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An evaluation of acute cecal diverticulitis with right lower quadrant pain or melena was carried out in a study of 25 patients. The diagnosis was difficult even in patients with prior appendectomy. The typical case was a middle-aged man, ill for about 60 hours with inflammatory disease of the right lower abdomen. Four patients presented with painless melena and 5 with a mass. Preoperative examination of the colon by x-ray was performed unless acute appendicitis was suspected. Four of 9 nonacute cases were correctly diagnosed. Cecal diverticulitis usually causes a firm, indurated, red to purple mass near the ileocecal valve and should be differentiated from carcinoma. Local excision and appendectomy are recommended when possible. Right hemicolectomy should be avoided with unprepared bowel.
Nicholas EE, Frymark WB, Raffensperger JR. Acute Cecal Diverticulitis: Report of 25 Cases. JAMA. 1962;182(2):157–160. doi:10.1001/jama.1962.03050410053011
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