Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature

Clinical Snapshot

Key Findings

• P Value: Not applicable (descriptive systematic review)

• Effect Size: CT correctly identified diverticulitis in 85% of cases; complicated disease (perforation, abscess, peritonitis) occurred in 17% of patients

• Primary Outcome: Clinical characterisation of paediatric colonic diverticulitis: predominantly right-sided solitary cecal diverticulum in adolescent males, closely mimicking appendicitis

• Nnt Or Sensitivity: CT sensitivity for paediatric colonic diverticulitis: 85% (no specificity, PPV, NPV, or confidence intervals reported); complication rate: 17/101 patients

• Confidence Interval: Not reported

Clinical Application

Conservative management with antibiotics is feasible for uncomplicated cases and avoids unnecessary surgery. CT imaging is the primary diagnostic modality. Diagnostic laparoscopy remains appropriate when imaging is inconclusive or clinical deterioration occurs, as demonstrated by the index case. The condition is sufficiently rare that most paediatric surgeons will encounter it infrequently, making awareness the primary clinical intervention. In Australian paediatric surgical practice, right lower quadrant pain in adolescents is predominantly managed under RACGP and paediatric surgery guidelines with appendicitis as the primary differential. Paediatric colonic diverticulitis is not specifically addressed in current RACGP or Royal Australasian College of Surgeons (RACS) guidelines. CT is available in major paediatric centres (e.g., The Royal Children's Hospital Melbourne, Sydney Children's Hospital), though radiation dose considerations in paediatric patients favour ultrasound as a first-line modality where available. Antibiotics used for conservative management (e.g., amoxicillin-clavulanate, metronidazole with cephalosporins) are PBS-listed. TGA-approved imaging contrast agents are routinely available. This review supports inclusion of cecal diverticulitis in the differential diagnosis of paediatric right iliac fossa pain, particularly when CT findings are atypical for appendicitis. Paediatric patients (aged 3–17 years, median 14 years) presenting with acute right lower quadrant or right iliac fossa abdominal pain, particularly adolescent males in whom appendicitis has been excluded or is uncertain on imaging

Abstract

Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.

References

1. 1.Pistone, M., Bosisio, M., Wennemann, L., Tohmasi, S., Zani, A., & Zani-Ruttenstock, E. (2026). Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature. Pediatric Surgery International. https://doi.org/10.1007/s00383-026-05842-x