Laparoscopic resection of giant pseudo diverticulum of appendix: a very rare disease

Hiromitsu Ito¹, Naoto Nhisi¹, Haruhiko Aoyagi¹, Katsumi Higuchi¹, Keita Koseki¹, Ichiro Watanabe¹, Masashi Ito¹, Marius Calin, MD², Baongoc Nasri, MD³. ¹Toujun Hospital, ²Virtua Hospital New Jersey, ³Saint Vincent Hospital Indianapolis

Diverticulosis of the appendix is a rare disease found in 0.004% to 2.1% of appendectomies, first described in 1893. The clinical presentation may be acute inflammatory  with or without appendicitis or it may be an incidental finding in an uninflamed appendix. The congenital type is rare and it has all the bowel wall layers. It most frequently represents as pseudo diverticulum which lacks the muscularis layer. The pathogenesis of appendiceal diverticula is not completely elucidated. Its symptoms are similar to and often misdiagnosed for that early acute or chronic appendicitis. While appendectomy is curative for both entities, it is important to distinguish diverticulum of the appendix from appendicitis as it is four times more likely to perforate and may be a sign of an underlying neoplasm. We reported a very rare giant pseudo diverticulum of the appendix in a 69-year-old male presenting with chronic abdominal discomfort for months. Abdominal X-ray showed abnormal gaseous finding. Physical exam was significant for a soft rubbery mass in the periumbilical region. Blood work revealed slight elevation of C-reactive protein. Preoperative CT and MRI showed a 9-centimeter- large cavity composed of thin wall, located at the tip of the appendix with peri appendicular fat stranding. In the concern of pending obstructive symptom and chronic abdominal pain, we decided to perform the resection laparoscopic. The soft mass arose from the tip of the appendix. There were dense adhesions between the appendix, mesentery, and sigmoid colon. After adhesiohedlysis, laparoscopic appendectomy was performed with EndoGIA. The specimen was extracted through a small incision without spillage. Hospital course was uneventful and the patient was discharged on post-operative day 4. The pathological finding was consistent with a pseudo diverticulum of the appendix which lacked muscularis layer and the inner wall of the cavity was lined with a scattered cubital epithelial layer in the continuity with the appendiceal mucosal membrane. Here we report a successful laparoscopic resection of an extremely rare giant chronic pseudo diverticulum of the appendix.

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86408

Program Number: P176

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster