대한대장항문학회

Purpose: Because there are no significant differences of the clinical findings between the<br>appendicitis and cecal diverticulitis, it is very difficult to make a correct diagnosis<br>preoperatively and to choose a appropriate management intraoperatively. The purpose of this<br>study is to investigate the clinical charateristics of right diveticulitis and to evaluate the<br>appropriateness of surgical management.<br>Methods: We reviewed 45 cases of right colonic diverticulitis which underwent emergency<br>operation under the impression of acute appendicitis during 10 years from January 1988 to<br>December 1997.<br>Results: Of them, 38 cases were treated by diverticulectomy with appendectomy (Group I),<br>and 7 cases were treated by resection (ileocecal resection or right hemicolectomy) (Group II).<br>The male to female ratio was 4：1, and the mean age was 38.2 years. In Group I, all cases<br>had a solitary inflamed cecal diverticulum. In group II, two cases had a solitary cecal<br>diverticulitis, whereas five cases had multiple ones. Postoperative complications were found<br>in 14 cases, but all of them were not significant. Postoperative Barium enema was performed<br>in 22 cases of Group I, in two cases of Group II. In Group I, 8 cases had a residual diverticulum<br>at postoperative Barium enema. In Group II, no residual diverticulum was shown. Follow-up<br>study by Telephone was done at 16 cases, there were no symptomatic recurrences.<br>Conclusions: In conclusion, when right colonic diverticulitis is found at the time of operation,<br>surgical management is a safe treatment with low morbidity and low recurrence rate.<br>Diverticulectomy with appendectomy is a safe surgical procedure for the uncomplicated<br>diverticulitis. If diverticulitis is complicating, multiple or undistinguishable with malignancy,<br>resection (ileocecal resection, right hemicolectomy) should be considered as a primary surgical<br>treatment. Postoperative colon study is helpful, due to high incidence of residual diverticulum.<br>