Congenital Appendiceal Diverticulum: An Incidental Finding During an Appendectomy

Abstract

Diverticula are small outpouchings that form at weak points in the wall of the digestive tract. They are commonly found in the colon, and while they can occur anywhere in the digestive tract, occurrence in the appendix is rare. Here, we report the case of a young woman presenting with complaints of right lower quadrant abdominal pain. The patient's physical examination, laboratory values, and computed tomography (CT) result supported the presumptive diagnosis of uncomplicated appendicitis. The patient underwent a laparoscopic appendectomy, where an appendiceal diverticulum was appreciated. A postoperative pathology report supported the diagnosis of a true appendiceal diverticulum. The patient's symptoms improved postoperatively, and her recovery has been unremarkable. We conclude that appendiceal diverticula are often incidental findings that should be removed along with the appendix to reduce the risk of malignancy and perforation.

Is Appendiceal Diverticulitis Mimicking Acute Appendicitis?

“…Recently published articles highlighted the importance of preoperatively establishing the diagnosis due to its strong association with developing multiple complications [14]. Appendiceal perforation is one of its serious complications, specifically for the acquired type due to its thin wall and lack of muscular layer; moreover, the risk of perforation was found to be increased by fourfold compared to AA with a rate of 30-70% [6,15]. In addition to perforation, it has a risk for pseudomyxoma peritonei, gastrointestinal hemorrhage, pelvic pseudocyst formation, and the formation of appendicovesical fistula [15].…”

“…Appendiceal perforation is one of its serious complications, specifically for the acquired type due to its thin wall and lack of muscular layer; moreover, the risk of perforation was found to be increased by fourfold compared to AA with a rate of 30-70% [6,15]. In addition to perforation, it has a risk for pseudomyxoma peritonei, gastrointestinal hemorrhage, pelvic pseudocyst formation, and the formation of appendicovesical fistula [15]. Furthermore, a recently published study suggested a prophylactic appendectomy if the AD was found incidentally on radiological investigations due to its strong association with malignancy, mainly carcinoid tumors and mucinous adenomas [14,16].…”

A case of diverticulum of the appendiceal base resembling a submucosal tumor of the cecum under colonoscopy: a hitherto undescribed lesion

“…Congenital diverticula are true diverticula resulting from an abnormal bowel recanalization during the solid phase [7,8], and are associated with "D" trisomy or cystic fibrosis [9,10]. Congenital diverticula are very rare, and are characterized by an invagination of the entire intestinal wall including the mucosa, submucosa and muscularis propria into a normal intestinal wall [11]. In contrast, acquired diverticula are caused by invagination of the mucosal and submucosal layers through weakened portion of the intestinal wall, and they occur due to an increased intraluminal pressure [3].…”