Appendiceal Diverticulitis Research Articles

Clinical features and risk factors for appendiceal diverticulitis: a comparative study with acute appendicitis.

Despite their similar clinical characteristics, appendiceal diverticulitis (AD) and acute appendicitis (AA) are pathologically distinct. This study compared the clinical features of AD and AA and identified relevant risk factors. Patients who underwent appendectomy with a preoperative diagnosis of either AD or AA were categorized based on histopathological findings. The two groups were compared in terms of various clinical factors. Among the 854 patients included in the study, a histopathological evaluation revealed 49 and 805 cases of AD and AA, respectively. A univariate analysis demonstrated that AD was more prevalent than AA among older, taller, and heavier males. A multivariate analysis revealed that male sex, a white blood cell (WBC) count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a mean corpuscular volume (MCV) ≥ 91.6 fL were significant factors differentiating AD from AA. In addition, pathological AD emerged as an independent risk factor for abscess and/or perforation. AD was associated with an older age, robust physique, and significant risk of abscess and/or perforation despite a low WBC count. In addition to imaging modalities, the preoperative factors of male sex, a WBC count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a MCV ≥ 91.6 fL may be useful for distinguishing AD from AA.

A case of mesenteric venous thrombosis complicating appendiceal diverticulitis

BackgroundMesenteric venous thrombosis (MVT) and appendiceal diverticulitis are rare diseases. There has been no previous report on MVT complicating appendiceal diverticulitis. Herein, we report the first case of MVT complicating appendiceal diverticulitis.Case presentationA 70-year-old male patient with right lower abdominal pain presented to our hospital. Abdominal contrast-enhanced computed tomography (CT) suggested MVT complicating appendiceal diverticulitis. Initially, we started conservative treatment with antibacterial drugs, but on the 2nd hospital day his general condition deteriorated due to sepsis that seemed to be caused by appendiceal diverticulitis. Therefore, we performed laparoscopic appendectomy. Histopathological findings of the specimen showed appendiceal diverticulitis. After the operation, he gradually improved. He was discharged on the 30th hospital day.ConclusionsWe report a successfully treated case of MVT complicating appendiceal diverticulitis by surgical intervention. This is the first case of MVT complicating appendiceal diverticulitis.

Multi-Detector CT Findings of Typical and Atypical Appendicitis: A Pictorial Essay

Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based on MDCT findings can be difficult and challenging when the observed findings are inconsistent with the typical features. Atypical appendicitis includes a wide spectrum of features, such as variable positions of the appendix and cecum, complications, and unusual pathological findings of secondary appendicitis that mimic or induce appendicitis. Our pictorial essay describes the diverse spectrum of atypical appendicitis and appendicitis-like conditions in terms of location abnormalities, complications, and uncommon pathologies, including related tumors, reactive appendicitis, appendiceal diverticulitis, and IgG4-related disease. Through this essay, the readers can become more familiar with MDCT findings of atypical appendicitis.

A Case of Appendiceal Diverticulitis Preoperatively Diagnosed by Ultrasonography

A Case of Appendiceal Diverticulitis Preoperatively Diagnosed by Ultrasonography

Diverticulitis and Diverticulosis of the Appendix: A Case Series.

Introduction Diverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung's disease, cystic fibrosis and adult age, where some reports claim that they arealso associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitisand one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methods A total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied.The demographic details and clinicaldata including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. Results The study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptomswere right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. Conclusion Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula - this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.

An appendiceal diverticulitis patient presenting with acute appendicitis symptoms

Appendiceal diverticulitis is a very infrequent cause of pain in the right lower quadrant of the abdominal area. To have good management, it is essential to understand its clinical evolution, whether it is symptomatic or discovered incidentally during an appendectomy or barium enema. So far, few cases of appendiceal diverticulitis in different people have been reported. It is important in this case to avoid misdiagnosis in the form of another disease, especially acute appendicitis and/or possible complications. In this report we present the case of a 45-year-old man who came to the emergency room with symptoms of acute appendicitis. CT scan showed suspicious mass-like tissue in the appendiceal region, while pathological examination showed inflammation with no malignancy. An open appendicectomy was performed in this patient and appendicular diverticulitis was established as the final diagnosis.

Appendiceal Diverticulitis Presenting as Acute Appendicitis and Diagnosed After Appendectomy.

