Diverticulitis of the caecum and ascending colon: an unavoidable diagnostic pitfall?

Purpose: The infrequency of right-sided colonic diverticulitis prompted thi s presentation of our experiences, with emphasis on the diagnostic aspects. Patients and Methods: Charts and documentation regarding 20 patients who un derwent surgery for diverticulitis of the caecum and/or ascending colon ove r 22 years were reviewed. Results: Eleven patients underwent pre-operative instrumental examinations: right-sided diverticulitis was recognized in five patients (two by barium enema, two by both ultrasonography and computerized tomography, one by all three examinations) and was suspected in another four. All diagnoses on mer ely clinical grounds - acute appendicitis in 10 patients and perforated pep tic ulcer in one - were erroneous. Surgery consisted of 13 right standard o r limited hemicolectomies, six conservative procedures and one Mickulicz' o peration and subsequent right hemicolectomy. No operative deaths or longter m failures were reported. Conclusions: In the presence of clinical features atypical of acute appendi citis, right-sided colonic diverticulitis should be taken into account; pre -operative instrumental examinations might increase diagnostic accuracy, th ereby leading to a more correct therapeutic approach.