Appendiceal diverticular disease is a rare entity. We report a case of appendiceal diverticulitis mimicking acute appendicitis and diagnosed postoperatively on histopathology. A 28-year-old female presented with a 2-day history of shifting periumbilical pain associated with nausea and anorexia. A computed tomography scan of the abdomen demonstrated acute appendicitis. She was taken to laparoscopic appendectomy. Histopathology showed appendiceal diverticulitis, and perforation of an inflamed diverticulum with periappendicitis. Diverticulosis of the appendix is classified as congenital and acquired. Diagnosis can be made preoperatively by imaging. In this case, diverticulosis was not radiologically evident, and was interpreted as acute appendicitis. Gross appearance of the resected appendix was not suggestive of diverticulitis. Other cases reported that the gross specimen had evidence of diverticular disease. Surgeons should be aware that inflamed appendixes may harbor different pathologies warranting further management.
Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that mainly affects the perineum and pelvis in females of reproductive age. AA is commonly misdiagnosed as a Bartholin’s duct cyst, abscess or levator hernia. A 42-year-old female presented with a large, progressive and painless perineal swelling. She was initially diagnosed with an obturator hernia three times over the past 10 years and underwent multiple surgeries for recurrences. For this presentation, she underwent exploratory laparotomy. No hernia was identified. A large mass over the perineal area extending from the vulvar commissure to the anus was visualized. The diagnosis of AA was made on histopathology. Leuprolide (GnRHa) was used as hormonal therapy postoperatively. AA should be considered in any pelvic mass in a young female that recurs after excision. Prompt diagnosis will contribute toward minimizing local destruction of surrounding structures.
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