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Cecum Diverticulum


Presentation

  • Clinical case presentations , highlighted in special boxes, demonstrate how embryology concepts relate to clinical practice and are ideal for preparing for the USMLE Step 1.[books.google.com]
  • […] female who presented with free air in the abdomen after pelvic laproscopy.[sages.org]
  • Presentation A 34 year old male presents to the ER with exquisite tenderness in the right upper and lower quadrants. Patient Data Age: 34 Gender: Male Loading images... There are marked inflammatory changes in the right lower quadrant.[radiopaedia.org]
  • Special Notes boxes present ICD-10 features that affect your understanding of the terminology presented. Root operation tables illustrate the root operations in PCS and their associated suffixes.[books.google.ro]
  • Figure 2 Figure 2: Open solitary diverticulum of the cecum presenting fecaliths. Ileocolectomy with primary end-to-end ileocolic anastomosis was performed.[ispub.com]
Pain
  • They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis.[scielo.isciii.es]
  • […] obstipation Causes: Volvulus (with persistent fibrous band), torsion, foreign body, Littre’s Hernia (inclusion in hernia sac), inversion intussusception Diverticulitis ( 17%) Second most common complication in adults RLQ or periumbilical acute abdominal pain[learningradiology.com]
  • Perforated peptic ulcer: this usually produces upper quadrant pain but pain may be lower. Right inguinal/femoral hernia: an incarcerated right inguinal or femoral hernia may present as RIF pain.[patient.info]
  • The doctors will assess this area if there is abdominal pain in this region. Abdominal pain in the LLQ may be a symptom of colitis, diverticulitis, or ureteral colic. Pain in this region may also be caused by ovarian cysts or a pelvic inflammation.[newhealthguide.org]
Inflammation
  • We report on 5 cases of inflammation and perforation of a solitary cecal diverticulum, and perform a literature review.[scielo.isciii.es]
  • Colonoscopy is contraindicated during acute inflammation but is essential in ruling out malignancy in follow-ups .[amboss.com]
  • It can be inflammation of a diverticulum, which is an outpouching foudn in the large intestine.[autoprac.com]
  • This would reduce blood supply, causing inflammation. Other research suggests that obesity, smoking and certain medications may cause inflammation.[livescience.com]
  • The orifice of the appendix was below the thickened terminal ileum and shows no evidence of inflammation and outer dimension of the appendix was measured about 0.3 cm (between crosshairs). D.[e-ultrasonography.org]
Fever
  • They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis.[scielo.isciii.es]
  • All of my cases had localized pain in the right iliac fossa, induration or tumor, McBurney's tender point, fever and furred tongue. Some had vomiting, all had diarrhea... ‎[books.google.de]
  • Symptoms include abdominal pain, bloody or watery diarrhea, fever and decreased appetite. Symptoms may come and go and the disease may be active or in remission.[livestrong.com]
  • Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea.[mayoclinic.org]
  • Most patients are asymptomatic but may present with lower left abdominal pain , change in bowel habits, and fever in the event of diverticulitis . Diagnosis is based on the clinical features and elevation of inflammatory markers in blood tests.[amboss.com]
Asymptomatic
  • Abstract Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications.[ncbi.nlm.nih.gov]
  • They are usually asymptomatic, and manifest clinically only with complications such as inflammation, perforation, or bleeding.[scielo.isciii.es]
  • Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%).[wjgnet.com]
  • Diverticulosis refers to the presence of asymptomatic diverticula, while diverticulitis refers to symptomatic diverticular inflammation .[amboss.com]
  • Some surgeons prefer to resect the diverticulum in children and young adults even though it is asymptomatic.[merckmanuals.com]
Surgical Procedure
  • Such mistake is responsible for more than 70% of cecum perforation in patients with cecum diverticulitis who had undergone a surgical procedure due to acute appendicitis preoperatively.[medcraveonline.com]
  • 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.[umbalk.org]
  • There is no standard surgical procedure for the treatment of an acute, inflamed solitary caecal diverticulum, since the surgical approaches are not evidence-based.[scirp.org]
  • During the surgical procedure, perforation of the cecum was found. Initially, a perforated diverticulum was suspected; however, a mass lesion was noted over the peri-perforation region.[jacobspublishers.com]
  • The finer points of diagnosis can be accomplished when the abdomen is open for inspection during a surgical procedure. This situation is called an acute abdomen.[medical-dictionary.thefreedictionary.com]
Abdominal Pain
  • They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis.[scielo.isciii.es]
  • pain Can result in perforation Enteroliths ( 10%) Neoplasia ( 3%) Most often carcinoid (M F) Imaging Findings Abdominal Film, non-specific: Enteroliths, small bowel obstruction, perforation Abdominal CT Diverticulum off distal ileum, small bowel obstruction[learningradiology.com]
  • Symptoms include abdominal pain, bloody or watery diarrhea, fever and decreased appetite. Symptoms may come and go and the disease may be active or in remission.[livestrong.com]
  • Patients presenting with abdominal pain and focal tenderness should have CT with oral contrast. If vomiting and colicky abdominal pain predominate, flat and upright x-rays of the abdomen can be done to diagnose obstruction.[merckmanuals.com]
