A CASE OF PERFORATED DIVERTICULITIS OF APPENDIX IN WHICH PREOPERATIVE DIAGNOSIS WAS VERY DIFFICULT

Abstract

A 77-year-old male complaining of left lower abdominal pain, fever, and diarrhea was admitted to the internal department for minute examination. Conservative treatments led to symptomatic remission, however, a tumor was palpated at the left lower abdomen. Abdominal ultrasonography and CT revealed some findings suspecting of abscesses at the left subphrenic and left lower abdominal regions. For the purpose of exploration and operation, the patient was transferred to our department. Colonic endoscopy indicated a narrowed lumen of the sigmoid colon, but no tumor nor ulcerative change was demonstrated on the mucous membrane. Barium enema showed several diverticula in the appendix and a leakage of the medium from one of them. The patient was diagnosed as locarlized peritonitis due to perforation of diverticulum of appendix. Appendectomy and intraperitoneal drainage were performed. There were 7 diverticula in the excised appendix, which were all pseudodiverticula, containing a perforated one. During surgery no association of diverticulum was found in any other regions of the colon.Extremely few reports described diverticulosis of appendix in Japan. Here we described a case of perforative diverticulitis of appendix, in which we had difficulties in the differential diganosis through clinical course and barium enema could yield preoperative definitive diagnosis.