e236 Ann R Coll Surg Engl 2012; 94: e235–e236
UWECHUE RICHARDS KURER
STAPLED DIVERTICULECTOMY FOR SOLITARY CAECAL
surgery. She developed a post-operative chest infection that
was treated successfully. She was discharged a week after
surgery. At the follow-up appointment two months later, she
had made a full recovery. She had developed a port site her-
nia at the left iliac fossa port but was asymptomatic from this.
The diagnosis of caecal diverticulitis is difcult to establish
accurately pre-operatively. The clinical presentation often
mimics that of acute appendicitis as seen in this case. Con-
sequently, the diagnosis is frequently made at the time of
surgery for presumed appendicitis.
Treatment options for caecal diverticulitis vary widely
depending on the presentation and local expertise. There is
no consensus among surgeons as to the best option. For un-
complicated caecal diverticulitis diagnosed pre-operatively,
a conservative approach can be taken with bowel rest and
However, others advocate aggressive surgical
resection in caecal diverticulitis as less than 40% of patients
are successfully managed conservatively without recurrent
The surgical approach to resection of a solitary cae-
cal diverticulum varies from a simple diverticulectomy to
a right hemicolectomy. These can be performed open or
laparoscopically. The rst report of a laparoscopic diverti-
culectomy was in 1994.
Since then, there have been several
other reports showing that laparoscopic resection is feasible
in experienced hands.
Our case posed several challenges. First, the patient had
COPD, a signicant medical co-morbidity. This increased
her risk of peri-operative and post-operative complications.
It was therefore felt that laparoscopic resection was the
most appropriate option in order to reduce these risks as
it involved smaller incisions and facilitated faster recovery.
Indeed, the patient did suffer from a post-operative chest
infection, which was treated successfully.
Second, the diagnosis was made intra-operatively and
a decision as to how to treat this needed to be made intra-
operatively. Resection was performed as the diverticulum
was gangrenous and perforation was thought to be immi-
nent, the risk of recurrence if left unresected is known to be
and the surgeon was happy to proceed based on
Furthermore, the diagnosis of caecal cancer
must always be entertained in all acute abdomens with intra-
operative caecal pathology. If suspected, an oncologically
sound right colectomy is the treatment of choice. In reference
to our case and as is clear from the pictures, we felt cancer
was unlikely. This was because we encountered a discrete,
well dened, outpouching area of the caecal wall (the soli-
tary caecal diverticulum), which looked gangrenous, and felt
rather soft and as though it were about to perforate. We were
condent that no characteristics of malignancy were present.
Finally, the patient developed a port site hernia at the
12mm left iliac fossa incision. We feel that this is most likely
a result of the patient’s chronic cough that she experiences
as part of her COPD. This highlights the importance of care-
ful consideration of port placement and closure technique,
taking into account the general condition of the patient.
This port site was not sutured at the sheath. In hindsight, it
may have been prudent to have closed the sheath.
A laparoscopic stapled diverticulectomy for solitary caecal
diverticulitis for a safe and effective therapeutic option, espe-
cially in patients in whom more radical surgery would pose a
high risk. We believe this is the rst reported case in the UK.
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Figure 2 Diverticulum partially excised
Figure 3 Staple line following resection