Journal of General Practice

Appendiceal Diverticulosis in Acute Appendicitis: Our Experience and Literature Review

Abstract

Jaume Tur Martínez, Joaquin Rivero Deniz, Itziar Larrañaga Blanc, Esteban García Olivares, Xavier Rodríguez Alsina, Enrique Veloso Veloso

Background: The appendiceal diverticulum is an uncommon pathology. Its most common clinical presentation is the appendiceal diverticulitis and the symptoms are similar to acute appendicitis. Also, it can be considered as part of differential diagnosis for chronic abdominal pain.
Aim: Analyze the prevalence in our hospital of appendiceal diverticulosis in acute appendicitis and literature review.
Methods: Retrospective description study (January 2004 to December 2013) looking for presence of appendix diverticula in 1526 patients after appendectomy due to suspicion of acute appendicitis. Review of literature for term results: “appendiceal”, “appendicular”, “diverticulitis”, “diverticulosis”.
Results: Total sample: 2058 patients operated of appendectomy; 1526 of those were to suspicion of acute appendicitis and in 38 of those we found presence of appendiceal diverticula (2.49% prevalence). Distribution: men/ women (68.42%/31.57%), middle age (46.71 years). Lipton classification: Type I (28.94%), type II (34.21%), type III (21.05%) and type IV (15.78%). Other associations: carcinoid tumor (2.36%), villous adenoma (2.63%), serrated adenoma with low grade dysplasia (2.63%), perforated diverticula (7.89%), chronic diverticulitis (5.26%).
Conclusion: Prevalence is slightly higher in our series, probably because we considered only patients with acute appendicitis and not all surgical specimens with cecal appendix. According to reviewed bibliography there is possible relation with appendix neoplasias, more risk of perforation and mortality. It is a difficult pre-operative diagnosis and it has to be considered in the differential diagnosis for (acute and chronic) abdominal pain in right iliac fossa.