Right-sided colonic diverticulitis is generally considered less prone to severe complications than left-sided colonic diverticulitis; progression to an inguinal subcutaneous abscess via retroperitoneal extension is extremely rare. Herein, we report a unique case of cecal diverticulitis, wherein a retroperitoneal abscess extended into the inguinal region. A 65-year-old man presented with right inguinal swelling. Imaging revealed an abscess of cecal diverticulitis with retroperitoneal tracking into the inguinal subcutaneous tissue. After initial treatment with antibiotics and drainage, an interval laparoscopic right colectomy was performed. Intraoperative findings comprised severe adhesions and a suspected fistula, which was confirmed by indigo carmine staining of the resected specimen. This case highlights not only the rarity of right-sided colonic diverticulitis with inguinal extension, but also the clinical value of a reproducible, staged surgical strategy. Such a strategy-initial infection control followed by minimally invasive resection-demonstrates safety and effectiveness, even in anatomically challenging and atypical presentations.
Miya et al. (Thu,) studied this question.