Appendiceal diverticulitis, a rare relevant pathology: Presentation of a case report and review of the literature

Abstract

Introduction: Appendiceal diverticulitis is a rare pathology that mimics acute appendicitis. Appendiceal diverticula are classified into congenital and acquired with difference in incidence and pathogenesis. Appendiceal diverticulitis is often overlooked because of mildness of symptomatology with increasing risk of complications, such as perforation. Appendiceal diverticula are often associated to higher risk of neoplasm especially carcinoid tumors and mucinous adenomas.

Presentation of case: A 40-year-old caucasic male presented into Emergency Room with right lower quadrant pain associated with vomit, abdominal tenderness, fever and moderate leukocytosis (11.93×10; neutrophils 78.5%). Acute appendicitis was suspected and a surgical approach was chosen with a McBurney access. The removed specimen (Figs. 1 and 2) was 11cm long with multiple hyperaemic and oedematous diverticular protrusions. The postoperative course was regular. Discharging was on 4th postoperative day in optimal clinical conditions. The histological examination (Fig. 3) showed acute inflammation of appendiceal pseudodiverticula with acute peridiverticulitis and abscess.

Discussion: Currently, appendiceal diverticulitis is often overlooked with high risk of complications, above all perforation. Attention should be kept during the surgical procedure and the patholological examination in order to identify any associated neoplasm.

Conclusion: Appendiceal diverticulitis should be considered in adult male patients with right lower quadrant pain or tenderness. Accurate appendectomy should be performed in order to permit an appropriate pathological examination and possible associate neoplasm should always be searched through. Prophylactic appendectomy should be performed in case of incidental finding of appendiceal diverticula in asymptomatic patients in order to avoid the high perforation risk.

Keywords: Appendiceal diverticula; Appendiceal diverticulitis; Case report.

Fig. 1

View of the Appendix with full visible diverticula.

Fig. 2

Dimension of the appendix.

Fig. 3

Transversal histological section of an appendiceal pseudo diverticulum: M: mucosa; SM: submucosa; L: lymphatic nodule; ME: muscularis externa; P: peritoneum; A: appendicular lumen; D: diverticular lumen.