Acute Perforated Appendicitis Associated with Appendiceal Diverticulitis in a Young Man: A Case Report with Literature Review

Abstract

BACKGROUND Diverticulosis of the vermiform appendix is rare. In patients who present with appendicitis, appendiceal diverticulitis as a cause due is also rare. We report the case of a 35-year-old man who presented with typical symptoms and signs of acute appendicitis, which was confirmed by histopathology to be due to perforated acute appendiceal diverticulitis. CASE REPORT A 35-year-old man presented to our Emergency Department with a 1-day history of right lower-quadrant abdominal pain that radiated to the left lower quadrant, which was associated with fever, vomiting, and abdominal distention. Biochemical analysis revealed mild leukocytosis. Computed tomography (CT) revealed signs of acute perforated appendicitis and early mass formation. The patient underwent laparoscopic appendectomy. Histopathological examination revealed appendiceal diverticulitis (pseudo-diverticulum). CONCLUSIONS Appendiceal diverticulitis is a rare surgical entity and is often an overlooked diagnosis. The differential diagnosis of appendiceal diverticulitis in patients presenting with signs of acute appendicitis is important as it is associated with a higher rate of complications such as perforation and an increased risk of appendiceal neoplasms. Appendectomy is a safe and appropriate treatment for appendiceal diverticulitis.

Figure 1.

The intraoperative findings showing an inflamed and enlarged vermiform appendix with early mass formation without gross evidence of appendiceal diverticulum.

Figure 2.

Photomicrographs of the histopathology of the resected appendix using hematoxylin and eosin (H&E) and with 20× magnification. (A) A section through the appendix tip showing a thin-walled diverticulum containing acute inflammatory exudate (arrow). (B) A section through the appendix tip showing continuity of the diverticulum with marked inflammation (arrows) along with hypertrophy of the muscular wall (asterisk).