WOFAPS 2025 8th World Congress of Pediatric Surgery

Fatma Özcan Sıkı, Numan Kılıçlı, Mehmet Sarıkaya

University of Selcuk, Selcuklu Medical Faculty,Department of Pediatric Surgery

INTRODUCTION

Cecal diverticulum is a rare condition in children and is usually asymptomatic. When cecal diverticulum is infected, it causes right lower quadrant pain and is difficult to distinguish from acute appendicitis. Colon diverticulum is a blind intestinal pouch that occurs when the serosa and mucosa or full-thickness intestinal wall protrudes from a weak point in the colon. More than 60% of cecal diverticulum is seen after the age of 80 and 10% before the age of 40. Those in the left colon are usually numerous and develop later. Those located on the right are usually solitary and congenital.

CASE

A 17-year-old girl presented with abdominal pain for 3 days. Ultrasonography and direct abdominal films taken for ovarian and appendix pathologies revealed no pathology. Physical examination revealed defense, rebound and tenderness in the right lower quadrant. Following contrast-enhanced abdominal tomography, the patient underwent surgery with a preliminary diagnosis of cecal diverticulum. It was observed that the cecal diverticulum had perforated, was surrounded by inflamed omentum and formed a mass structure. Appendectomy, diverticulectomy and end-to-end ileocolic resection anastomosis were performed, and silicone penrose drain was placed in the abdomen. The patient was discharged with recovery on the sixth day after the surgery.

CONCLUSION

Cecal diverticula, unlike diverticula located in the distal colon, are mostly congenital and are true diverticula that include all layers of the colon wall. In contrast, in our case, the pathology result was reported in favor of a pseudodiverticulum. Cecal diverticula are more common in eastern societies than in western societies. They are more common especially in men and the young population. While diverticula located anteriorly in the cecum cause peritonitis when perforated, those located posteriorly cause a cecal mass when perforated and may mimic perforated carcinoma. In our case, the diverticulum was on the haustra and perforated from here and became a mass by being surrounded by omentum. There is no clear consensus on the treatment of cecal diverticulitis. It is in a spectrum ranging from conservative medical treatment to right hemicolectomy. There is no standard surgical intervention.Cecal diverticulum is rare in children and is usually asymptomatic. However, it should be considered in patients presenting with right lower quadrant pain. The surgical method to be applied should be decided by evaluating the patient's condition and surgical findings.