Incidental Appendiceal Diverticulosis Associated with Acute Appendicitis: A Case Report and Review of Literature

Abstract

Background: Appendiceal diverticulum (AD) is a rare surgical finding. This entity is classified as either congenital or acquired, with a reported incidence of 0.014% and 0.2-1.7%, respectively. AD can often be associated with acute or chronic appendicitis. Clinically, AD must be identified before any surgical procedure as its concomitant presence with acute or chronic appendicitis increases the risk of perforation and may be associated with underlying neoplasia such as low-grade mucinous adenoma. We hereby report a case of incidental appendiceal diverticulosis associated with acute appendicitis in an attempt to increase the physicians’ perception, knowledge, and awareness of this rare medical condition.

Case Presentation: We report a 40-year-old male patient, with no relevant family history, who presented to the Emergency Department after four days of vague and moderate epigastric pain and  nausea. The physical examination upon presentation was unremarkable. Computed Tomography (CT) scan was done and was suggestive of an inflamed appendix. The patient underwent an urgent laparoscopic appendectomy. The removed appendix was inflamed and grossly abnormal with multiple diverticulae. The patient had a smooth recovery.

Conclusion: Diverticulosis of the appendix is a rare clinical entity and, as in our case, is often diagnosed during or after appendectomy. When associated with acute appendicitis, it may be suspected preoperatively with the appropriate imaging technique. This is of paramount importance as it can rapidly progress to perforation and/or lead to a higher mortality rate.