  • The doctors will assess this area if there is abdominal pain in this region. Abdominal pain in the LLQ may be a symptom of colitis, diverticulitis, or ureteral colic. Pain in this region may also be caused by ovarian cysts or a pelvic inflammation.[newhealthguide.org]
Abdominal Pain
  • They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis.[scielo.isciii.es]
  • pain Can result in perforation Enteroliths ( 10%) Neoplasia ( 3%) Most often carcinoid (M F) Imaging Findings Abdominal Film, non-specific: Enteroliths, small bowel obstruction, perforation Abdominal CT Diverticulum off distal ileum, small bowel obstruction[learningradiology.com]
  • Symptoms include abdominal pain, bloody or watery diarrhea, fever and decreased appetite. Symptoms may come and go and the disease may be active or in remission.[livestrong.com]
  • Patients presenting with abdominal pain and focal tenderness should have CT with oral contrast. If vomiting and colicky abdominal pain predominate, flat and upright x-rays of the abdomen can be done to diagnose obstruction.[merckmanuals.com]
  • The doctors will assess this area if there is abdominal pain in this region. Abdominal pain in the LLQ may be a symptom of colitis, diverticulitis, or ureteral colic. Pain in this region may also be caused by ovarian cysts or a pelvic inflammation.[newhealthguide.org]
Vomiting
  • […] complications) Most common complication in children Heterotopic gastric mucosa ulceration and hemorrhage Occult blood loss and iron deficiency anemia (adults) Small bowel obstruction ( 35%) Most common complication in adults Abdominal guarding and distension, vomiting[learningradiology.com]
  • Seite 12 - Great pain in the ileo-coecal region, cannot bear the slightest touch, not even the bed cover, cannot easily turn in bed lying motionless on his back, nausea and vomiting. ‎[books.google.de]
  • Symptoms and Signs In all ages, intestinal obstruction is manifested by cramping abdominal pain, nausea, and vomiting.[merckmanuals.com]
  • Nausea and vomiting: Large tumors in the right side of your colon may cause food to "back up" through the small intestine and stomach, causing vomiting. Vomiting often is bilious, or yellow in color.[verywellhealth.com]
  • There had been no nausea or vomiting. Physical examination revealed spasm, tenderness, and rebound tenderness in the right lower quadrant. The temperature was 99.6 F., peristalsis was normal, and no mass was palpable. There was high right rectal[jamanetwork.com]
Colic
  • Microscopic haematuria is usually present in ureteric colic. It can also occur in abdominal aortic aneurysm. [ 3 ] Perform a pregnancy test if an ectopic pregnancy or a miscarriage is suspected.[patient.info]
  • […] muscle, femoral nerve, lateral femoral cutaneous nerve and variably, the appendix medial: ileocecal valve and terminal ileum superior: ascending colon inferior: the lateral third of the inguinal ligament anterior and posterior cecal arteries from the colic[radiopaedia.org]
  • Adrenal crisis Biliary colic Ruptured spleen Kidney stone Tx Pain relief Epidemiology Common Sx Determinig the cause can be diffcult, because many diseases can cause the Sx See also Pain Abdominal guarding Visceral pain[autoprac.com]
  • The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula).[medigraphic.com]
  • Abdominal pain in the LLQ may be a symptom of colitis, diverticulitis, or ureteral colic. Pain in this region may also be caused by ovarian cysts or a pelvic inflammation.[newhealthguide.org]
Hematochezia
  • […] old Embryology and Pathology Incomplete atrophy of omphalomesenteric (vitelline) duct True diverticulum on anti-mesenteric border of ileum 50% contain heterotopic mucosa Most often gastric (50%) and pancreatic (16%) Complications and Clinical Findings Hematochezia[learningradiology.com]
  • ., intestinal strictures, fistulas ) References: [4] [6] [7] Complications Diverticular bleeding Frequency: occurs in around 5% of cases of patients with diverticulosis Caused by erosions around the edge of diverticula Clinical findings Painless hematochezia[amboss.com]
  • Diverticular bleeding:Symptoms Most only have symptoms of bloating and diarrhea but no significant abdominal pain  Painless hematochezia  Start – stop pattern; “water faucet” Diverticulitis rarely causes bleeding 70.[slideshare.net]
  • ., bowel habit change, constipation, abdominal pain and hematochezia) revealed a higher prevalence of colonic diverticulosis than those performed in asymptomatic individuals.[wjgnet.com]
Muscle Spasm
  • Some think muscle spasms or strain (like when you have a bowel movement ) make pressure build in your colon and push against the lining.[webmd.com]
Ulcer
  • […] on anti-mesenteric border of ileum 50% contain heterotopic mucosa Most often gastric (50%) and pancreatic (16%) Complications and Clinical Findings Hematochezia ( 40% of complications) Most common complication in children Heterotopic gastric mucosa ulceration[learningradiology.com]
  • As the intestinal tissue begins to die, ulcers form that produce pus and mucus that cause bloody stool. The cause of ulcerative colitis is unknown, but one theory is that bacteria or a virus affects the immune system.[livestrong.com]
  • These deep ulcerations are classically seen in the colon associated with active ulcerative colitis.[appliedradiology.com]
  • By organ GI GI tract, including: Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumors[autoprac.com]
  • It is characterised by the presence of multiple ulcers in the terminal ileum, the long axis of each ulcer lying transversely. ‎[books.google.de]

