A 28-year-old previously healthy woman arrives in the emergency room complaining of 24 h of anorexia and nausea and lower abdominal pain that is more intense in the right lower quadrant than elsewhere. On examination she has peritoneal signs of the right lower quadrant and a rectal temperature of 38.38degC (101.8degF). At exploration through incision of the right lower quadrant, she is found to have a small, contained perforation of a cecal diverticulum. Which of the following statements regarding this situation is true?

**Core Concept**
Cecal diverticula are rare, acquired lesions that can cause complications such as perforation, leading to peritonitis. The management of cecal diverticula often involves surgical intervention to prevent further complications.

**Why the Correct Answer is Right**
In this scenario, the patient has a contained perforation of a cecal diverticulum, which requires prompt surgical management. Diverticulectomy (removal of the diverticulum) is essential to prevent recurrence of the diverticulum and further complications. Closure of the cecal defect is necessary to prevent leakage and further peritonitis. Appendectomy (removal of the appendix) may be indicated as the appendix is often closely related to the cecal diverticulum and can be simultaneously involved in the pathology. This approach allows for complete clearance of the affected area and reduces the risk of recurrence.

**Why Each Wrong Option is Incorrect**
**Option A:** Cecal diverticula are typically congenital in origin, not acquired. They are thought to result from herniation of the mucosa through weaknesses in the muscularis propria of the cecum, which are present at birth.
**Option B:** Cecal diverticula are usually solitary, not multiple. When they do occur in multiple locations, it is often referred to as multiple diverticula or diverticulosis.
**Option C:** Cecal diverticula are actually herniations of the mucosa and submucosa through the muscularis propria, not just the muscularis propria itself.

**Clinical Pearl / High-Yield Fact**
Cecal diverticula are a rare cause of abdominal pain and peritonitis, but they can be associated with significant morbidity and mortality if not promptly treated. Surgeons should be aware of this entity and consider it in the differential diagnosis of patients presenting with signs of peritonitis in the right lower quadrant.

✓ Correct Answer: D. Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated.

✓ Correct Answer: D. Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated