On-table cecoscopy : a novel diagnostic method in acute diverticulitis of the right colon.
OBJECTIVE
Controversies abound regarding the optimal surgical management in noncomplicated diverticulitis of the right colon, ranging from a conservative approach to diverticulectomy to right hemicolectomy. One of the arguments for resection is to exclude carcinoma. However, there is significant morbidity associated with resection. We aim to introduce on-table cecoscopy as a tool to improve the diagnosis of acute diverticulitis of the right colon, exclude carcinoma, and reduce the rate of resection.


METHODS
From October 1999 to June 2000, five patients presented to our unit with suspected acute appendicitis. Intraoperatively, we found a colonic inflammatory mass at either the cecum or the ascending colon. The cecum and ascending colon were mobilized, and bowel clamps were applied to the ascending colon and ileum. A bronchoscope (Olympus(R) BF-P200) was introduced through the appendix stump. To achieve a good endoscopic view, a limited volume of air was introduced through the working channel.


RESULTS
After on-table cecoscopy, all the patients were diagnosed as having acute nonperforated diverticulitis of the right colon. They received appendicectomy, and the diverticulitis was managed conservatively. They were treated with a course of cephalosporin and metronidazole. We performed colonoscopy four weeks later and confirmed that none of them had carcinoma of the colon.


CONCLUSIONS
On-table cecoscopy is a new, safe, and effective means of diagnosing acute diverticulitis of the right colon. We can confidently exclude carcinoma and reduce the amount of colonic resection in patients with noncomplicated diverticulitis of the right colon.
Chiu
Philip W Y
PW
Department of Surgery, United Christian Hospital, Hong Kong SAR, China.
Lam
Clement Y W
CY
Lam
S H
SH
Wu
Arthur H W
AH
Kwok
Samuel P Y
SP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002429:Cecal Diseases / Q000175:diagnosis* / Q000601:surgery; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000175:diagnosis* / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged