Perforated Solitery Cecal Diverticula

Abstract

Background: Solitary cecal diverticulitis (SCD) is an uncommon but important cause of right lower quadrant pain. It accounts for less than 1.5% of diverticular disease in Western populations and is often misdiagnosed as acute appendicitis, leading to unnecessary surgery in up to 7% of negative appendectomy cases

Aim: To highlight the diagnostic challenges of Solitary Cecal Diverticula in case of acute abdominal pain localized to the right lower quadrant and underscore the importance of maintaining clinical suspicion when imaging is inconclusive or when the appendix appears normal during surgery.

Methods: We describe two cases of perforated SCD in middle-aged women, both initially suspected to have appendicitis based on clinical symptoms including localized tenderness, fever, and leukocytosis (WBC >15 × 10⁹/L). Imaging either failed to detect the diverticulum or was delayed until deterioration. CT findings ultimately revealed cecal wall thickening, fat stranding, and extraluminal air.

Results: Intraoperatively, perforated solitary diverticula were found on the anterior cecal wall, while the appendix appeared normal. Right hemicolectomy with primary anastomosis was performed in both patients. Histopathology confirmed true diverticula with transmural necrosis. Postoperative recovery was uneventful, and both patients remained symptom-free at follow-up.

Conclusions: These cases highlight the diagnostic challenges of SCD and underscore the importance of maintaining clinical suspicion when imaging is inconclusive or when the appendix appears normal during surgery. While CT has a diagnostic accuracy of 83–90%, misdiagnosis remains common. Timely surgical intervention in perforated SCD ensures optimal outcomes. Greater awareness and structured diagnostic strategies are needed.