Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(2) > 1043471

Korean J Pediatr Gastroenterol Nutr. 2010 Sep;13(2):193-198. Korean.
Published online September 30, 2010.  https://doi.org/10.5223/kjpgn.2010.13.2.193
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
A Case of Ascending Colon Diverticulitis with Perforation in a Child
Joon Woo Baek, M.D., Jae Young Shin, M.D., Jee Hyun Lee, M.D., So Young Jung, M.D.,* Ah Young Jung, M.D., Jeong Won Kim, M.D., and Kon Hee Lee, M.D.
Department of Pediatrics, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul, Korea.
*Department of Surgery, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul, Korea.
Department of Radiology, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul, Korea.
Department of Pathology, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul, Korea.

Corresponding author (Email: jhped@hallym.or.kr )
Received August 06, 2010; Revised August 10, 2010; Accepted September 10, 2010.

Abstract

A diverticulum is a blind pouch communicating with the gut. The term "diverticulitis" indicates inflammation of a diverticulum or diverticula, which is commonly accompanied by gross or microscopic perforation. Acute diverticuitis is a rare disorder in early childhood. Itis difficult to diagnose acute right colon diverticulitis from common causes of RLQ pain. We report a case of acute diverticulitis in the right colon in a 6-year-old girl. She complained of typical RLQ pain mimicking acute appendicitis,but was diagnosed with acute diverticulitis by CT scanning. Conservative treatment failed because of peritonitis due to perforation of an inflamed diverticulum. After the diverticulcetomy, the symptoms resolved.

Keywords: Diverticulitis; RLQ pain; Child

Figures


Fig. 1
Contrast-enhanced CT shows an outpouching structure (1.8×1.5 cm, arrow) arising from the anterior aspect of the ascending colon with a thick wall and an internal hyper-attenuating fecalith. (A) coronal view, (B) axial view.
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Fig. 2
Follow-up ultrasound shows aggravated fat infiltration and wall thickening adjacent to the diverticulum.
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Fig. 3
Intraoperative view of the ascending colon diverticulitis (A: ascending colon, I: terminal ileum, D: diverticulum).
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Fig. 4
Light microscopic finding shows a diverticulum, including the muscle layer (short arrow). The wall architecture of the submucosa and mucosal integrity are distorted by aggregated lymphocytes and neutrophils (long arrow) (H&E, original magnification ×12.5).
Click for larger image

References
1. Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T. Diverticular disease of the colon: a review of 615 cases. Dis Colon Rectum 1984;27:531–537.
2. Buchanan GN, Nicholas J, Kenefick J, Richard C, Cohen G. Diverticulitis. Best Pract Res Clin Gastroenterol 2002;16:635–647.
3. Stollman NH, Raskin JB. Diverticular disease of the colon. J Clin Gastroenterol 1999;29:241–252.
4. Hwang KY, Yang HW, Kim SH, Kim AN, Jung SH, Lee YJ, et al. Clinical characteristics of colonic diverticulitis in young patients. Korean J Med 2008;74:250–257.
5. Sim JH, Song KH, Sim YJ, Cho DJ, Kim DH, Min KS, et al. A clinical study of acute colonic diverticulitis in children. J Korean Pediatr Soc 2003;46:1095–1100.
6. Lane JS, Sarkar R, Schmit PJ, Chandler CF, Thompson JE. Surgical approach to cecal diverticulitis. J Am Coll Surg 1999;188:629–635.
7. Jacobs DO. Diverticulitis. N Engl J Med 2007;357:2057–2662.
8. Nakaji S, Danjo K, Munakata A, Sugawara K, MacAuley D, Kernohan G. Comparison of etiology of right sided diverticula in Japan with that of left sided diverticula in the West. Int J Colorectal Dis 2002;17:365–373.
9. Chan CC, Lo KK, Chung EC, Lo SS, Hon TY. Colonic diverticulitis in Hong Kong: distribution pattern and clinical significance. Clin Radiol 1998;53:842–844.
10. Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa TK. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum 2000;43:1383–1392.
11. Yoon HY, Kim BC. Clinical analysis of 42 cases who underwent colectomy for suspected acute appendicitis. J Korean Soc Coloproctol 2005;21:357–361.
12. Lipton S, Estrin J, Glasser I. Diverticular disease of the appendix. Surg Gynecol Obstet 1989;168:13–16.
13. Lee IK, Kim SH, Lee YS, Kim HJ, Lee SK, Kang WK, et al. Diverticulitis of the right colon: tips for preoperative diagnosis and treatment strategy. J Korean Soc Coloproctol 2007;23:223–231.
14. Bogue CO, Mann EH. Imaging findings in right-sided diverticulitis in a child. Pediatr Radiol 2008;38:1125–1127.
15. Sreenivasan N, Kalyanpur A, Bhat A, Sridhar PG, Singh J. CT diagnosis of cecal diverticulitis. Ind J Radiol Imag 2006;16:451–452.
16. Matsushima K. Management of right-sided diverticulitis: a retrospective review from a hospital in Japan. Surg Today 2010;40:321–325.
17. Kim KY, Kim IK, Jung SW, Park KH, Park YJ. Analysis on the surgical treatment of colonic diverticulitis. J Korean Surg Soc 2007;73:36–41.
18. Jang JI, Lim YS, Choi JW, Lee YS. Management of right colon diverticulitis. J Korean Soc Coloproctol 2010;26:22–82.
19. Moon BC, Kim HS. Developmental pattern and treatment in colon diverticular disease. J Korean Soc Coloproctol 2007;23:305–311.