Acquired Diverticulosis of the Vermiform Appendix: A Disease of Multiple Etiologies

Abstract

Acquired diverticular disease of the vermiform appendix is a rare condition that usually presents with the symptoms of acute appendicitis. This analysis was undertaken to determine the spectrum and prevalence of the associated lesions in acquired appendiceal diverticulosis. Thirty-one cases of acquired appendiceal diverticular disease were identified from files over a period of 15 years (1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996). Diverticulosis was the only abnormality in 17 cases (54.8%). An associated neoplastic epithelium was present in nine (29%) patients (seven adenomata and two goblet cell carcinoids), fecalith formation in three (9.7%), and a neuroma in two (6.5%). Although rare, diverticular disease of the vermiform appendix was frequently seen in association with an adenomatous mucosa. In our experience, one appendiceal adenoma coexisted with a colonic adenocarcinoma. In conclusion, the diagnosis of appendiceal diverticulosis necessitates the exclusion of coexisting appendiceal neoplasia. Int J Surg Pathol 6(1): [23][24][25][26][27][28] 1998

Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases

“…Both congenital and acquired types of appendiceal diverticula are rare with reported incidence rates of 0.014 % and 0.20 to 1.7 %, respectively [20,21]. Acquired diverticula are false diverticula with herniation of the mucosa through the muscularis propria and typically arise at the vascular hiatus points of low resistance along both the mesenteric and antimesenteric surfaces [21,22]. Increased intraluminal pressure (fecalith, proximal tumors, excessive luminal mucous) is central to the formation of acquired appendiceal diverticula [22].…”

“…Patients must receive antihelminthic treatment because the appendectomy treats only the consequence and not the cause of the disease [19]. Both congenital and acquired types of appendiceal diverticula are rare with reported incidence rates of 0.014 % and 0.20 to 1.7 %, respectively [20,21]. Acquired diverticula are false diverticula with herniation of the mucosa through the muscularis propria and typically arise at the vascular hiatus points of low resistance along both the mesenteric and antimesenteric surfaces [21,22].…”

Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm

“…Both congenital and acquired types of appendiceal diverticula are rare with reported incidence rates of 0.014% and 0.20% to 1.7%, respectively [1][2][3][4]. Acquired diverticula are false diverticula with herniation of the mucosa through the muscularis propria and typically arise at the vascular hiatus-points of low resistance along both the mesenteric and antimesenteric surfaces [2,4,5].…”

The relationship between diverticula and low-grade mucinous neoplasm of the appendix. Does the diverticulum play a role in the development of periappendicular mucin deposition or pseudomyxoma peritonei?

“…Diverticula accompanying epithelial neoplasms were reported in the literature. In the series by Medlicott and Urbanski a primary appendiceal neoplasm was detected in 30% of acquired diverticulum cases, which were all non-mucinous neoplasms [18]. There are few studies regarding the association of diverticulum with LGMNs.…”

“…Increased intraluminal pressure, which occurs as a result of fecalitis, proximally located tumours, and accumulated luminal mucus, plays a part in the formation of the diverticulum. Perforation of a pseudo-diverticulum is frequent because of the absence of a muscular layer [9,18,19]. Diverticula accompanying epithelial neoplasms were reported in the literature.…”