Acute Cecal Perforated Diverticulitis Synchronous with Acute Appendicitis. Clinical Case

Abstract

Introduction: Diverticular disease of the colon is an increasingly common condition in developed countries. Diverticula can develop in any segment of the colon, but are more common on the left side. The prevalence of cecal diverticula in Western countries is 1-2%, while in the East it represents 43-50% of colonic diverticula. Furthermore, in the West, the majority are solitary. When they are solitary, they are generally congenital and true, and if they are multiple, they are typically false (pseudodiverticula) and acquired.

Clinical case: 50-year-old female, administrative employee, with a history of systemic arterial hypertension and mixed dyslipidemia; that she presented to the emergency medical service reporting anorexia, generalized abdominal pain, fever of 38.2 °C on one occasion and in the absence of alterations in fecal evacuations. On physical examination, the abdomen was presented with decreased peristalsis, slightly tympanic on percussion, painful on palpation in the left iliac fossa with involuntary muscular resistance. An abdominal mass was also palpated in the left iliac fossa. Additionally, he reported mild pain on palpation in the iliac fossa. right, doubtful Mc Burney sign, negative rebound. During his hospitalization, laboratory studies were performed, which reported leukocytosis, neutrophilia and thrombocytopenia, in addition to a simple and contrasted abdominopelvic tomography which reported multiple diverticular formations in the descending and sigmoid colon, which were accompanied by striation of the pericolic fat, with fluid. free in the left slide, pelvic and perihepatic cavity, with gas particles in the slide, thickening and increased enhancement of the walls of the descending colon and sigmoid.

Discussion.  Right-sided diverticulitis is a rare disease in the West, accounting for 1 to 3.6% of total cases of diverticular disease. Approximately 80% of right-sided diverticula are located on the anterior surface of the cecum, close to the ileocecal valve, and are usually asymptomatic.