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CASE REPORT |
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Year : 2014 | Volume
: 7
| Issue : 6 | Page : 758-759 |
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Diverticulosis of appendix
Falguni Rakesh Varma
Consulting General Surgeon, D.N.A. Hospital, Saraswati Hospital, Balahanuman Hospital, Residential Add., G-701, Satellite Garden Phase -1, Filmcity Road, Goregaon - East, Mumbai, Maharashtra, India
Date of Web Publication | 18-Nov-2014 |
Correspondence Address: Falguni Rakesh Varma Consulting General Surgeon, Res. address, G-701, Satellite Garden Phase -1, Filmcity Road, Goregaon - East, Mumbai - 400 063, Maharashtra India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.144868
Diverticulosis of appendix is rarely encountered. It is an uncommon cause of lower-right quadrant pain. Whether it presents symptomatically or is an incidental finding during surgery understanding its clinical behavior is important for proper management since it can significantly increase morbidity and mortality. It is also likely to be associated with pseudomyxoma peritonei. Appendectomy is the treatment of choice. A case of diverticulosis of appendix is described Keywords: Appendicular diverticulosis, more prone to perforation, right lower quadrant pain, rare condition, types of diverticulosis, treatment is surgery, uncommon
How to cite this article: Varma FR. Diverticulosis of appendix. Med J DY Patil Univ 2014;7:758-9 |
Introduction | | |
Appendicular diverticulosis was first described in 1893 by Kelynac. [1] Diverticulosis of appendix is rarely encountered. Appendicular diverticulosis as aetiology of right lower quadrant pain is also uncommon. Though it is a rare cause of pain in right quadrant, the possibility must be kept in differential diagnosis of abdominal pain. The vermiform appendix can rarely be a site of development of diverticula that may be found inflamed or noninflamed, with or without appendicitis. [2] Those with diverticulitis of appendix are four times more likely to have perforation than patients with only appendicitis, as a result resulting in higher morbidity and mortality. [3],[4] The mass may often be mistaken for carcinoma. [5] The incidence of diverticulosis of appendix found in appendectomy specimen range from 0.004% to2.1 %. [6]
Case Report | | |
A 56-year-old male presented us complaining of pain in right iliac fossa (RIF) not associated with vomiting or fever. Clinically patient had tenderness in RIF and incidental finding of right inguinal hernia. Sonography of abdomen was done that revealed an elongated tubular thick and hyper-echoic-walled rigid aperistaltic bowel segment in RIF. There was loculated fluid collection (measuring 21 × 13 mm) at tip of it suggestive of perforation of appendix.
Patient was operated for appendectomy. Intraoperative findings were of inflamed appendix with mass at tip of appendix [Figure 1].
Histopathological examination revealed diverticulosis of appendix with appendicitis [Figure 2].
Discussion | | |
Intestinal diverticula can be classified as congenital or acquired .Congenital diverticulum is true diverticulum, while acquired is false. Acquired diverticulum is present on mesenteric border of appendix often in association of arteriolar blood vessel thinning of muscularis propriea. [3] Mucosa is thought to prolapse through muscularis propriea due to constant increased intraluminal pressure. Patients with appendiceal diverticulitis present at average age of 38 years. [7] It is more common in men and in patients with cystic fibrosis. [3]
Appendiceal diverticulosis has been classified in to four subtypes. [5] They are as follows
Type 1: When there is noninflamed appendix with acutely inflamed diverticulum.
Type 2: When there is inflamed appendix with inflamed diverticulum.
Type 3: When there is inflamed appendix with non inflamed diverticulum (like found in the present case).
Type 4: When there is noninflamed appendix with non inflamed diverticulum.
In several cases pseudomyxoma peritonea have been reported with appendicular diverticulosis. [8] The diagnosis is seldom made before operation, during surgery it can be misinterpreted as carcinoma and hemicolectomy has been performed. [9] Sometimes CT scan of abdomen or barium meal follow through can diagnose it.
Although recognition of diverticulum at operation is difficult, it is probably not impossible if surgeon keeps the condition in mind on finding a bulbous or club-shaped appendix with a pronounced thickening of the mesentery. With such clues mistaken diagnosis of neoplasm can be avoided. [9],[10]
Although appendiceal diverticulosis is very rarely diagnosed, it has increased morbidity and mortality and also significant association with obstructing or incidental appendicular neoplasm. [11] Surgical treatment is advised whenever diagnosed.
Conclusion | | |
Diverticulosis of appendix is very rarely encountered. During surgery if it is encountered, it can be confused with carcinoma, or sometimes for appendicle lump. In past hemicolectomy has been done because it was confused with carcinoma. Also, it is very rarely diagnosed preoperatively. So appendicular diverticulosis, although rare should always be considered in differential diagnosis of RIF pathology. In view of increased possibility of perforation and significant association with appendiceal neoplasm, whenever it is diagnosed appendectomy should be performed.
References | | |
1. | Kelynack TN. A Contribution to the Pathology of the Vermiform Appendix. London, England: HK Lewis; 1893. p. 60. |
2. | Delikaris P, Stubbe Teglebjaerj P, Fisker-Sorensen P, Balslev I. Diverticula of the vermiform appendix: Alternatives of clinical presentation and significance. Dis Colon Rectum 1983;26:374-6. |
3. | Place RJ, Simmang CL, Huber PJ Jr. Appendiceal diverticulitis. South Med J 2000;93:76-9. |
4. | Simpson J, Lobo DN, Spiller RC, Scholefield JH. Diverticular abscess of the appendix: Report of a case and review of the literature. Dis Colon Rectum 2003;46:832-4. |
5. | Lipton S, Estrin J, Glasser I. Diverticular disease of the appendix. Surg Gynecol Obstet 1989;168:13-6. |
6. | Trollope ML, Lindenaur SM. Diverticulosis of the appendix: A collective review. Dis Colon Rectum 1974;17:200-18. |
7. | Lock JH, Wheeler WE. Diverticular disease of the appendix. South Med J 1990;83:350. |
8. | Lin CH, Chen TC. Diverticulosis of the appendix with diverticulitis: Case report. Chang Gung Med J 2000;23:711-5. |
9. | Yates LN. Diverticulum of the vermiform appendix. A Review of 28 cases. Calif Med 1972;116:9-11. |
10. | Halder SK, Khan I. An Indian female presenting with appendicular diverticulitis: A case report and review of literature. Cases J 2009;2:8074. |
11. | Abdullgafar B. Diverticulosis and diverticulitis of appendix. Int J Surg Pathol 2009;17:231-7. |
[Figure 1], [Figure 2]
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