|Year : 2018 | Volume
| Issue : 3 | Page : 169-171
Rare case of acute abdomen: Right colon perforation due to the colon diverticulitis
Faruk Pehlivanli1, Gökhan Karaca1, Oktay Aydin1, Sevilay Vural2, Figen Coskun3
1 Department of General Surgery, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
2 Department of Emergency Medicine, Faculty of Medicine, Bozok University, Yozgat, Turkey
3 Department of Emergency Medicine, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
|Date of Web Publication||10-Sep-2018|
Department of General Surgery, Faculty of Medicine, Kirikkale University, 71850 Kirikkale
Source of Support: None, Conflict of Interest: None
Colonic diverticula and related complications are common pathologies in elderly patients. In older patients, colonic diverticulum perforation is more common in the sigmoid colon, whereas right colon diverticulum perforation is rather rare. In younger patients, especially in patients under 30 years of age, right colon diverticula are more common than left colonic diverticula. Therefore, right colon diverticulum perforation should be considered in patients with acute abdomen in this age group. In this case, right column diverticulum perforation is presented in a patient with acute abdomen findings.
Keywords: Acute abdomen, diverticulitis, perforation, right colon
|How to cite this article:|
Pehlivanli F, Karaca G, Aydin O, Vural S, Coskun F. Rare case of acute abdomen: Right colon perforation due to the colon diverticulitis. Apollo Med 2018;15:169-71
|How to cite this URL:|
Pehlivanli F, Karaca G, Aydin O, Vural S, Coskun F. Rare case of acute abdomen: Right colon perforation due to the colon diverticulitis. Apollo Med [serial online] 2018 [cited 2019 Oct 22];15:169-71. Available from: http://www.apollomedicine.org/text.asp?2018/15/3/169/240940
| Introduction|| |
Right colon diverticulum is a rare pathology that is less common than sigmoid colon diverticulum. Cecum and right colon diverticula are more common in young population., These diverticula are more prevalent in Asian populations. Cecum and right colon diverticula can cause acute abdomen and can often be difficult to diagnose because it can be confused with the most common complicated acute appendicitis in this age group. Right colon diverticula can also be misinterpreted as colon tumors in this region., In this case, the right colon diverticulum perforation is discussed in a 47-year-old male patient who was admitted to emergency service due to acute abdomen and underwent right hemicolectomy.
| Case Report|| |
A 47-year-old male patient was admitted to the emergency room with complaints of abdominal pain, distention, nausea, and vomiting that started 2 days ago. The patient had a history of smoking and alcohol consumption and there was no history of drug use. The patient's blood pressure was measured as 130/60 mmHg and fever as 37.5°C. On physical examination, there were tenderness, muscular defense, and rebound in all quadrants with distension. Routine laboratory tests revealed leukocytes: 20,600/mm3, Hb: 13.3 g/dL, Hct: 40, blood glucose: 173 mg/dL, blood urea nitrogen: 59 mg/dL, creatinine: 0.45 mg/dL, Na+: 136 mEq/L, K+: 3.9 mmol/L, Ca + 2: 7.9 mg/L. Liver function tests were normal. Intravenous 0.9% NaCl was initiated and direct abdominal X-ray showed dense gas in the colon and small intestine. Abdominal computed tomography with intravenous contrast showed increased wall thickness in the proximal section of the ascending colon, as well as increased density and minimal fluid consistent with diffuse contamination of the mesenteric fat tissue [Figure 1]. The patient was diagnosed with acute abdomen and was operated. There was blurred fluid in the abdomen. It was seen that the 7-cm long piece of the proximal part of the right colon was severely inflamed [Figure 2] and [Figure 3]. Right hemicolectomy was performed. Pathologic examination was reported as perforated diverticulitis. The patient was discharged without any problems on the 5th postoperative day.
|Figure 1: Abdominal computed tomography concentric thickening in the right colon, stenosis in the passage and contamination of the mesentery|
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| Discussion|| |
Colonic diverticular diseases are a common clinical condition, especially in western societies, and are frequently seen in the left colon (50%–90%). Right colonic diverticula are less common in general population in western countries (0.9%–5%). Right colonic diverticula are more common in Asian populations. In diverticular disease of the right colon, the patient usually presents with right lower quadrant pain. Clinical findings may be mistaken for other acute abdominal diseases and patients are usually diagnosed with acute appendicitis preoperatively. Right colonic diverticular diseases may also be associated with infectious diseases as well as malignant colonic diseases, inflammatory bowel diseases, foreign body perforations, and Yersinia enteritis. Patients with right-sided diverticulosis usually present with right lower quadrant pain and local peritoneal findings, but in this case, there was widespread tenderness and rebound in the abdomen in addition to abdominal pain in the right lower quadrant. For this reason, other pathologic conditions were considered in differential diagnosis rather than appendicitis.
There are various factors in the etiology of diverticular diseases. These include nutrition with low fiber diet, smoking and alcohol use, use of corticosteroids, increased acetylcholine activity in the sigmoid colon, and aging.,, In our case, there were no additional factors other than smoking and alcohol intake in the patient.
Methods used radiologically in the diagnosis of diverticular disease are also important. In recent studies, it has been reported that right colon diverticulitis is better diagnosed by computerized tomography and the treatment option is determined according to the imaging results.,, Computerized tomography is useful in differential diagnosis of especially other conditions such as inflammatory bowel disease, tuberculosis, and amebiasis, which give colonic mass images. The radiological appearance of our case has been difficult to diagnose as diverticulum perforation is similar to right colon tumor. Although tomographic examination shows diverticula, the fact that the lesion cannot be distinguished from the colon tumor in the case of diverticulitis affects the intraoperative decision mechanisms as in this case.
The choice of treatment for colonic diverticulitis varies according to the location of the lesion and its complications. A conservative approach is recommended in cases with no complications. Surgery is necessary, however, in cases of complications arising despite conservative treatment. Bleeding, perforation, fistula, and peritonitis should be taken into account when choosing treatment. Surgical options in right colon diverticular diseases range from diverticulectomy to right hemicolectomy. In this case, right hemicolectomy was performed because of the lack of diagnostic accuracy of the imaging technique and presence of perforation.
| Conclusion|| |
Although right colon diverticula are rare, they should be kept in mind in the differential diagnosis of acute abdomen, especially in young patients.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]