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AlAli MN, Alsweed NI, Alshehri A, Essa MS, Aldeghaither SK, Meaigel MA, Alrashed M, Al-Shoaibi AM, Amer SM, Alsubaih MH. Is Appendiceal Diverticulitis Mimicking Acute Appendicitis? Cureus 2023; 15:e51214. [PMID: 38283468 PMCID: PMC10819125 DOI: 10.7759/cureus.51214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
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.
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Affiliation(s)
- Mohammed N AlAli
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Nardeen I Alsweed
- Department of Clinical Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Ameen Alshehri
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohamed S Essa
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Saud K Aldeghaither
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohammad A Meaigel
- Department of Surgery/Acute Care and Trauma Surgery, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Muath Alrashed
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Abdulbaset M Al-Shoaibi
- Department of Radiology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Sadiq M Amer
- Department of Pathology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohammed H Alsubaih
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
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Hunsaker JC, Aquino R, Wright B, Kobes P, Kennedy A, Dunn D. Review of appendicitis: routine, complicated, and mimics. Emerg Radiol 2023; 30:107-17. [PMID: 36376643 DOI: 10.1007/s10140-022-02098-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Appendicitis is one of the most common sources of abdominal pain in the emergency setting and is generally considered a straightforward diagnosis. However, atypical appearances, non-visualization, and inconclusive features can make these cases more complicated. The objectives of this article are to review the differential diagnoses for right lower quadrant pain, discuss the imaging characteristics of simple appendicitis on computed tomography (CT), and provide guidance for equivocal cases, complicated appendicitis, and appendicitis mimics. This review will also discuss the identification and management of neoplasms of the appendix.
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Kimura T, Goi T, Kidoguchi Y, Ohnishi K, Togawa T, Iida A, Sato Y. A case of diverticulum of the appendiceal base resembling a submucosal tumor of the cecum under colonoscopy: a hitherto undescribed lesion. BMC Gastroenterol 2022; 22:262. [PMID: 35619064 PMCID: PMC9137188 DOI: 10.1186/s12876-022-02337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diverticulosis of the appendix is an uncommon clinical entity, and a preoperative diagnosis is often difficult. Herein we report an unusual case of appendiceal diverticulosis. CASE PRESENTATION A 72-year-old male was referred to our hospital to examine the cause of hematochezia. A colonoscopy study showed a protruding lesion resembling a submucosal tumor (SMT), approximately 20 mm in diameter, at the site around the appendiceal orifice of the cecum. An abdominal computed tomography and magnetic resonance imaging showed a cystic lesion at the appendiceal base. The lesion was clinically diagnosed as a cystic tumor of the appendix, but the possibility of a malignant tumor could not be excluded. Therefore, a laparoscopic ileocecal resection with lymph node dissection was performed. The pathological examination of the resected specimen revealed that the lesion was a diverticulum (pseudodiverticulum) occurring solitarily at the appendiceal base, in which the mucosal layer of the appendix was invaginated into the submucosa of the adjacent cecum, thus forming an SMT-like lesion. CONCLUSION To our knowledge, this is the first case report in the English literature showing that an appendiceal diverticulum can manifest as an SMT-like lesion in the cecum. This condition should be recognized as a differential diagnosis for such lesions.
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Affiliation(s)
- Toshihisa Kimura
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193 Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193 Japan
| | - Yuki Kidoguchi
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Kenji Ohnishi
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
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