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Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis
Ming Li Chia1, Shaun Wen Yang Chan2, Vishal G Shelat1,2
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Introduction:
Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores.
Methods:
The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated.
Results:
The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality.
Conclusion:
DDA is a distinct clinical pathology associated with complicated appendicitis.
Insights
Diverticular disease of the vermiform appendix (DDA) occurs in less than 1% of appendicectomy specimens and is linked to complicated appendicitis. This study validates DDA
Area of Science:
- Gastroenterology
- Surgical Pathology
- Clinical Diagnostics
Background:
- Diverticular disease of the vermiform appendix (DDA) is a rare condition with an incidence of 0.004-2.1% in appendicectomy specimens.
- DDA is associated with complications such as perforation and malignancy.
- This study investigates a single-center experience with DDA.
Purpose of the Study:
- To validate the association between DDA and complicated appendicitis or malignancy.
- To evaluate the utility of systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores in DDA patients.
Main Methods:
- Retrospective review of 2,305 appendicectomy specimens from January 2011 to December 2015.
- Histopathological analysis identified 22 cases of DDA.
- Patient demographics, clinical data, operative details, and outcomes were analyzed, along with Modified Alvarado, Andersson, SIRS, and qSOFA scores.
Main Results:
- The incidence of DDA was 0.95% (22/2,305).
- Of the DDA patients, 45.5% had diverticulitis, and 36.4% presented with complicated appendicitis (perforation or abscess).
- SIRS criteria were met by 63.6% of patients, while no patients had a high qSOFA score.
Conclusions:
- Diverticular disease of the vermiform appendix is a distinct clinical entity.
- DDA is significantly associated with complicated appendicitis, highlighting its clinical importance.
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