Hatice GÜMÜŞ, İbrahim Halil TACYILDIZ, Murat KAPAN, Zülfü ARIKANOĞLU, Fatih TAŞKESEN

Diverticulitis of cecum mimicking plastron appendicitis: A diagnostic and therapeutic dilemma

Çekal divertikülit klinik olarak apandisite benzeyen nadir bir durumdur. Genellikle asemptomatik olmasına rağmen, inflamasyon, kanama ve perforasyona sebep olabilir. Vakaların çoğunluğunda tanı zordur ve genellikle laparatomide tanı konulur. Literatürde çekal divertikülitin tedavisi ile ilgili çeşitli tartışmalar mevcuttur. Bu yazının amacı akut karının nadir bir nedeni olan çekal di- vertiküliti detaylı bir şekilde incelemektir. Akut sağ alt kadran ağrısı, bulantı ve ateşi olan 40 yaşında kadın hastanın hafif lökosi- tozu vardı. Abdominal ultraonografi ve tomografide plastrone apendisiti düşündüren bulgular mevcuttu. Çekal divertikülit tanısı operasyon esnasında konuldu. Hastaya divertikülektomi ve apendektomi yapıldı. Çekal divertikülit, sağ alt kadran ağrısı olan acil vakalarda ayrıcı tanıda düşünülmesi gereken nadir görülen bir durumdur.

Blastron apendisiti taklit eden çekum divertiküliti

Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. Although it is usually asymptomatic, it may cause inflammation, bleeding, or perforation. The diagnosis is not always easy and in the majority of cases, the diagnosis is usually made at laparotomy. There have been various controversies in the literature regarding the optimal management of cecal diverticulitis. The aim of this study is a detailed description of this rare cause of acute abdomen. A 40-year-old female patient presenting with acute onset pain in the right lower abdominal quadrant, nausea and fever had mild leukocytosis. Abdominal ultra- sonography and computed tomography revealed findings suggestive of plastron appendicitis. The diagnosis of cecal diverticulitis was established during the surgery. The patient underwent diverticulectomy and appendectomy operations. Cecal diverticulitis is rare clinical entity that should be considered in the differential diagnosis of emergency patients admitted with the complaint of pain in the right lower abdominal quadrant.

PDF

___

1.W.Schummer, C.Schummer, E.Hoffmann. Chylothorax nach Anlage eines zentralvenösen Katheters. Anaesthesist 2003;52:91924.
2.Frassinelli P, Pasquale MD, Cipolle MD, Rhodes M. Utility of chest radiographs after guide wire exchanges of cen- tral venous catheters. Crit Care Med 1998;26:611-5.
3.Moyers JR. Application of the basic physical examination to intraoperative monitoring. In: Morgan GE, Mikhail MS, Murray MJ, editors. Clinical anesthesiology. 4th ed. New York: McGraw-Hill Medical; 2006. pp. 148-69.
3.David LR, Mittnacht JCA, Manecke GR, Kaplan JA. Monitoring of the heart and vascular system. In: Kaplan JA, Reich DL, Savino SJ, editors. Cardiac Anesthesia. 6th ed. Philadelphia: W.B. Saunders, 2010. pp. 416-50.
4.Yilmazlar A, Bilgin H, Korfali G, Eren A, Ozkan U. Complications of 1303 central venous catheterizations. J Roy Soc Med 1997;90:319-21.
6. Berman W Jr, Fripp RR, Yabek SM, Wernly J, Corlew S. Great vein and right atrial thrombosis in critically ill infants and children with central venous lines. Chest 1991;99:963-7.
7. Demirhan R, Cevik A, Kucuk HF, Altintas M, Kurt N. Traumatıc chylothorax: case report Turkish j thorac car- diovasc surg 2003;11:50-1.
8. Hui-Fang Hsu, Yi-Hung Chou, Chao-Ran Wang, Shu-Chuan Wu. Catheter-Related Superior Vena Cava Syndrome Complicated by Chylothorax in a Premature Infant Chang Gung Med J 2003;26:782-6.
9. Berkenbosch JW., Monteleone PM, and Tobias JD. Chylothorax Following Apparently Spontaneous Central Venous Thrombosis in a Patient With Septic Shock Pediatric Pulmonology 2003;35:2303.
10. Wu ET, Takeuchi M, Imanaka H, Higuchi T, Kagisaki K. Chylothorax as a complication of innominate vein throm- bosis induced by a peripherally inserted central catheter. Anaesthesia 2006;61:584-6.