IntroductionDiverticular disease of the appendix (DDA) is a rare appendiceal pathology. It is usually present similar to acute appendicitis. Because of its rarity, the DDA is poorly comprehended. This study evaluates the incidence, clinical and pathological characteristics of appendiceal diverticulitis diagnosed after appendectomy.MethodsWe performed a retrospective analysis of patients who underwent appendectomy between January 2016 and January 2022 at the Istanbul Sultanbeyli State Hospital General Surgery Clinic. The following parameters were analyzed: age and gender, preoperative diagnosis, laboratory results, radiological imaging findings, surgical technique, histopathological examination of specimens, and complications.ResultsA total of 1586 patients were analyzed. In the pathology, diverticular disease of the appendix was detected in 10 patients (0.63%). The DDA patients’ mean age was 34.4 years, and the male to female ratio was 4:1. We detected low-grade appendiceal mucinous neoplasia in one of our patients.ConclusionAppendiceal diverticulitis is rare and usually presents as acute appendicitis. Most DDAs are detected incidentally during the postoperative period and are associated with an increased risk of appendiceal neoplasm. Appendectomy specimens should be carefully examined histopathologically to detect diverticular disease of the appendix.

A Case of Appendiceal Diverticulitis with True Appendiceal Diverticulosis Resected by Laparoscopic Surgery

A Case of Appendiceal Diverticulitis with True Appendiceal Diverticulosis Resected by Laparoscopic Surgery

Incidental Findings of Appendiceal Diverticulitis Presenting as Acute Appendicitis.

Diverticulosis of the appendix (DA) is a rare pathological finding that clinically imitates acute appendicitis and is most commonly found in adult males with chronic abdominal pain. It has a higher rate of perforation compared to acute appendicitis (84% vs 12%, P<0.01), and is consequently associated with a higher rate of mortality. Appendiceal diverticulitis has been found to have a significant association with incidental appendiceal neoplasms, therefore elective prophylactic appendectomy is recommended to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm. Meticulous gross examination in addition to thorough histological examination of the entire appendectomy specimen by pathologists is essential in order to identify diverticula. We present two female patients with signs and symptoms consistent with acute appendicitis, they were found to have appendiceal diverticulitis on pathologic evaluation.

Diverticulitis of the appendix—case report and literature review

ABSTRACTAppendiceal diverticulitis is a rare diagnostic most often mistaken for an acute appendicitis.A 72-year-old man presented with a transfixing abdominal pain for 48 hours. Appendicitis was diagnosed on computed tomography scan, but a neoplasm could not be excluded. A laparoscopic hemicolectomy was performed after a surgical consensus considering the neoplastic appearance of the lesion and anatomical feature. Histopathology finally revealed an appendiceal diverticulitis.Appendiceal diverticulum is a rare condition. Most will lead to an appendiceal diverticulitis, which present similarly to an appendicitis. Perforation rate and mortality rate are much higher in appendiceal diverticulitis than in appendicitis. Furthermore, appendiceal diverticular disease is strongly associated with neoplasms, especially mucinous neoplasms and thus pseudomyxoma peritonei.Considering the high complication rate and malignant association, an appendicectomy in case of an appendiceal diverticulitis or of an incidental finding of appendiceal diverticulosis should be recommended to the patient.

Appendiceal Diverticulitis in a Young Female Diagnosed on Pathology after Laparoscopic Appendectomy for Acute Appendicitis

Background. Appendiceal diverticulitis is a rare cause of inflammation of the appendix, which may mimic acute appendicitis. Its diagnosis is often delayed, and its occurrence carries an increased risk of significant complications, such as perforation. Case Presentation. A 23-year-old woman presented with sudden onset, severe, right lower quadrant abdominal pain and nausea. Her WBC was elevated, and abdominal CT showed findings indicative of acute appendicitis with a 13 mm fluid-filled appendix and local stranding. During laparoscopic appendectomy, significant inflammation was found around the appendix with some mucous material around the tip. The appendix base was not involved, and an endoloop was used to secure the stump. No other intra-abdominal abnormalities were observed. The patient recovered uneventfully. Pathology showed no classic appendicitis but appendiceal diverticulitis with signs of perforation. Discussion. Appendiceal diverticulitis is a rare condition which cannot be distinguished from acute appendicits clinically and on imaging. Diagnosis may be established based on pathology such as in our case. Appendectomy is indicated in appendiceal diverticulitis, and an appendix diverticulum is incidentally found during surgery or other investigations. This is due to the increased risk of perforation and the reported development of malignant tumors, including the appendix carcinoid.

Acute appendiceal diverticulitis diagnosed in the postoperative context of appendectomy

Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result. We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain. Laboratory and imaging studies led to the diagnosis of acute appendicitis. In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed. Later pathological exam showed diverticulitis of the vermiform appendix. Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings. Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms.

Appendicitis and beyond: a pictorial review of various appendiceal abnormalities.

