Diagnostic pitfalls and management patterns of pediatric right-sided colonic diverticulitis: a single-center retrospective study
To characterize the clinical features, imaging findings, and management patterns of pediatric right-sided colonic diverticulitis (rsCD), identify common diagnostic pitfalls, and summarize institutional experience that may improve diagnostic accuracy and clinical decision-making. This retrospective study reviewed pediatric patients diagnosed with rsCD at a tertiary pediatric medical center between January 2018 and December 2025. Demographic, clinical characteristics, laboratory and imaging findings, management, pathologic diagnosis and outcomes were summarized. Patients with uncomplicated appendicitis (UA) and complicated appendicitis (CA) were included as clinical reference cohorts for exploratory comparisons. A total of 26 pediatric patients with rsCD were included in the main analytic cohort. Most patients had no symptoms other than abdominal pain. Diarrhea was observed in only three patients (11.5%). Preoperative diagnostic accuracy was low, with rsCD suspected in only three patients (11.5%). Modified Hinchey classification showed localized inflammation (type Ia/Ib) in 21 patients (80.8%). Laparoscopic diverticulectomy was performed in 13 patients (50.0%), laparoscopic conversion to open ileocecal resection in 4 (15.4%), and laparoscopic peritoneal lavage in 5 (19.2%). Appendectomy was performed in 17 patients (65.4%). All patients recovered without major postoperative complications. In exploratory comparative analysis, rsCD patients were similar to UA patients in inflammatory markers, pediatric appendicitis score (PAS) (P = 0.219), and fecalith prevalence (P = 0.279). Compared with CA patients, rsCD patients had lower inflammatory markers (P < 0.05), a lower PAS category (P = 0.032), fewer associated symptoms (P < 0.001), and a shorter length of stay (9.6 ± 2.6 vs. 12.3 ± 2.1 days, P < 0.001). Pediatric rsCD is a rare condition with nonspecific clinical manifestations that frequently overlap with common causes of pediatric acute abdomen. Therefore, rsCD should be considered in the differential diagnosis of children presenting with right lower quadrant abdominal pain.