Synchronous gangrenous cholecystitis and appendicitis secondary to appendiceal diverticulum perforation

Acute appendicitis and acute cholecystitis are among the commonest pathologies in acute general surgery. They are characterized by distinct symptoms, clinical examination findings and typical elements of the history which direct further investigations. In the absence of these classic findings, these diagnoses can be missed, particularly where they occur synchronously. Here we present the interesting case of a 63-year-old male who presented to the emergency department with epigastric pain and vomiting with no classical appendicitis or cholecystitis findings who was found to have both appendicitis with a 3 cm collection and gangrenous cholecystitis, managed with urgent laparoscopic appendicectomy and cholecystectomy. This patient had a background of Type 2 Diabetes which may have reduced awareness of symptoms. Given the increasing prevalence of Type 2 Diabetes and the risk of rapid deterioration in these patients, this case demonstrates the importance of prompt assessment of the entire abdomen when these patients present with acute abdomen.