Acute appendiceal diverticulitis: a case report

Abstract

Acute appendiceal diverticulitis is a difficult prospective diagnosis due to both its rarity and clinical overlap with other ileocecal diseases, such as acute appendicitis. Few preoperative radiological images of acute appendiceal diverticulitis have been presented in the literature. We report a case of acute appendiceal diverticulitis initially diagnosed with outpatient ultrasound and confirmed with contrast-enhanced computed tomography in an 85-year-old male who presented with right lower quadrant pain. Appendiceal diverticulitis is an often overlooked diagnosis, and given its association with appendiceal neoplasms and relatively high rate of perforation, it is important to consider this entity in patients with right lower quadrant pain in order to ensure that they are managed appropriately. The addition of high quality ultrasound and computed tomography (CT) images to the literature may heighten awareness of this rare condition and facilitate accurate preoperative diagnosis and management in these patients.

Keywords: Abdominal pain; Appendiceal diverticulitis; Appendicitis; Ultrasound.

Fig. 1

Longitudinal (A) and transverse (B) grayscale US images of the right lower quadrant demonstrate a mildly dilated appendix (short white arrow) with multiple small diverticular outpouchings (long white arrow) along the mesenteric border and increased echogenicity of the adjacent fat (black arrow).

Fig. 2

Coronal (A), axial (B), and sagittal (C) contrast-enhanced CT images of the right lower quadrant demonstrate multiple appendiceal diverticula (arrows) with inflammatory infiltration of the periappendiceal fat. Surgical clips related to prior inguinal hernia repair are seen.