Interval laparoscopic ileocecectomy in a child with cecal diverticulitis

Abstract

Cecal diverticulitis is a rare condition in children that can present diagnostic and surgical challenges. Cecal diverticulitis has a similar presentation to appendicitis, but the surgical management is much different. We present a case of cecal diverticulitis in a 13-year-old Hispanic male who was initially treated nonoperatively, but ultimately underwent laparoscopic assisted ileocecectomy as definitive treatment. This is the only case report to describe a delayed surgical approach to this rare medical condition. We feel this approach has particular merit with respect to cecal diverticulitis as the possibility of diagnostic uncertainty is high. Cecal diverticulitis is a rare disease process, particularly in children. Patients predictably present with right lower quadrant abdominal pain in a manner similar to appendicitis. Imaging may reveal a phlegmon, perforation, bowel wall thickening, or nonspecific inflammatory changes. These imaging findings may not always indicate a clear diagnosis, especially if the appendix cannot be well visualized. Urgent operation may be ill advisable in this situation as the surgeon may encounter a hostile operative field with dense inflammatory changes resulting in an increased risk of ileostomy creation. We present a case of cecal diverticulitis managed safely with a delayed surgical approach. We feel a delayed surgical approach may provide an alternative option for patients with an uncertain diagnosis or surgeons who wish to avoid a potentially hazardous dissection. A delayed approach may also help to facilitate a minimally invasive approach.