Cecal diverticulitis with atypical presentation in a 57-year-old man: a case report

<p><strong>Background:</strong> Right-sided diverticulitis, particularly cecal diverticulitis, is a rare condition that can mimic other causes of acute abdomen and pose a diagnostic challenge.<br /><strong>Case Presentation:&nbsp;</strong><br />A 57 year old male presented with acute tearing epigastric pain followed by lower abdominal pain. Examination revealed bilateral iliac fossa tenderness with guarding in the right iliac fossa and positive psoas and obturator signs. Laboratory testing showed elevated C reactive protein (70 mg/L) with otherwise unremarkable results. Because the initial tearing epigastric pain raised concern for serious conditions, including acute coronary syndrome, pancreatitis, and aortic pathology, cardiac enzymes, ECG, serum lipase, and contrast‑enhanced CT were obtained, which excluded these diagnoses. Abdominal ultrasound demonstrated focal bowel wall thickening in the right lumbar region. Contrast‑enhanced CT identified a cecal diverticulum with surrounding pericolic fat stranding and localized inflammatory changes without abscess or perforation, consistent with Hinchey stage Ia cecal diverticulitis. The patient was managed conservatively with intravenous ceftriaxone and metronidazole, providing broad‑spectrum gram‑negative and anaerobic coverage, and showed rapid clinical improvement.<br /><strong>Conclusion:&nbsp;</strong><br />Cecal diverticulitis might present atypically and mimic other causes of acute abdomen. Early cross-sectional imaging is crucial for accurate diagnosis, and conservative antibiotic therapy is effective in uncomplicated cases.</p>