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Incidental Findings of Appendiceal Diverticulitis Presenting as Acute Appendicitis
Benjamin Souferi1, Kristin Sheppard1, Ayolola O Onayemi1
1Department of Surgery, Hackensack Meridian Health, 14331Palisades Medical Center, North Bergen, NJ, USA.
Abstract:
Diverticulosis of the appendix (DA) is a rare pathological finding that clinically imitates acute appendicitis and is most commonly found in adult males with chronic abdominal pain. It has a higher rate of perforation compared to acute appendicitis (84% vs 12%, P<0.01), and is consequently associated with a higher rate of mortality. Appendiceal diverticulitis has been found to have a significant association with incidental appendiceal neoplasms, therefore elective prophylactic appendectomy is recommended to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm. Meticulous gross examination in addition to thorough histological examination of the entire appendectomy specimen by pathologists is essential in order to identify diverticula. We present two female patients with signs and symptoms consistent with acute appendicitis, they were found to have appendiceal diverticulitis on pathologic evaluation.
Insights
Diverticulosis of the appendix (DA) is a rare condition mimicking appendicitis, with higher perforation and mortality rates. Early diagnosis and prophylactic appendectomy are crucial for preventing complications and ruling out neoplasms.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Diverticulosis of the appendix (DA) is a rare condition.
- It often presents with symptoms similar to acute appendicitis.
- DA is more prevalent in adult males with chronic abdominal pain.
Purpose of the Study:
- To highlight the clinical presentation and pathological findings of appendiceal diverticulitis.
- To emphasize the increased risk of perforation and mortality associated with DA.
- To underscore the importance of prophylactic appendectomy in managing DA.
Main Methods:
- Case report of two female patients presenting with acute appendicitis-like symptoms.
- Pathological evaluation of appendectomy specimens.
- Review of existing literature on diverticulosis of the appendix.
Main Results:
- Both patients were diagnosed with appendiceal diverticulitis post-operatively.
- Diverticulosis of the appendix has a significantly higher perforation rate (84%) than acute appendicitis (12%).
- A significant association exists between appendiceal diverticulitis and incidental appendiceal neoplasms.
Conclusions:
- Appendiceal diverticulitis requires meticulous pathological examination for accurate diagnosis.
- Prophylactic appendectomy is recommended to prevent complications and detect coexisting neoplasms.
- This condition, though rare, necessitates consideration in the differential diagnosis of acute appendicitis.
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