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Abstracts: CLINICAL VIGNETTES/CASE REPORTS - COLON

An Old Man's Diagnosis in Young Women

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Viswanathan, Prakash MD; Zoeb, Shabnam MD; Buscaglia, Jonathan MD; Richards, Robert MD

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American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S338-S339
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Purpose: Diverticulitis is uncommon in patients under the age of 30, which may lead to a delay in diagnosis with subsequent clinical repercussions. We report 2 young patients who present with right-sided diverticulitis who were diagnosed early and managed appropriately.

Case Presentations: A 19-year-old Bengali female presented to the emergency department with the chief complaint of worsening right-sided abdominal pain for three days. On physical examination, the patient was afebrile. The abdominal exam was remarkable for moderate right lower quadrant tenderness. Laboratory results were significant for leukocytosis. Computed tomography of the abdomen and pelvis revealed an inflammatory mass in the ascending colon. Subsequently, colonoscopy revealed an inflamed diverticulum in the ascending colon. The patient was medically managed with bowel rest and intravenous antibiotics and underwent a full recovery. A 20-year-old Caucasian female presented to the emergency department with the chief complaint of new onset supra-pubic abdominal pain for one day. On physical examination, the patient was afebrile. The abdominal exam was remarkable for mild supra-pubic tenderness. Laboratory values were within normal limits. Computed tomography of the abdomen and pelvis revealed focal transverse colon diverticulitis. The patient was medically managed with bowel rest and intravenous antibiotics and made a full recovery. Colonoscopy performed few months later confirmed extensive ascending colon diverticulosis. Conclusion: Diverticulosis is defined as a mucosal herniation which protrudes through openings in the colonic wall. Disease prevalence of right sided diverticulosis is uncommon in Western countries affecting approximately 5% of the population, as compared to Asian countries where right sided diverticulosis accounts for 20% of patients with diverticular disease. Right sided diverticulosis presents at a younger age(mean=35-45 years), and ranges from asymptomatic disease to an inflammatory process or diverticulitis. Clinical symptoms of right sided diverticulitis may mimic other etiologies of abdominal pain such as appendicitis, cholecystitis, gastritis and peptic ulcer disease. Radiographic imaging with computed tomography is the modality of choice to diagnose diverticulitis. Mainstay of therapy for right sided diverticulitis is bowel rest and intravenous antibiotics.

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