Appendiceal Diverticulitis Presenting as Acute Appendicitis and Diagnosed After Appendectomy

Abstract

Introduction Diverticular disease of the appendix (DDA) is a rare appendiceal pathology. It is usually present similar to acute appendicitis. Because of its rarity, the DDA is poorly comprehended. This study evaluates the incidence, clinical and pathological characteristics of appendiceal diverticulitis diagnosed after appendectomy. Methods We performed a retrospective analysis of patients who underwent appendectomy between January 2016 and January 2022 at the Istanbul Sultanbeyli State Hospital General Surgery Clinic. The following parameters were analyzed: age and gender, preoperative diagnosis, laboratory results, radiological imaging findings, surgical technique, histopathological examination of specimens, and complications. Results A total of 1586 patients were analyzed. In the pathology, diverticular disease of the appendix was detected in 10 patients (0.63%). The DDA patients' mean age was 34.4 years, and the male to female ratio was 4:1. We detected low-grade appendiceal mucinous neoplasia in one of our patients. Conclusion Appendiceal diverticulitis is rare and usually presents as acute appendicitis. Most DDAs are detected incidentally during the postoperative period and are associated with an increased risk of appendiceal neoplasm. Appendectomy specimens should be carefully examined histopathologically to detect diverticular disease of the appendix.

Keywords: acute appendicitis; appendectomy; appendiceal diverticulitis; appendiceal diverticulosis; appendicular diverticulitis; diverticular disease of the appendix; diverticulitis; diverticulitis of the appendix; diverticulosis of the appendix.

Figure 1. Histopathological images, sagittal sections, showing appendiceal diverticulitis at the tip of the appendix (white stars: diverticular lumen). Hematoxylin and eosin stain (H&E), 20x magnification.

Figure 2. Coronal images of the abdominal computed tomography scan showing multiple diverticula of the appendix (white arrows).