Diverticulosis of the appendix.

Abstract

Diverticulosis of the vermiform appendix of the colon is encountered infrequently in roentgenographic study of the intestinal tract. Whether discovery of these diverticula is important has yet to be determined. It is conceivable, however, that they might have clinical significance. It seems reasonable, therefore, for radiologists to keep this entity in mind and to mention its discovery with at least as much care as that accorded to diverticula in other portions of the alimentary canal. This report concerns two cases in which diverticula of the appendix were visualized in the course of radiologic examination of the colon by barium enema. The first was in a 51-year-old Negro mortician, referred for care because of addiction to Demerol, of two years duration. He had had numerous symptoms for which complete evaluation was undertaken. On roentgenologic examination the colon appeared normal except for three well defined diverticula arising from the mid portion of the appendix (Fig. 1). Appendectomy was not deemed advisable. The second patient, a white salesman, aged fifty years, was examined at the Ochsner Clinic because of recurring abdominal pains and diarrhea. The only positive physical abnormalities discovered were pronounced diverticulosis of the colon, involving all segments, and a solitary diverticulum arising from the appendix near its base (Fig. 2). Treatment with a low-residue diet resulted in improvement of symptoms. Discussion In 1936, Collins (2) presented an extensive historical study of diverticula of the appendix. In the world's literature he found reports of 67 cases, to which he added 30 personal examples that had been discovered in the course of studying 4,071 appendices after surgical resection or at necropsy. The sex incidence was essentially similar and the average age at the time of discovery was thirty-six years. In 60 per cent of the cases a solitary diverticulum was discovered. In 73 per cent the diverticula were located on or beside the mesenteric border of the appendix. Associated disease was frequent: acute appendicitis in 60 per cent, chronic appendicitis in 33 per cent, perforation of the appendix in 28 per cent, and mucocele or pseudomyxoma peritonei in 20 per cent. These data would seem to indicate that diverticulosis of the appendix is a finding that the radiologist should stress. Few instances of roentgenographic visualization have been recorded. In 1926, Spriggs and Marxer (11) reported 6 cases in which appendiceal diverticula had been visualized; their report includes an illustration of a diverticulum of a retrocecal appendix. Kadrnka and Sarasin (7) recorded 2 more cases in 1932, one a solitary appendiceal diverticulum in a patient with ulcerative colitis and the other an instance of multiple appendiceal and cecal diverticula.