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Case Reports
. 2024 Nov 21;16(11):e74138.
doi: 10.7759/cureus.74138. eCollection 2024 Nov.

An Unusual Presentation of Acute Appendicitis Mimicking Sigmoid Diverticulitis: A Case Report

Muhammed Salih Suer  1
Affiliations
Case Reports

An Unusual Presentation of Acute Appendicitis Mimicking Sigmoid Diverticulitis: A Case Report

Muhammed Salih Suer. Cureus. .

Abstract

Acute appendicitis typically causes right lower quadrant pain, but in elderly patients with comorbidities, it can present atypically, complicating diagnosis. This case highlights a rare presentation, mimicking sigmoid diverticulitis. A 70-year-old man with chronic heart failure, arrhythmia, and renal failure presented with two days of left lower quadrant pain. Examination showed tenderness, rebound, and guarding. Laboratory tests revealed a white blood cell count of 12,000/µL and creatinine of 2.5 mg/dL. C-reactive protein was elevated at 25 mg/L. Computed tomography revealed an inflamed appendix with an appendicolith and localized inflammation near the sigmoid colon, but no diverticulitis. An appendectomy confirmed a perforated appendix in contact with the sigmoid colon. In elderly patients, acute appendicitis may present atypically with left-sided pain, risking misdiagnosis. Careful evaluation and imaging are essential for accurate diagnosis and management in those with comorbidities.

Keywords: acute appendicitis; computerize tomography; diverticulitis; geriatric; surgery.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A) The appendix is inflamed and extended. B) An appendicolith is present in the pelvis, with surrounding tissue also exhibiting inflammation. C) and D) The sigmoid colon is inflamed, with no evidence of diverticular disease.
Figure 2
Figure 2. Acute perforated appendicitis with appendicolith.
See this image and copyright information in PMC

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