Indraneil Mukherjee, Zach Garcia, Weihua Song, Jocelyn Villanueva, Kokila Mody. Staten Island University
Introduction: Appendiceal diverticulitis, a rare but distinct clinical entity that was 1st described in 1983 by Kelynak. It can be both congenital or acquired, however the former is extremely rare with an incidence of 0.014% while acquired has an incidence of 1.9%. Appendiceal diverticulitis may mimic acute appendicitis, however, it occurs in relatively older age group, with a fourfold increased risk of perforation and 30 times increased mortality as reported in the literature. They are also frequently associated with mucinous adenomas and carcinoid tumors.
Presenting Cases: We present two cases of congenital appendiceal diverticulitis encountered in our hospital in the last one year.
Case 1: He is a 30-year-old man, who presented to the ED with right lower abdomen pain with nausea and vomiting. The patient was afebrile with a WBC count of 13.1K/mm3. Acute appendicitis was suspected, and the patient underwent a Laparoscopic appendectomy. The histological diagnosis revealed an acute appendicitis and periappendicitis, in a 3.4cm long tip of appendix and a separate 1.7cm long congenital diverticulum.
Case 2: She was a 30-year-old lady, with right lower abdomen pain for 1 day. She presented with a WBC count of 8.9K/mm3. Post Laparoscopic appendectomy, her histological diagnosis revealed, a 5 cm appendix with acute appendicitis in the appendiceal diverticulum.
Both patients were discharged on post-op day 1 and recovered well.
Discussion: Histologically acquired diverticuli are usually seen at the distal end of the appendix, ranging from 2-5 mm and described as “pseudo diverticuli”. They have only the mucosa and submucosa herniate through a defect in the muscle layer. A herniation of all three layers is seen in the congenital form, which is located on the antimesenteric edge of the appendix.
Appendiceal diverticulitis has been classified in 4 sub-types. Type 1 occurs when a normal appendix is found with an acutely inflamed diverticulum. Type 2 implies an acutely inflamed diverticulum with surrounding appendicitis. Type 3 is a normal appendicitis with an incidental uninvolved diverticulum. Type 4 is an incidental appendiceal diverticulum with no evidence of appendicitis or diverticulitis. Both of our cases were Type 2.
Results: Appendiceal diverticulitis while rare should be considered in right lower quadrant pain. Due to its milder symptoms at presentation, they can often get missed and result in perforation. Therefore, we recommend prompt appendectomy on diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94832
Program Number: P329
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster