Wednesday, 4 December 2013

Diverticulitis – Misdiagnosis

Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulosis.
In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).
A. Misdiagnosis
1. Glioma
There is a report of a case of a 64 year old woman with diverticulitis complicated by a metastatic cerebral abscess is reported. Presentation was atypical and investigations were misleading; the computed tomographic scan was interpreted as showing a glioma(31).
2. Crohn’s disease
Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal system. there is a report of a 19-year-old case with Meckel’s diverticulum operated with ileus while under followup, who was assumed to have Crohn’s disease(32).
3. Acute prostatitis
According of the study by, abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. There is a report of an atypical presentation, the patient was initially misdiagnosed and treated as having acute prostatitis(33).
4. Appendicitis
The clinical diagnosis of appendicitis and diverticulitis remains challenging. There is a report of a case of a patient with right-sided diverticulitis misdiagnosed as appendicitis both clinically and on plain film radiography(34).
5. Prostate abscess
There is a report of a case report of sigmoid diverticular abscess presenting as prostate abscess. Helical computed tomography (CT) scan revealed the prostate abscess but failed to demonstrate the underlying diverticular abscess(35).
6. Ruptured aortic aneurysm
The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients(36). There is a report of a misdiagnosis of ruptured aortic aneurysm in diverticular disease(36).
7. Etc.
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