Acute appendicitis is the most common disease of the appendix. However, the differential diagnosis for an abnormal appendix includes other conditions that often present with symptoms and imaging features that overlap with acute appendicitis. In this pictorial essay, we review the normal anatomy of the appendix and outline the pathogenesis, clinical manifestations, and imaging findings that are characteristic of acute appendicitis and other less common appendiceal abnormalities. Inflammatory/non-neoplastic processes including appendiceal diverticulitis, stump appendicitis, foreign body appendicitis, Crohn's appendicitis, and appendiceal hernias are discussed. Neoplastic considerations include appendiceal neuroendocrine tumors, mucinous and non-mucinous (colonic type) epithelial neoplasms, and lymphoma. It is important for the radiologist to be able to differentiate these alternative diagnoses for the purpose of directing appropriate patient management.

Goblet Cell Adenocarcinoma of the Appendix Associated with Appendiceal Diverticulitis—Report of Two Cases—

Goblet Cell Adenocarcinoma of the Appendix Associated with Appendiceal Diverticulitis—Report of Two Cases—

A Rare Intra-Operative Sighting of Appendiceal Diverticulitis

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 intraoperatively. Our treatment was appendicectomy. The purpose of this article was to provide pictorial evidence of this exceedingly rare intra-operative finding.

Chronological Changes in Appendiceal Pathology Among Patients Who Underwent Appendectomy for Suspected Acute Appendicitis.

Given recent advances in imaging and the development of diagnostic parameters, the rate of unnecessary appendectomy (i.e., negative appendectomy) has been decreasing. However, the incidence of acute appendicitis (AA) in elderly patients is rising due to the aging of society. We aimed to identify chronological changes in demographics and appendiceal pathology among patients who underwent appendectomy for suspected AA. Data from 881 patients who underwent appendectomy for suspected AA between January 2006 and December 2017 were analyzed. The final diagnosis was based on intraoperative findings, pathological reports, and clinical course. Negative appendectomy was defined as the absence of appendiceal diseases including inflammation, fibrosis, and neoplasm. We compared demographics and appendiceal pathology between early (2006-2011) and late study phases (2012-2017). The mean age of patients with pathologically proven AA (n = 761) was significantly greater in the late phase than in the early phase (38.6 ± 19.8years vs. 44.0 ± 20.3years, p = 0.0002), and the ratio of patients with AA aged ≧75years was also increased (from 5.6 to 8.6%, p = 0.1120). The incidences of complicated appendicitis (defined as perforated or gangrenous appendicitis) and appendiceal diverticulitis (AD) were increased in the late phase compared to those in the early phase (61.3% vs. 77.2% and 3.7% vs. 6.6%, respectively). The negative appendectomy rate was significantly reduced in the late phase compared to that in the early phase (10.0% vs. 2.5%, p < 0.0001). During a 12-year period, the mean age of patients with AA and the incidences of complicated appendicitis and AD increased, whereas the negative appendectomy rate decreased.

Diagnosis of appendiceal diverticulitis by multidetector computed tomography.

Because appendiceal diverticulitis (AD) has a high risk of perforation, precise diagnosis is important for patients with suspected acute appendicitis (AA). In this study, we aimed to reveal the characteristics of computed tomography (CT) images of AD. CT images were comparatively analyzed in patients who underwent appendectomy and had histopathologically proved AD (n = 23) or AA (n = 365) to reveal specific findings of CT image for AD and determine sensitivity and specificity of CT for AD. Univariate analysis showed that maximal diameter of the appendix in AD was significantly smaller than that in AA. Multivariate analysis showed that saccular structure of the appendix wall, cecum or ascending colon diverticulum and peri-appendiceal or -cecal fluid collection were significant independent indicators of AD. Based on that saccular structure of the appendix wall which was the most important specific finding, the sensitivity and specificity of CT for AD were 48% and 99%, respectively. The saccular structure of the appendix wall, cecum or ascending colon diverticulum and peri-appendiceal or -cecal fluid collection in CT suggest AD in patients with suspected AA. The sensitivity and specificity of CT for diagnosing AD were 48% and 99%, respectively.

Two Cases of Appendiceal Diverticulitis Presenting as Multilocular Cystic Lesions by CT Examination

Two Cases of Appendiceal Diverticulitis Presenting as Multilocular Cystic Lesions by CT Examination

Perforated Appendiceal Diverticulitis Diagnosed Preoperatively; Report of a Case

Perforated Appendiceal Diverticulitis Diagnosed Preoperatively; Report of a Case

Appendiceal Diverticulitis as a Cause of Acute Appendicitis

Appendiceal Diverticulitis as a Cause of Acute Appendicitis