Appendiceal diverticulitis: a rare disorder

Author(s):
Tobi Onafowokan; Hugo Bonatti

Background:

Appendiceal diverticulosis is an uncommon pathology, first described in 1893. It may be congenital or acquired.

Hypothesis:

Appendiceal dicerticulitis may mimick appendicitis.

Methods:

A 23 year old woman presented to the Emergency Room with sudden onset, severe right lower quadrant pain and nausea. On examination, her abdomen was soft with tenderness in the right lower quadrant; she had a positive Murphy’s sign. Abdominal CT with contrast showed a fluid-filled and dilated appendix with thickened walls and soft tissue inflammatory change; indicative of acute appendicitis.

Results:

She was started on antibiotics and the next morning taken to the operating room for laparoscopic appendectomy. The appendix was found to be acutely inflamed with severe periappendiceal inflammation. There was some mucosal secretion on the tip of the appendix. A window was created between the appendix and the mesoappendix, which was widened toward tip and base and ultimately the mesoappendix was cut off the appendix. Two Endoloops were used to secure the vascular pedicle and the base of the appendix, respectively. The specimen was removed using a retrieval bag. The postoperative course was uneventful with same day discharge. Pathology revealed diverticulitis at the tip of the appendix, with chronic serositis at the nearby serosal surface. No acute appendicitis was present.

Conclusions:

Appendiceal diverticulitis is a rare disorder that presents identical to acute appendicitis. Accurate diagnosis and resection is warranted due to the higher risk of perforation compared to appendicitis. Prophylactic appendectomy should also be considered when these diverticuli are incidentally found, in order to avoid future morbidity.