Workup

  • The historical concept that RCD in the Western world was a more aggressive disease than LCD was merely a reflection of the unfamiliarity with this disease, an inadequate diagnostic workup and decision making in the operating room.[omicsonline.org]
Colitis
  • […] infectious colitis and, rarely, focal amyloidosis. 64 Accordion sign The “accordion sign” describes the appearance of colonic wall thickening in the setting of colitis.[appliedradiology.com]
  • The exact cause of colon cancer is unknown, but genetics, polyps, Crohn’s disease, ulcerative colitis and Lynch syndrome seem to increase cancer development, according to Cedars-Sinai Hospital.[livestrong.com]
  • In these cases, the presence of the endoscopic colitis is confirmed pathologically. 2.[hdda.net]
  • By organ GI GI tract, including: Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumors[autoprac.com]
  • , pseudomembranous colitis, renal disease, small bowel obstruction, UTI, ulcerative colitis, and ovarian cyst, abscess, neoplasm, or torsion. 4,6,9,10 The European Association of Endoscopic Surgeons (EAES) has devised a classification system to aid in[uspharmacist.com]

Treatment

  • The preferable treatment is simple resection.[ncbi.nlm.nih.gov]
  • […] ischemia) Differential Diagnosis Appendicitis, colonic diverticulitis, acute mesenteric lymphadenitis Single small intestinal diverticulum Communicating enteric duplication Pseudosacculations (Crohn’s Disease) Cavitating malignancies (lymphoma, GIST) Treatment[learningradiology.com]
  • References: [2] [4] [5] [6] Differential diagnoses Treatment Treatment of diverticulitis Disease Conservative management Surgical management (Acute) uncomplicated diverticulitis Outpatient treatment Restricted, clear liquid diet and bowel rest until pain[amboss.com]
  • In our case laparotomy at the emergency was conducted compared with literature data there is a possibility of laparoscopy treatment of this pathology with the possibility of conversion into open treatment.[scirp.org]
  • Treatment of complicated diverticulitis 57.[slideshare.net]

