Miya Koki, Yagi Fumitaka, Kato Takeshi, Saitoh Takashi, Suzuki Katsuhiko
Department of General Surgery, Honjo Daiichi Hospital, Akita, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70140. doi: 10.1111/ases.70140.
Right-sided colonic diverticulitis is generally considered less prone to severe complications than left-sided colonic diverticulitis; progression to an inguinal subcutaneous abscess via retroperitoneal extension is extremely rare. Herein, we report a unique case of cecal diverticulitis, wherein a retroperitoneal abscess extended into the inguinal region. A 65-year-old man presented with right inguinal swelling. Imaging revealed an abscess of cecal diverticulitis with retroperitoneal tracking into the inguinal subcutaneous tissue. After initial treatment with antibiotics and drainage, an interval laparoscopic right colectomy was performed. Intraoperative findings comprised severe adhesions and a suspected fistula, which was confirmed by indigo carmine staining of the resected specimen. This case highlights not only the rarity of right-sided colonic diverticulitis with inguinal extension, but also the clinical value of a reproducible, staged surgical strategy. Such a strategy-initial infection control followed by minimally invasive resection-demonstrates safety and effectiveness, even in anatomically challenging and atypical presentations.
一般认为,右侧结肠憩室炎比左侧结肠憩室炎更不易发生严重并发症;经腹膜后扩展至腹股沟皮下脓肿的情况极为罕见。在此,我们报告一例独特的盲肠憩室炎病例,其中腹膜后脓肿扩展至腹股沟区。一名65岁男性因右侧腹股沟肿胀就诊。影像学检查显示盲肠憩室炎伴腹膜后蔓延至腹股沟皮下组织形成脓肿。在初始使用抗生素和引流治疗后,进行了择期腹腔镜右半结肠切除术。术中发现包括严重粘连和疑似瘘管,经切除标本靛胭脂染色得以证实。该病例不仅凸显了右侧结肠憩室炎伴腹股沟扩展的罕见性,还体现了可重复的分期手术策略的临床价值。这种策略——先控制感染,然后进行微创切除——即使在解剖结构具有挑战性和表现不典型的情况下,也显示出安全性和有效性。