Acute cecal diverticulitis mimicking appendicitis in a 16-year-old female.

Acute appendicitis is a difficult diagnosis to accurately obtain in children. There are many other entities that need to be excluded, especially in females, such as diverticulitis, mesenteric adenitis, UTI, cervicitis, PID, ovarian torsion, ectopic pregnancy, and gastroenteritis. Therefore, if the history and physical exam are inconclusive, a CT scan may performed. On occasion the CT scan may reveal what looks like appendicitis yet another rare entity is encountered. A 16-year-old female presented with 1 day history of abdominal pain, anorexia, and vomiting. There was no fever, diarrhea, or pulmonary symptoms. Her past medical history was unremarkable. She had no previous surgeries. Her head, neck, chest, and heart exam were normal. Her abdominal exam was remarkable for tenderness and mild rebound to the RLQ. Her pelvic exam was unremarkable. Her initial WBC count was 11,100/[mm.sup.3] with 50% neutrophils. Her hemoglobin was 7.0 g/dl and platelets 840,000/[mm.sup.3]. Her electrolytes, BUN, creatinine, glucose, liver function tests, amylase, lipase and urinalysis were normal. A CT scan of the abdomen revealed stranding medial to the cecum with a dilated appendix consistent with appendicitis. She was taken to the operating room and was found to have a normal appendix; however there was a protuberant mass extending from the cecum which appeared inflamed. This mass was resected. The surgical pathology report showed multiple cecal diverticuli with acute diverticulitis. Postoperatively she did well and has resumed her normal daily activity. Acute colonic diverticulitis typically occurs in patients older than 60 years of age. It is a relatively rare problem, especially in children, which may lead to a delay in diagnosis. The incidence is <1% among patients under 30 years of age undergoing appendectomy. It is often indistinguishable from acute appendicitis. Management has included right hemicolectomy, ileocolic resection or appendectomy, and conservative treatment with antibiotics.

Antonio E. Muniz, MD, Steve Liner, MD, Sam Bartle, MD, Chris Woleben, MD, and Robin L. Foster, MD. Department of Emergency Medicine and Pediatrics, Virginia Commonwealth University Medical Center, Richmond, VA.