as in this case can contain strong echoes representing gas or feces or a stone in the lumen. Regional pericolic or peridiverticular fat thickening with increased echogenicity is a frequent finding
For more examples of diverticulitis and appendicitis visit www.ultrasoundcases.info

 
Case References

Ultrasonography of the acute abdomen: gastrointestinal conditions.Puylaert JB.

Radiol Clin North Am. 2003 Nov;41(6):1227-42, vii. Review.

Sonography of acute right side colonic diverticulitis.

Chou YH, Chiou HJ, Tiu CM, Chen JD, Hsu CC, Lee CH, Lui WY, Hung GS, Yu C.

Am J Surg. 2001 Feb;181(2):122-7.

 
Follow Up

The patient was operated and underwent a ileocecectomy. The pathologist confirmed the diagnosis

 
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