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

Abstract

Patient: Male, 35-year-old Final Diagnosis: Appendiceal diverticulitis Symptoms: Abdominal pain Medication: — Clinical Procedure: Laparoscopic appendicectomy Specialty: Surgery Objective: Challenging differential diagnosis Background: Diverticulosis of the vermiform appendix is rare. In patients who present with appendicitis, appendiceal diver-ticulitis as a cause due is also rare. We report the case of a 35-year-old man who presented with typical symptoms and signs of acute appendicitis, which was confirmed by histopathology to be due to perforated acute appendiceal diverticulitis. Case Report: A 35-year-old man presented to our Emergency Department with a 1-day history of right lower-quadrant abdominal pain that radiated to the left lower quadrant, which was associated with fever, vomiting, and abdominal distention. Biochemical analysis revealed mild leukocytosis. Computed tomography (CT) revealed signs of acute perforated appendicitis and early mass formation. The patient underwent laparoscopic appendectomy. Histopathological examination revealed appendiceal diverticulitis (pseudo-diverticulum). Conclusions: Appendiceal diverticulitis is a rare surgical entity and is often an overlooked diagnosis. The differential diagnosis of appendiceal diverticulitis in patients presenting with signs of acute appendicitis is important as it is associated with a higher rate of complications such as perforation and an increased risk of appendiceal neoplasms. Appendectomy is a safe and appropriate treatment for appendiceal diverticulitis.

A Rare Simultaneous Occurrence of Appendiceal Diverticulitis and Peptic Ulcer that Leads to Abdominal Peritonitis Symptoms

“…Different cases of appendiceal diverticula with different symptoms and complications have been reported, including patients of various ages and with different health conditions [2,6,7]. This disease is classified into two groups based on the number of layers herniating through the appendix wall.…”

“…This disease is classified into two groups based on the number of layers herniating through the appendix wall. Acquired or pseudodiverticula form and congenital or true form, which means all three appendiceal layers herniate through a normal wall histologically [2,4,8]. The congenital type is rare and accounts for 3% of all diagnosed appendix diverticulosis cases [9][10][11].…”

“…Also, it can be synchronous neoplasms such as carcinoids and mucinous adenomas and adenocarcinomas, or it can mimic other diseases' symptoms. So the preoperative diagnosis of this disease is challenging and essential [2,5]. As regards this issue, a patient with generalized abdominal peritonitis symptoms, without any specific appendicitis symptoms, presented in this article and finally discovered appendiceal diverticulitis as the main reason but mimicking abdominal peritonitis due to perforated peptic ulcer.…”

“…The first person who described Appendiceal diverticulitis was Kelynack, a pathologist in the 19th century. He described it as "a greatly distended appendix, totally shut off from the cecum, having two distinct diverticular processes directed between the folds of the mesentery" and classified it into congenital and acquired types [1,2]. It is a rare condition with a prevalence incidence of 0.014% to 1.9 % [2][3][4].…”

“…He described it as "a greatly distended appendix, totally shut off from the cecum, having two distinct diverticular processes directed between the folds of the mesentery" and classified it into congenital and acquired types [1,2]. It is a rare condition with a prevalence incidence of 0.014% to 1.9 % [2][3][4]. Studies showed that despite the similarities between appendiceal diverticulitis and acute appendicitis, the prevalence of perforation in appendiceal diverticulitis is three to four times higher which increases the risk of abdominal peritonitis.…”