Preoperative recognition of appendiceal diverticulitis: a case report with multimodal correlation

Appendiceal diverticulitis is a rare clinicopathological entity that often mimics acute appendicitis and is infrequently recognized preoperatively. We report a 41-year-old woman presenting with migratory right iliac fossa pain in whom contrast-enhanced computed tomography (CT) prospectively identified a small inflamed appendiceal diverticulum with inflammatory change centered on it. Laparoscopic appendicectomy confirmed an inflamed distal appendiceal diverticulum. Macroscopic examination demonstrated a corresponding diverticulum, while histopathology confirmed an appendiceal pseudodiverticulum with acute diverticulitis and associated acute suppurative appendicitis. Review of recently published reports demonstrates variable multimodal documentation, with detailed radiological, intraoperative, macroscopic, and histopathological reporting across all four modalities remaining uncommon. This case provides complete multimodal correlation from prospective imaging diagnosis to histopathological confirmation and highlights the potential for accurate preoperative recognition when characteristic CT features are identified. Recognition may support operative management and definitive pathological assessment given reported associations with perforation and appendiceal neoplasia.