Right-sided colonic diverticula were first described by Potier in 1912 and account for approximately 0.9% to 1.7% of all colonic diverticula cases in Western populations. Inflammatory cells distort the wall architecture of the submucosa, and acute serositis with purulent exudate of the outer wall can be seen ( A) perforation with destruction of mucosal integrity is also observed ( B). He had an uneventful hospital course and was discharged on postoperative day 8 after a short course of ceftriaxone.įigure 1-CT scan of the abdomen and pelvis (coronal view) showing a nonobstructing colonic mass at the level of the hepatic flexure with associated pericolonic inflammatory changes.įigure 2-Histopathology images using hematoxylin and eosin staining showing true diverticula. After surgery, the patient's fever and abdominal pain subsided. Histological examination revealed the patient's condition to be true diverticula with pericolonic abscess, serositis, and perforation (Figure 2).
![hepatic flexture resection hepatic flexture resection](https://i.ytimg.com/vi/rD7lyxljEZg/maxresdefault.jpg)
We suspected that this mass could be perforated colon cancer, and it was resected via an oncologic right hemicolectomy. A large, firm mass was found in the hepatic flexure. We saw no evidence of purulent or feculent contamination. He underwent an emergency exploratory laparotomy. The patient developed a low-grade fever, and his abdominal tenderness increased. An infused computed tomography (CT) scan of the abdomen and pelvis showed a solitary mass in the hepatic flexure, which was suggestive of perforated colon cancer (Figure 1). The patient's white blood cell count was 8.2 x 10 9/L (normal, 3.5-11 x 10 9/L), and liver function tests were normal. A rectal examination revealed guaiac-negative stool. On physical examination, localized tenderness to palpation was elicited in the right abdomen. His temperature was 37.4☌, heart rate was 80 beats per minute, and blood pressure was 160/52 mm Hg. He reported no nausea, vomiting, obstipation, or constipation. He described it as being poorly localized, progressive, and unrelated to oral intake. Case reportĪ 43-year-old African American man presented to the hospital after experiencing a sudden onset of right flank pain, which had persisted for the previous 2 days. The authors have no relationship with any commercial entity that might represent a conflict of interest with the content of this article and attest that the data meet the requirements for informed consent and for the Institutional Review Boards. Our patient presented with a rare case of a perforated diverticular inflammatory mass with disease limited to the hepatic flexure. 5ĭiagnosing right-sided diverticulitis is challenging, and most lesions are found at laparotomy in a predominantly cecal distribution.
Hepatic flexture resection series#
The largest reported series come from Hong Kong 4 and Japan. 2,3 In Asia, right-sided diverticulitis, which primarily involves the cecum, is the rule rather than the exception. Right-sided diverticulitis constitutes only 0.9% to 1.7% of all colonic diverticula in Western populations. 1 The most common clinical presentation of diverticular disease in Western countries is left-sided, with extension to the right when diverticulosis of the entire colon is present. Accurate preoperative diagnosis is difficult but could prevent unnecessary laparotomy and bowel resection in many cases.ĭiverticular disease is being seen with greater frequency in the Western world and involves an increasingly younger patient population. Typical CT findings include an inflamed right colonic diverticulum, pericolonic inflammation or abscess, and colonic wall thickening. CT scanning can help facilitate the diagnosis of uncomplicated diverticulitis. The authors discuss the differences between true and false diverticula and review the literature regarding diagnosis and management of right-sided diverticula.Ĭonclusion: True right-sided diverticulitis often responds to conservative management with antibiotics, and recurrence is rare. A histologic examination revealed true diverticula with pericolonic abscess, serositis, and perforation. The mass was initially suspected to be perforated colon cancer and was resected during an emergency laparotomy. Computed tomography (CT) scans of his abdomen and pelvis showed a solitary mass in the hepatic flexure.
![hepatic flexture resection hepatic flexture resection](https://basicmedicalkey.com/wp-content/uploads/2017/03/B9780702044816000133_f13-05-9780702044816-1.jpg)
Results and discussion: This paper describes the case of a patient who presented to the hospital because of a sudden onset of right flank pain. Although right-sided diverticulitis is seen regularly in Asia, it constitutes only a fraction of colonic diverticula cases in Western populations. Introduction: Diverticular disease is a growing health problem in the Western world, where left-sided involvement is typical.