Clinicopathological Study of 25 Cases of Diverticular Disease of the Appendix: Experience from Farwaniya Hospital

Al-Brahim, Nabeel; Al-Kandari, I. M.; Munahai, Musaad; Sharma, Prem N.

doi:10.1155/2013/404308

Cited by 45 publications

(26 citation statements)

References 11 publications

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“…True diverticula are congenital and very rare: the vast majority of appendiceal diverticula are, in reality, pseudo‐diverticula, with herniation of appendiceal mucosa through micro‐anatomical defects in the muscularis propria, and acquired . Presentation with appendiceal diverticulitis often differs from that of acute appendicitis . It occurs in adults, is characterised by intermittent episodes of right iliac fossa pain over 2 days to 2 weeks and is less likely to be associated with nausea, anorexia and/or emesis compared to acute appendicitis .…”

Section: Introductionmentioning

confidence: 99%

“…4 Presentation with appendiceal diverticulitis often differs from that of acute appendicitis. 5 It occurs in adults, is characterised by intermittent episodes of right iliac fossa pain over 2 days to 2 weeks and is less likely to be associated with nausea, anorexia and/or emesis compared to acute appendicitis. 6 There is also usually a lower white blood cell count and a higher serum C reactive protein level compared with acute appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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Complicated appendiceal diverticulosis versus low‐grade appendiceal mucinous neoplasms: a major diagnostic dilemma

et al. 2019

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Aims To research and identify how often complicated diverticular disease of the appendix [appendiceal diverticular disease (ADD)] shows histological mimicry of low‐grade appendiceal mucinous neoplasms (LAMNs) and to provide guidance on the useful histopathological features that allow the appropriate diagnosis to be made. Methods and results Seventy‐four cases of complicated appendiceal diverticular disease were identified from two specialist centres. Of the second opinion/consultation cases, 71% of the ADD cases had been diagnosed by referring pathologists as LAMNs. Salient pathological features were identified and agreed upon to reach the applicable diagnosis. For a diagnosis of complicated diverticulosis, particularly when associated with mucus cysts, the following morphological features were regarded as important: relative retention of the normal mucosal architecture with lamina propria and a maintained crypt architecture, crypts arranged in regular array, epithelial hyperplasia and a lack of nuclear abnormalities extending the length of the crypts. In a formal case–control study undertaken on 30 cases with each diagnosis, ADD and LAMN, loss of lamina propria, a filiform architecture and hypermucinosis were significantly associated with low‐grade appendiceal mucinous neoplasms. Mucosal neuromas were significantly associated with diverticular disease of the appendix. Conclusions To our knowledge, this study represents the largest series in the world literature and serves to highlight the important pathological features to distinguish complicated diverticular disease of the appendix from LAMNs, and emphasises the difficulties experienced by diagnostic pathologists in diagnosing complicated appendiceal diverticulosis. This is important, as LAMNs have a significant risk of transcoelomic spread, while complicated appendiceal diverticulosis has no such risk.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complicated appendiceal diverticulosis versus low‐grade appendiceal mucinous neoplasms: a major diagnostic dilemma

et al. 2019

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“…Collectively from the 11 studies, 17 147 patients underwent appendicectomy, 4,5,[10][11][12][13][14][15][16][17][18] of which 341 patients had DA. The characteristics of the included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of the association between diverticulosis of the appendix and neoplasia

Lim

Cheah

Kwok

et al. 2020

ANZ Journal of Surgery

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Background: Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta-analysis was performed to evaluate the prevalence of DA and its association with neoplasia. Methods: A systematic search of literature (Cochrane, EMBASE, PubMed and Medline) reporting the prevalence of DA and association with neoplasia was performed in November 2019. Relevant articles were assessed in accordance with the PRISMA guidelines. Risk of bias assessment was carried out using modified Newcastle-Ottawa scale. Meta-analysis with risk ratio and random-effects model was performed using RevMan. Results: The initial search identified 1122 potential articles of which 11 were appropriate for quantitative analysis. The prevalence rate of DA was 1.74%. The mean age of patients with DA and those without DA was 41.2 and 33.9 years, respectively. The ratio of male to female was 1.8:1. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Only four studies addressed the prevalence of locoregional neoplasia in the setting of DA compared to control. Meta-analysis with random-effects model demonstrated that pooled risk ratio was 25.46 (95% confidence interval 12.77-50.75, P < 0.00001). Conclusion: The strong association with neoplasia in this meta-analysis reinforces the clinical significance of DA. Surgeons, pathologists and radiologists should be mindful of this uncommon pathology and consider individualized patient management, until further evidence can direct clinical guidelines for the management of patients with DA. We conducted a systematic review and meta-analysis of the available literature to evaluate the current evidence on DA prevalence and its association with neoplasia. To our knowledge, this is the first meta-analysis to examine this association. A significant positive association would suggest that the discovery of DA may warrant further investigations to guide appropriate patient management. Methods Literature search strategy

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“…It represents a herniation of the mucosa through a muscular defect of the appendix (mainly on the mesenteric border). 10 The exact pathogenesis is still unknown, but several explanations have been postulated. 3 The inflammatory theory is one of these explanations: it postulates that an attack of appendicitis occurs with a post-appendicitis weakness of the wall, followed by ulceration and regenerated epithelium over the injured area.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case Report of True Diverticulum of Appendix

C¹,

Kaza²,

Desai³

et al. 2019

IJCMR

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Introduction: Diverticulitis of the appendix is a rare clinical finding which is often confused with acute or chronic appendicitis. It is rarely diagnosed pre-operatively and is usually identified during or after appendectomy. It has a higher risk for perforation in comparison with appendicitis and may be associated with an underlying malignancy. Case report:A 40 yr old male presented to the casualty with complaints of pain abdomen since 1 day, associated with 3 episodes of vomiting with localised tenderness and guarding in the right lower quadrant of the abdomen. On ultrasonography, a non-compressible tubular blind structure with minimal free fluid was identified, indicating acute appendicitis and the patient was prepared for an open appendectomy. Intraoperatively, appendix was found to be inflammed with an outpouching noted at its antimesenteric border, 1cm distal to the base. The tip of this outpouching was perforated (Fig 1 and 2). An appendectomy was performed and specimen sent for histopathological examination. On HPE, the outpouching was diagnosed as a true diverticulum of the appendix. The diverticulum as well as the appendix was found to be inflamed. Conclusion:This case report highlights the symptomatology, atypical patient demographics that should raise the suspicion of Diverticulum of appendix. Although the definitive treatment in both conditions is same, diverticulum of appendix is associated with unique risks and complications. The importance of a thorough radiological assessment would prove valuable in differentiating between the two entities.

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Clinicopathological Study of 25 Cases of Diverticular Disease of the Appendix: Experience from Farwaniya Hospital

Cited by 45 publications

References 11 publications

Complicated appendiceal diverticulosis versus low‐grade appendiceal mucinous neoplasms: a major diagnostic dilemma

Complicated appendiceal diverticulosis versus low‐grade appendiceal mucinous neoplasms: a major diagnostic dilemma

Systematic review and meta‐analysis of the association between diverticulosis of the appendix and neoplasia

A Rare Case Report of True Diverticulum of Appendix

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