Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis

Abstract

<b><i>Introduction:</i></b> Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. <b><i>Methods:</i></b> The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (<i>n</i> = 110), DDA (<i>n</i> = 22), endometriosis of appendix (<i>n</i> = 6), and an absent appendix (<i>n</i> = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. <b><i>Results:</i></b> The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23–87), with male preponderance (<i>n</i> = 12, 54.5%). The median Modified Alvarado score was 8 (range 4–9), and the median Andersson score was 5 (range 2–8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [<i>n</i> = 2] or abscess [<i>n</i> = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. <b><i>Conclusion:</i></b> DDA is a distinct clinical pathology associated with complicated appendicitis.

Giant Mucinous Carcinoma Originating from the Appendix: A Case Report

“…One of the differential diagnoses in the present case was mucinous carcinoma arising from the appendiceal diverticulum. Although there are reports that diverticular disease of the appendix may be associated with malignancy, a recent paper suggested that diverticular disease of the appendix is not associated with malignancy (9). In the present case, immunohistochemistry of the cut tumor surface confirmed the presence of another digestive lumen structure surrounding the tumor in addition to the initial colonic lumen structure.…”

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

“…The congenital type is rare and accounts for 3% of all diagnosed appendix diverticulosis cases [9][10][11]. Appendiceal diverticulitis risk factors are male gender, age over 30, cystic fibrosis, and Hirschsprung disease [12]. Appendiceal diverticulitis is not only a rare condition that can mimic other diseases' symptoms, and most of all, it is confused with acute appendicitis, but also it can be synchronous with other serious diseases such as carcinoid tumors [2,5].…”

“…Still, both methods are highly dependent on radiologists' experiences [10,13]. On the other hand, the diagnosis of appendiceal diverticulitis may not be possible due to the small size or involvement of inflammatory mass [12]. So, the definitive diagnosis way is a postoperative pathology report [15].…”

Acute appendicitis–advances and controversies

“…In a retrospective study including 125 patients, Nozoe et al [ 27 ] reported that the SIRS score was lower in patients who were recommended non-operative management (NOM)[ 27 ]. Similarly, diverticular disease of the appendix (DDA) is associated with a higher perforation rate, and Chia et al [ 30 ] have shown that a high SIRS score is useful in clinical decision making for surgery in DDA[ 30 ]. The total white blood cell count is a non-specific biochemical marker, and novel markers may improve the performance of scoring systems.…”

“…Imaging is integral not only to establish a diagnosis but also to rule out another diagnosis. These include right colonic diverticulitis[ 30 , 61 - 63 ], Yersinia enterocolitis[ 64 , 65 ], right-sided renal disease[ 66 ], mesenteric lymphadenitis[ 67 ] and Meckel’s Diverticulitis[ 68 , 69 ]. The meta-analysis investigating the role of MRI scan in pediatric AA reported that alternative diagnosis was present in about 20% of patients, most common being adnexal cyst and enteritis/colitis[ 61 ].…”