title: Ischaemic diverticular disease may mimic acute appendicitis.
abstract: An 81-year-old man with a medical history significant for diverticulosis and irritable bowel syndrome presented to the emergency department with a 1-day history of periumbilical pain that woke him from sleep and ultimately localised to his right lower quadrant. He reported nausea, anorexia and chills but denied vomiting, diarrhoea, melena, hematochezia or fever. His physical exam was notable for focal tenderness at McBurney's point. Diagnostic information included a normal white blood cell count and an abdominal CT scan that demonstrated a normal appendix with no other pathology noted. The patient opted to proceed with laparoscopy where a normal appendix was found. The caecum, however, contained a large ischaemic diverticulum not noted on CT scan. Following laparoscopic ileocecectomy, pathology demonstrated haemorrhage, inflammation, oedema and full thickness necrosis of the caecal wall. Recovery was uneventful; the patient was discharged from the hospital 3 days following surgery.
authors.affiliation: Department of Cabarrus Family Medicine, Carolinas Medical Center-Northeast, Concord, North Carolina, USA. kara.gallagher@carolinashealthcare.org
authors.forename: Kara Lee
authors.initials: KL
authors.lastname: Gallagher
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001064:Appendicitis / Q000175:diagnosis; D002429:Cecal Diseases / Q000175:diagnosis*; D002432:Cecum / Q000098:blood supply*; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000175:diagnosis*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D008297:Male
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