Prognosis

  • Prognosis Compared with left-sided colon cancers, right-sided colon cancers, such as those of the cecum, have somewhat poorer survival rates.[verywellhealth.com]
  • Prognosis after second attack Second attack  Risk of recurrent attacks is high ( 50%)  Some studies suggest a higher rate (60%) of complications (abscess, fistulas, etc) in a second attack and a higher mortality rate (2x compared to initial attack)[slideshare.net]
  • Prognosis The outcome after surgery is usually excellent. The source of bleeding, pain, or obstruction is removed so the symptoms also disappear. A Meckel's diverticulum will not return.[medical-dictionary.thefreedictionary.com]
  • It also prevents recurrence of diverticulitis episodes in patients with complicated diverticulitis. 11 Prognosis Diverticulitis will recur in 20% to 30% of patients. 2,7 Roughly one-third of patients treated nonoperatively will have a recurrent episode[uspharmacist.com]

Etiology

  • Although the etiology of caecal diverticula is Figure 2 .[scirp.org]
  • Etiology Caused mainly by lifestyle and environmental factors Increasing age Genetic factors Diet ( low-fiber , rich in fat and red meat) Obesity , low physical activity Cigarette consumption References: [2] [3] Classification Pathophysiology Diverticulosis[amboss.com]
  • Acute abdomen Acute abdomen is sudden, severe abdominal pain of unclear etiology, Traumatic: Blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney Inflammatory: Infections, including: Acute appendicitis, most commonly Acute cholecystitis[autoprac.com]
  • Perforated solitary cecal diverticulum: An etiological challenge at emergency. Journal of Acute Medicine . 2016;6(2):49–51. Karatepe O, Gulcicek OB, Adas G, et al. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases.[medcraveonline.com]
  • RCD is considered to have another etiology than left-sided colonic diverticulitis (LCD) because the type and location of the diverticula differ between Asians and Caucasians [ 7, 8 ].[omicsonline.org]

Epidemiology

  • : [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • First of all, we need to remind ourselves of the epidemiological perspective.[iffgd.org]
  • Epidemiology Before the 20th century, diverticular disease was rare Prevalence has increased over time  1907 First reported resection of complicated diverticulitis by Mayo  1925 5-10%  1969 35-50% 4. Epidemiology Increases with age  Age 40 5.[slideshare.net]
  • Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis. . Accessed July 24, 2018. Tursi A, et al.[mayoclinic.org]
  • […] the SMA (superior mesenteric artery) Abdominal aortic aneurysm Hemoperitoneum Sickle cell anemia Other: Diabetic ketoacidosis Ectopic pregnancy Ovarian torsion Acute uteric colic Adrenal crisis Biliary colic Ruptured spleen Kidney stone Tx Pain relief Epidemiology[autoprac.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Law of Laplace: P kT / R Pressure K x Tension / Radius Sigmoid colon has small diameter resulting in highest pressure zone 21.[slideshare.net]
  • Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al.[mayoclinic.org]
  • Etiology Caused mainly by lifestyle and environmental factors Increasing age Genetic factors Diet ( low-fiber , rich in fat and red meat) Obesity , low physical activity Cigarette consumption References: [2] [3] Classification Pathophysiology Diverticulosis[amboss.com]
  • The lead pipe appearance of the colon is classically seen with chronic, smoldering ulcerative colitis. 68 The lead pipe appearance likely represents the visual manifestation of multiple pathophysiological processes.[appliedradiology.com]
  • Most of several available texts of gastroenterology, medicine, and pathophysiology do not mention nuts or seeds in their descriptions of the pathogenesis, prevention, or treatment of diverticulosis and diverticulitis.[iffgd.org]

Prevention

  • Low-fiber foods can help prevent bloating and gas as your body heals.[livestrong.com]
  • The decision whether or not to exclude seeds or nuts as primary or secondary prevention of diverticulitis will boil down to common sense and personal choice. Primary prevention would be difficult.[iffgd.org]
  • Preventing problems It's not clear yet if we can prevent diverticulosis or diverticulitis. Exercising, controlling your weight, and eating less red meat and more fiber may help.[health.harvard.edu]
  • Diet high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition.[medical-dictionary.thefreedictionary.com]
  • Preventive care for diverticulosis Here are things you can do to help prevent or slow the progression of diverticular disease: Eat more fiber.[advancedgitexas.com]

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