Surgical rarities: case report of appendicular diverticulitis and literature review

Abstract

Appendicular diverticulosis is a rare condition observed in about 0.004–2% of all appendectomy specimens. Risk of perforation/bleeding is high and a relevant association with mucinous neoplasms is known. Appendectomy is indicated even in case of occasional finding. We present the case of a 22-year-old man who entered the Emergency Room for pain in right iliac fossa. Blood tests showed only a slight increase in C-reactive protein. Abdominal ultrasound (US) evidenced an appendix with thickened walls and a rounded fluid-filled hypoechoic lesion at its distal tip. Laparoscopic appendectomy confirmed the presence of mucocele. Postoperative course was uneventful and the patients discharged on postoperative day 3. Histological examination indicated diverticulitis/peridiverticulitis of the appendix and acute suppurative appendicitis. No perforation of the diverticula was detected. No neoplastic epithelium/mucous material was observed. In our case, preoperative US proved to be a useful alternative to computed tomography for the diagnosis.

Is Appendiceal Diverticulitis Mimicking Acute Appendicitis?

“…We extensively reviewed the English literature and conducted the search in the titles, keywords, and/or abstracts of the articles that were indexed in PubMed using the following keywords: "AD," "AD mimicking acute appendicitis," and "appendiceal diverticulosis." Our findings showed limited published cases in the literature worldwide (approximately 155 cases), few cases in the Arab Gulf region, and only three case reports with no case series in our country [4][5][6][7]. In our series, we found five cases, and the findings are summarized in Table 1.…”

“…A limited number of cases concerning AD are available in the literature (approximately 155 cases), and only three cases were reported in our country, and a few cases in the Arab Gulf region [4][5][6][7]. Therefore, we present a case series of five interesting incidental findings of AD that were initially diagnosed as AA based on intraoperative and histopathological findings.…”

“…Male gender, age > 30 years, chronic appendicitis, cystic fibrosis, and Hirschsprung's disease are known risk factors for AD [4]. AD carries a higher risk of bleeding, perforation, and appendiceal neoplasms, with a higher rate of mortality than acute appendicitis (AA) [4][5][6]. In addition, the mean operation duration and postoperative hospital stay were longer than in AA [6].…”

Appendiceal diverticulitis diagnosed by ultrasound

“…Perforation and abscess formation are among the possible complications, with a perforation rate of 30%–70%, four times higher than that of acute appendicitis. Diagnosis of this entity is also clinically relevant because of the higher risk of neoplastic transformation (especially carcinoid tumors and mucinous neoplasms) 3 . The preoperative radiological diagnosis is often not correctly made, probably due to both the lack of knowledge of the entity and the frequent subtlety of its findings.…”

“…Diagnosis of this entity is also clinically relevant because of the higher risk of neoplastic transformation (especially carcinoid tumors and mucinous neoplasms). 3 The preoperative radiological diagnosis is often not correctly made, probably due to both the lack of knowledge of the entity and the frequent subtlety of its findings. The diagnostic key to differentiate it from acute appendicitis lies in the identification of appendiceal wall-dependent diverticula in the center of the inflammatory changes.…”