Elizabeth A Verrico, DO, Lindsay Tse, DO, Maurizio Miglietta, DO. Hackensack Meridian Health Palisades
Appendiceal diverticulitits is an uncommon pathology that can clinically mimic acute appendicitis. Some radiographic distinctions have been reported, but final pathologic examination of the surgical specimen is required to confirm the diagnosis. Symptoms are often more mild, which can lead to a delayed diagnosis, and increases the risk of severe complications such as perforation.
A 48 year old female presented with a three day history of right lower quadrant pain. She described the pain as constant and radiating to the left lower quadrant. Associated symptoms included nausea and vomiting, and decreased appetite; she denied fevers or diarrhea. The patient had no significant past medical history, and surgical history was significant for a total nephrectomy for living donor kidney transplant to her mother. On physical exam she was tender in the right lower quadrant with rebound and a positive Rosving’s sign. All laboratory results were unremarkable, and she was hemodynamically stable. CT scan was performed and demonstrated a dilated fluid filled appendix with surrounding inflammatory change without abscess or free intra-peritoneal air. She was subsequently admitted to the hospital, made npo, started on IV antibiotics, and was taken to the operating room where she underwent an uncomplicated laparoscopic appendectomy. Post-operatively, her hospital course was unremarkable. Pathology revealed acute suppurative appendicitis secondary to an acutely inflamed appendiceal diverticula, consistent with a final diagnosis of acute appendiceal diverticulitis.
Appendiceal diverticulitis should be considered in patients presenting with acute right lower quadrant abdominal pain. Although some consider appendiceal diverticulitis a variant of acute appendicitis, it is important to distinguish between the two diagnoses. Appendiceal diverticulitis has a higher rate of complications, including perforation, and is associated with a higher risk of neoplasm, particularly mucinous adenomas and carcinoid tumors. Appendectomy should be performed in all cases in order to obtain appropriate pathological examination and rule out coexistent neoplasms. Laparoscopic appendectomy is a safe and appropriate approach to treatment of appendiceal diverticulitis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88306
Program Number: P156
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster