Appendiceal Diverticulitis in a Young Female Diagnosed on Pathology after Laparoscopic Appendectomy for Acute Appendicitis

Abstract

Background. Appendiceal diverticulitis is a rare cause of inflammation of the appendix, which may mimic acute appendicitis. Its diagnosis is often delayed, and its occurrence carries an increased risk of significant complications, such as perforation. Case Presentation. A 23-year-old woman presented with sudden onset, severe, right lower quadrant abdominal pain and nausea. Her WBC was elevated, and abdominal CT showed findings indicative of acute appendicitis with a 13 mm fluid-filled appendix and local stranding. During laparoscopic appendectomy, significant inflammation was found around the appendix with some mucous material around the tip. The appendix base was not involved, and an endoloop was used to secure the stump. No other intra-abdominal abnormalities were observed. The patient recovered uneventfully. Pathology showed no classic appendicitis but appendiceal diverticulitis with signs of perforation. Discussion. Appendiceal diverticulitis is a rare condition which cannot be distinguished from acute appendicits clinically and on imaging. Diagnosis may be established based on pathology such as in our case. Appendectomy is indicated in appendiceal diverticulitis, and an appendix diverticulum is incidentally found during surgery or other investigations. This is due to the increased risk of perforation and the reported development of malignant tumors, including the appendix carcinoid.

Is Appendiceal Diverticulitis Mimicking Acute Appendicitis?

“…The progression from diverticulosis to diverticulitis might occur as a result of a partial or complete obstruction of the appendix [12]. Histopathologically, AD is classified as congenital (true diverticula), which includes all the layers of the appendiceal wall (mucosa, submucosa, muscularis layer, and serosa), or acquired (false diverticula), which includes all the layers except the muscular layer [2].…”

Appendiceal Diverticulitis Presenting as Acute Appendicitis: A Case Report

“…Identification of AD on CT can be difficult because of the associated inflammatory changes [ 19 ]. Histopathological diagnosis is very important to follow as the clinical and radiological differentiation between AD and acute appendicitis is difficult [ 1 , 4 , 20 ]. Our case was only a histopathological diagnosis.…”

Appendix diverticulosis in a patient diagnosed on pathology after laparoscopic appendectomy for appendicular mucinous mass—case report and literature review

“…Appendicular mucocele most likely to be in elderly women with variable presentations, which differ from AD that tends to be asymptomatic in male patient unless they present with inflammatory changes [ 9 ]. Images might help in the differentiation between AD and MAN; the classical CT abdomen finding of AD is: appendiceal diverticulum with hyperdense pericaecal fat [ 2 ] compared with a thin capsulated cystic mass in the right lower quadrant with low attenuation and wall calcification for MAN [ 10 ]. Colonoscopy also has some ability in identifying appendicular mucocele if the appendiceal orifice is seen at the center of the mound, which is known as ‘Volcano sign’ [ 11 ].…”

“…Appendicular diverticulum (AD) is considered as one of the rare entities, which was firstly reported in 1893 by Kelynack, and its reporting incidence is up to 2% [ 1 ]. Despite that AD is a pathological diagnosis, clinically and radiologically it can mimic acute appendicitis (AA) [ 1 , 2 ]. Toh et al [ 3 ] has reported a remarkable increase of malignancy rate and complications such as perforation in association of the AD.…”