Question

Difference between right iliac fossa and inguinal region

Answer 1

A solitary diverticulum of the caecum is a rare benign condition which was first described by Potier in 1912 [1]. Clinical symptoms are usually a manifestation of complications arising from inflammation, perforation or haemorrhage. Despite radiological imaging, a pre-operative diagnosis is infrequent.

Case presentation

We report two cases of right iliac fossa pain associated with a solitary caecal diverticulum. We discuss the clinical presentation, investigative modalities, and current therapeutic guidelines associated with this rare condition and highlight the difference from the more common conditions of appendicitis in the young and caecal neoplasms in the older patient.

Conclusion

Complications of a solitary caecal diverticulum should be considered in the differential diagnosis of acute right lower quadrant pain. Mild caecal diverticulitis verified pre-operatively by radiological imaging or laparoscopically can be ameliorated by antibiotics alone. However, severe inflammation, perforation, haemorrhage or torsion necessitates a localised or radical resection. The presence of multiple diverticula, caecal phlegmon, or the inability to rule out an underlying caecal neoplasm warrants a right hemicolectomy.

Background

A solitary diverticulum of the caecum is a rare benign condition which was first described by Potier in 1912 [1]. Although higher incidences have been reported in the Asian population, the condition still remains rare in the Western World [2]. Caecal diverticula are usually congenital in nature and arise as an out-pouching of the caecum involving all layers of the colonic wall [2]. They are usually asymptomatic unless complicated by inflammation, perforation or haemorrhage where presentation may mimic acute appendicitis with pyrexia, right lower abdominal pain and leucoytosis. Pre-operative diagnosis is invariably difficult even after radiological imaging. Therapeutic management varies from conservative treatment with antibiotics to surgical intervention ranging from diverticulectomy or wedge resections for local complications to right hemicolectomy in the presence of severe inflammation or if an underlying caecal neoplasm cannot be excluded.