However, an acquired counterpart is considered a false diverticulum arising from similar aetiopathogenetic factors as the left sided diverticular disease and therefore does not contain muscular wall layer [10]. The majority of caecal diverticula arise from the anterior aspect of the caecum and usually
solitary, thus when inflamed they have the tendency to perforate and cause peritionitis. However, a posteriorly situated caecal diverticulitis when perforated may present as a caecal mass and mimicking a perforated carcinoma [5]. The preoperative diagnosis of caecal diverticulitis Selleck ��-Nicotinamide is difficult and one report claims it is only made in 9% of the cases, and most of these patients have had previous appendicectomy [5]. Acute appendicitis is by far the initial preoperative diagnosis on account of similar presentation of low grade fever, right iliac fossa pain and tenderness with guarding. However some studies have suggested certain subtle clinical features that may help in differentiating caecal
diverticulitis from acute appendicitis including a relatively longer history of right iliac fossa pain with relative lack of systemic toxicity despite prolonged duration of the symptoms especially with a posteriorly located lesion. Nausea and vomiting are less frequent, abdominal pain typically starts and remains in the right iliac fossa rather than beginning in the central abdomen and shifting to the RIF and RIF tenderness is not usually as marked
S3I-201 as in acute appendicitis [2, 5, 11]. As acute appendicitis is mainly a clinical diagnosis, many patients presenting with RIF pain and tenderness with a presumptive diagnosis of appendicitis are Alectinib clinical trial usually not subjected to preoperative radiological investigations except where the diagnosis is in doubt especially in female patients or where a mass is palpable and a caecal carcinoma is suspected. Our patient did not have a preoperative radiological investigation because of a strong suspicion of an acute appendicitis. However, abdominal ultrasound scan (USS) and computerised tomography (CT) scan have been shown to have high diagnostic accuracy and may play a role in the preoperative diagnosis [5, 12–14]. In a review of 934 patients with caecal diverticulitis presenting with indeterminate right lower quadrant abdominal pain, Chou et al [13] reported a sensitivity of 91.3% and a specificity of 99.5% with abdominal USS with an overall accuracy of 99.5% in the diagnosis of caecal diverticulitis. The preoperative accuracy of distinguishing acute appendicitis from caecal diverticulitis with CT scan has been shown in various studies with a sensitivity and specificity of 98% [8, 12, 13].