Appendiceal diverticular disease: evaluation of the clinical, radiologic, and pathologic findings in 153 patients

Appendiceal diverticular disease (ADD) is an uncommon condition that may clinically and radiologically mimic acute appendicitis and it is associated with a high risk of perforation. Limited awareness and diagnostic challenges frequently result in a diagnosis only after histopathological examination.

Among 6,853 emergency appendectomies performed between January 2015 and June 2024, 153 patients with histopathologically confirmed ADD were retrospectively analyzed in this study. The demographic data, clinical presentation, imaging findings, operative outcomes, and pathological characteristics were reviewed. All CT scans and pathology slides were re-evaluated by gastrointestinal radiologists and a gastrointestinal pathologist. The diverticula were classified according to the Lipton system.

The frequency of ADD detection in histopathological reports was 2.23%. The mean age was 40.5 ± 15.0 years, and 60.8% of the patients were male. Acquired diverticula predominated (99.3%), with type 2 being the most common subtype (68.6% of cases). Perforation was identified intraoperatively in 32.7% and histologically in 40.5% of the cases, occurring almost exclusively in type 1 and type 2 diverticula. ADD was not diagnosed on initial emergency CT reports. However, a retrospective review identified diverticula in 59.1% of cases, most commonly cystic and located at the appendiceal apex. No malignancies were detected.

ADD is a rare but clinically important entity with high perforation rates and substantial diagnostic limitations in routine imaging. Multidisciplinary reassessment improves the diagnostic accuracy and it may support optimized management strategies.