Complicated appendicular diverticulitis

Appendiceal diverticulum diagnosed after appendectomy: Two case reports and literature review

INTRODUCTION

Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis and is usually treated by appendicectomy.

CASES PRESENTATION

We present two cases: a 50-year-old female patient and a 35-year-old male patient, both of whom presented with signs and symptoms of acute appendicitis and were managed accordingly. Final pathological examination confirmed the presence of an appendiceal diverticulum.

CLINICAL DISCUSSION

Diverticulitis of the appendix is four times more likely to lead to perforation when compared to appendicitis and may be associated with underlying neoplasm. Therefore, it is extremely important to distinguish diverticulitis of the appendix from appendicitis.

CONCLUSION

Clinicians should always consider appendiceal diverticulitis when evaluating patients with right-sided, lower quadrant abdominal pain.

A case report on appendicular diverticulitis: Eluding traditional diagnosis

INTRODUCTION AND IMPORTANCE

Diverticula of the vermiform appendix are rare entities. Although the pathogenesis and natural course of appendiceal diverticulitis (AD) are different from acute appendicitis, AD is treated like acute appendicitis because of similar clinical manifestations and low incidence.

CASE PRESENTATION

We describe cases of two male patients of different ages who respectively underwent elective laparoscopic appendectomy and an emergent laparoscopic appendectomy in a multi-speciality hospital in Kerala, India. Both of them had acute appendicitis, as confirmed by imaging and laboratory testing. Subsequent histopathological examination revealed AD.

CLINICAL DISCUSSION

AD is an uncommon but potentially more serious form of appendiceal disease that can mimic acute appendicitis or malignancy. The first patient mimicked a malignancy with the mass presentation, while the second case presented like appendicitis. Unlike colonic diverticula, AD diverticula are typically not detectable by imaging or colonoscopy, which poses a diagnostic challenge.

CONCLUSION

In patients who present with lower abdominal pain or who may have appendicitis, AD should be considered as a differential diagnosis.

Is Appendiceal Diverticulitis Mimicking Acute Appendicitis?

Appendicular diverticulitis (AD) is a rare entity characterized by the inflammation of the arising diverticulum of the appendix. It has been reported to carry a high risk of perioperative complications, such as bleeding and perforation. Furthermore, multiple articles have highlighted the importance of diagnosing AD early due to its strong association with malignancies. Limited published cases concerning AD in our country and globally are available in the literature. Hence, we present in this article a case series of five exciting cases of incidental findings of AD that were initially diagnosed as acute appendicitis based on clinical evaluation and imaging findings. In our series, we performed a retrograde evaluation of the computed tomography scans of all five cases that showed diverticula. In conclusion, histopathological evaluation remains the method of choice to reach the definitive diagnosis; however, it is essential to highlight the relevance of imaging in diagnosing AD preoperatively in the early stages to reduce morbidity and mortality.

Appendiceal diverticulitis diagnosed by ultrasound

Appendiceal diverticulitis is a rare entity that may present clinically simulating appendicitis. The importance of its diagnosis lies in the higher risk of complications including malignant transformation. The presence of small cystic appendicular peripheral images with thickened wall and hyperechoic surrounding fat are the diagnostic key.

Complicated appendiceal diverticulitis a extremely rare cause of acute abdomen: A case report and literature review

INTRODUCTION AND IMPORTANCE

Appendiceal diverticulitis (AD) represents a rare cause of acute abdomen. Diagnosis of AD is a challenge because of its rarity and resemblance to other ileocecal diseases like as cecal diverticulitis (CD) and acute appendicitis (AA). Preoperative imaging can be useful to aid diagnosis. Surgery represents the correct treatment of AD.

CASE PRESENTATION

A 48-year-old Caucasian male presented to the Emergency Department with a two-day history of right lower quadrant (RLQ) abdominal pain and fever. Physical examination revealed RLQ abdominal pain and rebound tenderness with muscle guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal computed tomography(CT) scan showed findings of AA and a thin-walled 5 mm appendiceal diverticulum. The patient underwent laparoscopic appendectomy. The postoperative course was uneventful, the patient was discharged on the 5th postoperative day in a stable condition. Gross anatomy confirmed the presence of appendiceal diverticulum in the distal appendix on the mesenteric border. Histopathological examination revealed an inflamed and perforated appendiceal pseudo-diverticulum with surrounding AA and peri-appendicitis.

CLINICAL DISCUSSION

Appendiceal diverticulosis is an uncommon entity, classified as congenital or acquired based on the number of appendiceal layers herniating through the normal wall. Two thirds of diverticula will develop acute or chronic diverticulitis that can lead to several complications some of which can be life-threatening.

CONCLUSION

AD is a rare surgical emergency and represents often an overlooked diagnosis. Early diagnosis and treatment are crucial for reducing morbidity and mortality Appendectomy represents a safe and appropriate treatment of AD.