A Rare Intra-Operative Sighting of Appendiceal Diverticulitis

A B S T R A C T

Appendiceal diverticulitis is a rare diagnosis and culprit for acute appendicitis. The majority of these cases are diagnosed post-operatively on histopathology. In the following case it was grossly identifiable intra-operatively. Our treatment was appendicectomy. The purpose of this article was to provide pictorial evidence of this exceedingly rare intra-operative finding.

Keywords

Appendiceal diverticulitis

Case Description

A 25-year-old female presented with a 4-day history of lower abdominal pain, accompanied by nausea and anorexia. On examination, she was tender in the right iliac fossa and guarding was present. Blood tests revealed raised inflammatory markers. The patient underwent diagnostic laparoscopy, which revealed an oedematous appendix with an injected serosa. Multiple diverticulae were visible along its surface (Figure 1). Appendicectomy was performed accordingly. Histopathological analysis confirmed a diagnosis of appendiceal diverticulitis. Her recovery was uneventful.

Figure 1: Gross appendiceal diverticulae detected intra-operatively.

Appendiceal diverticulitis is a rare pathology. The reported incidence of this discrete clinical process is 0.2%. It carries an earlier and higher rate of perforation (at least 4 times) compared to simple appendicitis. Accordingly, it carries a higher mortality (30-fold) [1]. Although diagnosis can be suspected on radiographic imaging or upon gross inspection of the specimen, histopathological confirmation is required to make a formal diagnosis. It can be categorised into 4 main subtypes according to the microscopic findings [2]. Our case is consistent with type 2 – inflammation of the diverticula with surrounding appendicitis.

Learning Points

i. Appendiceal diverticulitis is a rare but important clinical diagnosis the clinician should be aware of.
ii. It carries an early and higher rate of perforation compared to acute appendicitis.

Conflicts of Interest

None.

Article Info

Article Type
Case Report
Publication history
Received: Fri 03, Jul 2020
Accepted: Mon 13, Jul 2020
Published: Sat 18, Jul 2020
Copyright
© 2019 Artemis Fedder. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved.
DOI: 10.31487/j.JSCR.2020.04.05

Author Info

Corresponding Author
Artemis Fedder
East Lancashire Hospitals NHS Trust, East Lancashire, UK

Figures & Tables

Science Repository

Figure 1: Gross appendiceal diverticulae detected intra-operatively.



References

  1. B J Phillips, C W Perry (1999) Appendiceal diverticulitis. Mayo Clin Proc 74: 890-892. [Crossref]
  2. Martin Friedlich, Neesh Malik, Martin Lecompte, Yasmine Ayroud (2004) Diverticulitis of the appendix. Can J Surg 47: 146-147. [Crossref]