Saijo Fumito, Sawada Kentaro, Nomura Ryohei, Mutoh Mitsuhisa, Narushima Yoichi, Iwama Noriyuki, Nakayama Fumie, Tokumura Hiromi
Department of Surgery, Tohoku Rosai Hospital, 4-3-21, Dainohara, Aobaku, Sendai, Miyagi 981-8563, Japan.
Department of Pathology, Tohoku Rosai Hospital, 4-3-21, Dainohara, Aobaku, Sendai, Miyagi 981-8563, Japan.
Case Rep Surg. 2020 Oct 27;2020:7361389. doi: 10.1155/2020/7361389. eCollection 2020.
Terminal ileum diverticulitis is a rare clinical disease. It can frequently mimic other processes, such as acute appendicitis. Diagnosis and therapeutic decision making (surgical or conservative treatment) can be complex. We report four interesting cases of terminal ileum diverticulitis. . Case 1: a 55-year-old male presented to us with a 3-day history of severe right lower quadrant pain. Computed tomography (CT) showed penetration of terminal ileum diverticulitis. Following a 7-day conservative treatment, he underwent ileocecal resection. Pathology results revealed a false diverticulum and two in five points of perforated terminal ileum diverticulum. Case 2: a 77-year-old male presented to us with severe right lower quadrant pain and unconsciousness. CT showed penetration of terminal ileum diverticulitis and air in the mesentery. Ileocecal resection was performed 2 days postadmission. Pathology results revealed a false diverticulum and penetrated terminal ileum diverticulum. Case 3: a 61-year-old male presented to us with a right lower quadrant pain for 10 days and fever for 6 days. CT showed penetration of terminal ileum diverticulitis and abscess of the psoas muscle. Puncture and drainage of abscess were performed. Laparoscopic ileocecal resection was performed 30 days postadmission. Pathology results revealed a false diverticulum and penetrated terminal ileum diverticulum. Case 4: a 39-year-old female presented to us with right lower quadrant pain for 9 days, suspicious of appendicitis. CT showed abscess of pericecal area. Puncture and drainage were performed. A drainage tube was located into the cecum through the terminal ileum. Conservative therapy was effective, and she was discharged 23 days postadmission.
All four cases had right lower quadrant pain. Three cases were diagnosed by CT, whereas one was diagnosed by abscess drainage. Two cases required surgical treatment within 3 days, one within about 1 month, and one case did not require surgery. The decision of whether to manage a patient surgically or conservatively is difficult. It is critical not to delay the decision of performing a surgical treatment until each patient reaches a stable general condition.
回肠末端憩室炎是一种罕见的临床疾病。它常常可类似其他病症，如急性阑尾炎。诊断及治疗决策（手术或保守治疗）可能很复杂。我们报告4例有趣的回肠末端憩室炎病例。病例1：一名55岁男性因严重右下腹痛3天前来就诊。计算机断层扫描（CT）显示回肠末端憩室炎穿孔。经过7天的保守治疗后，他接受了回盲部切除术。病理结果显示为假性憩室，回肠末端憩室穿孔5处中有2处穿孔。病例2：一名77岁男性因严重右下腹痛及意识丧失前来就诊。CT显示回肠末端憩室炎穿孔及肠系膜积气。入院2天后行回盲部切除术。病理结果显示为假性憩室及回肠末端憩室穿孔。病例3：一名61岁男性因右下腹痛10天、发热6天前来就诊。CT显示回肠末端憩室炎穿孔及腰大肌脓肿。对脓肿进行了穿刺引流。入院30天后行腹腔镜回盲部切除术。病理结果显示为假性憩室及回肠末端憩室穿孔。病例4：一名39岁女性因右下腹痛9天前来就诊，怀疑为阑尾炎。CT显示盲肠周围区域脓肿。进行了穿刺引流。通过回肠将引流管置入盲肠。保守治疗有效，她在入院23天后出院。
所有4例均有右下腹痛。3例通过CT诊断，1例通过脓肿引流诊断。2例在3天内需要手术治疗，1例在约1个月内需要手术治疗，1例不需要手术。决定对患者进行手术治疗还是保守治疗很困难。至关重要的是不要将手术治疗的决定推迟到每个患者的一般状况稳定之后。
