Perforated diverticulitis of the appendix: ultrasonographic diagnosis

Abstract

Appendiceal diverticulitis is an uncommon condition, mimicking appendicitis, but with greater risk of perforation and complications. Preoperative diagnosis is rare, but can be achieved by ultrasonography as identification of the diverticulum and classical signs of appendicitis. We report a case of ultrasonographic diagnosis of a perforated appendiceal diverticulitis in an adult male and discuss this condition.Keywords: Appendix; Diverticulum; Diverticulitis/ultrasonography; Diverticulitis/diagnosis; Case reports RESUMO A diverticulite do apêndice é uma patologia incomum, eventualmente confundida com a apendicite cecal, tendo, porém, maior risco de perfuração e de outras complicações. Seu diagnóstico pré-cirúrgico é raramente realizado, mas pode ser obtido pela ultrassonografia com a demonstração de um divertículo associado a sinais clássicos de apendicite. Relatamos o caso de um homem adulto em que foi possível o diagnóstico ultrassonográfico de diverticulite do apêndice cecal e revisamos os principais aspectos relacionados a essa condição.

Acute Perforated Appendicitis Associated with Appendiceal Diverticulitis in a Young Man: A Case Report with Literature Review

“…Appendiceal diverticulitis (AD) is difficult to diagnose preoperatively, as it mimics acute appendicitis in clinical manifestations. For example, lower-quadrant abdominal pain is a key feature of both AD and acute appendicitis, but some differences exist; for example, it has been reported that the pain associated with AD is milder and longer lasting than that associated with appendicitis, and AD tends to affect adults aged >30 years with a history of similar episodes [ 4 , 6 ], whereas appendicitis is more common in children. Most patients seek medical advice once the symptoms become more prominent, and the risk of perforation increases [ 6 ].…”

“…For example, lower-quadrant abdominal pain is a key feature of both AD and acute appendicitis, but some differences exist; for example, it has been reported that the pain associated with AD is milder and longer lasting than that associated with appendicitis, and AD tends to affect adults aged >30 years with a history of similar episodes [ 4 , 6 ], whereas appendicitis is more common in children. Most patients seek medical advice once the symptoms become more prominent, and the risk of perforation increases [ 6 ]. Generally, the risk of perforation of AD has been shown to be 3–4 times higher than that of acute appendicitis, and this is associated with a 30-fold higher mortality risk [ 1 , 3 , 7 ].…”

“…In our case, the duration of symptoms was only 1 day, but presented with features of perforation on the radiological findings. The risk of perforation in acquired diverticulosis is higher than that of congenital diverticulosis (up to 66% vs 6.6%, respectively) due to a thin wall and lack of a thick muscularis propria [ 4 , 6 ].…”

“…US findings of AD include a focal or diffusely thickened appendiceal wall (>3 mm), non-compressible firm dilated organ, and well-defined hypoechoic round or oval-shaped cysts attached to the enlarged appendix. The diverticulum neck may be identified at the level of the vascular hiatus under optimal conditions with adjacent inflammatory changes [ 6 , 8 ]. In the case of perforation, the diverticulum wall will appear in discontinuity with presence of fluid collection [ 6 ].…”

“…The diverticulum neck may be identified at the level of the vascular hiatus under optimal conditions with adjacent inflammatory changes [ 6 , 8 ]. In the case of perforation, the diverticulum wall will appear in discontinuity with presence of fluid collection [ 6 ].…”