Treatment of Localized Peritonitis Caused by Penetrated Diverticulum in the Terminal Ileum Using a Laparoscopic Approach

Abstract

A 28-year-old man presented at our hospital with right lower abdominal pain of 5 daysʼ duration. Physical examination revealed tenderness and muscular guarding localized in the right lower quad-rant of the abdomen. Abdominal CT imaging showed no evidence of appendicitis or coproma, but se-vere inflammatory change was present in the terminal ileum. The white blood cell count was 14,100/ μL and C-reactive protein level was 9.18 mg/dL. As local peritonitis due to acute appendicitis or diverticulum could not be ruled out, an emergency procedure was performed. From the laparoscopic view, the appendix had a normal appearance and no ascites was seen. Due to abscess formation adja-cent to the terminal ileum, ileocecal resection was carried out laparoscopically. Pathological examination demonstrated ileal diverticulitis with penetration at a point 2 cm proximal to Bauhinʼs valve. Re-covery was uneventful and the patient was discharged 11 days post-procedure. Terminal ileal diverticulitis is rare and preoperative diagnosis is difficult. Penetration or perforation of ileal divertic-ula should be considered a differential diagnosis for inflammatory processes in the ileocecal region.