Surgical approach to cecal diverticulitis

Background: Cecal diverticulitis is a rare condition in the Western world, with a higher incidence in people of Asian descent. The treatment for cecal diverticulitis has ranged from expectant medical management, which is simi lar to uncomplicated left-sided diverticulitis, to right hemicolectomy. Study Design: A retrospective chart review was conducted of the 49 patients treated for cecal diverticulitis at Olive View-UCLA Medical Center from 19 76 to 1998. This was the largest-ever single-institution review of cecal di verticulitis reported in the mainland US. Results: The clinical presentation was similar to that of acute appendiciti s, with abdominal pain, low-grade fever, nausea/vomiting, abdominal tendern ess, and leukocytosis. Operations performed included right hemicolectomy in 39 patients (80%), diverticulectomy in 7 patients (14%), and appendectomy with drainage of intraabdominal abscess in 3 patients (6%). Of the 7 patien ts who had diverticulectomy, 1 required right hemicolectomy at 6 months fol lowup for continued symptoms. Of the three patients who underwent appendect omy with drainage, all required subsequent hemicolectomy for continued infl ammation. Of the 39 patients who received immediate hemicolectomies, there were complications in 7 (18%), with no mortality. Conclusions: We endorse an aggressive operative approach to the management of cecal diverticulitis, with the resection of all clinically apparent dise ase at the time of the initial operation. In cases of a solitary diverticul um, we recommend the use of diverticulectomy when it is technically feasibl e. When confronted with multiple diverticuli and cecal, phlegmon, or when n eoplastic disease cannot be excluded, we advocate immediate right hemicolec tomy. This procedure can be safely performed in the unprepared colon with f ew complications. Excisional treatment for cecal diverticulitis prevents th e recurrence of symptoms, which may be more common in the Western populatio n. (J Am Cell Surg 1999;188: 629-634. (C) 1999 by the American College of S urgeons).