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Diverticulitis of the appendixReport of sixty-one cases

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Abstract

Analysis of ninety cases of diverticulum of the appendix makes it possible for us to classify this lesion into five main groups, thus recognizing this disease as a definite pathologic entity.

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... Luc Deschenes et al. in 1971 described five morphological types [6]. The first is the presence of primary diverticulitis with or without peri-diverticulitis. ...
... The fourth type is a simple diverticulum with acute appendicitis (the diverticulum is uninvolved in the inflammatory process). Lastly, the fifth type is the presence of chronic peri-diverticulitis with acute appendicitis [6]. The morphological classification of diverticular disease of the appendix was similarly described by Lipton et al. in 1989 [7]. ...
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Introduction Diverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung’s disease, cystic fibrosis and adult age, where some reports claim that they are also associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitis and one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methods A total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied. The demographic details and clinical data including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. Results The study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptoms were right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. Conclusion Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula - this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.
Article
Despite their similar clinical characteristics, appendiceal diverticulitis (AD) and acute appendicitis (AA) are pathologically distinct. This study compared the clinical features of AD and AA and identified relevant risk factors. Patients who underwent appendectomy with a preoperative diagnosis of either AD or AA were categorized based on histopathological findings. The two groups were compared in terms of various clinical factors. Among the 854 patients included in the study, a histopathological evaluation revealed 49 and 805 cases of AD and AA, respectively. A univariate analysis demonstrated that AD was more prevalent than AA among older, taller, and heavier males. A multivariate analysis revealed that male sex, a white blood cell (WBC) count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a mean corpuscular volume (MCV) ≥ 91.6 fL were significant factors differentiating AD from AA. In addition, pathological AD emerged as an independent risk factor for abscess and/or perforation. AD was associated with an older age, robust physique, and significant risk of abscess and/or perforation despite a low WBC count. In addition to imaging modalities, the preoperative factors of male sex, a WBC count < 13.5 × 103/μL, an eosinophil count ≥ 0.4%, and a MCV ≥ 91.6 fL may be useful for distinguishing AD from AA.
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Diverticulosis of the appendix (DA) is rare and frequently found incidentally. Some cases are discovered after presenting with similar symptomatology to acute appendicitis, whereas other cases may be completely silent. Fibrous obliteration (FO) is a histologic finding indicative of cellular proliferation secondary to relapses of subclinical inflammatory processes. We report a case of a 75-year-old female with a history of chronic, intermittent abdominal pains who presented to the general surgery clinic after an abnormal thickening of the appendix was discovered on abdominal and pelvic computed tomography imaging. The patient underwent laparoscopic appendectomy for suspicion of malignancy. The histologic evaluation of the specimen demonstrated a diverticulum at the distal end of the appendix with FO of the lumen. We suspect the chronic nature of her disease course may have led to the FO of the diverticulum. An extensive literature search was performed, which revealed no other cases of FO of appendiceal diverticula. This may be the first case of diverticulosis of the appendix with FO in the English medical literature. If DA is discovered early with non-invasive imaging, surgical excision should be performed prophylactically as an association with an increased risk of perforation and neoplastic progression has been found.
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Appendicular diverticulosis is a rare condition observed in about 0.004–2% of all appendectomy specimens. Risk of perforation/bleeding is high and a relevant association with mucinous neoplasms is known. Appendectomy is indicated even in case of occasional finding. We present the case of a 22-year-old man who entered the Emergency Room for pain in right iliac fossa. Blood tests showed only a slight increase in C-reactive protein. Abdominal ultrasound (US) evidenced an appendix with thickened walls and a rounded fluid-filled hypoechoic lesion at its distal tip. Laparoscopic appendectomy confirmed the presence of mucocele. Postoperative course was uneventful and the patients discharged on postoperative day 3. Histological examination indicated diverticulitis/peridiverticulitis of the appendix and acute suppurative appendicitis. No perforation of the diverticula was detected. No neoplastic epithelium/mucous material was observed. In our case, preoperative US proved to be a useful alternative to computed tomography for the diagnosis.
Chapter
The vermiform appendix is often regarded as a rudimentary or vestigial organ in human beings. This view has been challenged time and again, and contrary to earlier considerations, its role in immunological surveillance of the gut is now well understood. The histology of the appendix to some extent overlaps and probably represents a transition between the terminal ileum and colon. Nevertheless, the appendix have several unique features and specialized cells. The different layers of appendix include an innermost columnar-lined mucosa with enterocytes, specialized cells like goblet cells, entero-endocrine cells, and Paneth cells, surrounded by submucosa with an externally located muscularis externa and serosa. The large lymphoid follicles, often with prominent germinal centers and with unique immunophenotype and functions, may represent an embryological extension of the Peyer’s patches of the terminal ileum. This chapters covers the congenital malformations, different forms of appendicitis with related granulomatous and infectious etiologies, and also provides an immunological perspective of the appendix. This is followed by a brief account on some of the rare non infectious conditions.
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Introduction: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. Methods: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. Results: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. Conclusion: DDA is a distinct clinical pathology associated with complicated appendicitis.
Chapter
Multiple non-neoplastic disorders can affect the appendix. Acute appendicitis is the most common finding seen in appendectomies. However, other disease processes such as ulcerative colitis and Crohn’s disease can have appendiceal involvement. Infections and rare entities such as Rosai-Dorfman disease and IgG4-related disease are also important to keep in the differential diagnosis when evaluation appendiceal specimen. The gross and histologic findings that can be seen in appendiceal specimens are described in this chapter.
Article
Aims To research and identify how often complicated diverticular disease of the appendix (ADD) shows histological mimicry of low grade appendiceal mucinous neoplasms (LAMNs) and to provide guidance on the useful histopathological features that allow the appropriate diagnosis to be made. Methods and results 74 cases of complicated appendiceal diverticular disease were identified from two specialist centres. Of the second opinion/consult cases, 71% of the ADD cases had been diagnosed by referring pathologists as LAMNs. Salient pathological features were identified and agreed upon to reach the applicable diagnosis. For a diagnosis of complicated diverticulosis, particularly when associated with mucus cysts, the following morphological features were regarded as important: relative retention of the normal mucosal architecture with lamina propria and a maintained crypt architecture, crypts arranged in regular array, epithelial hyperplasia and a lack of nuclear abnormalities extending the length of the crypts. In a formal case control study undertaken on 30 cases with each diagnosis, ADD and LAMN, loss of lamina propria, a filiform architecture and hypermucinosis were significantly associated with low grade appendiceal mucinous neoplasms. Mucosal neuromas were significantly associated with diverticular disease of the appendix. Conclusions This study represents the largest series in the world literature and serves to highlight the important pathological features to distinguish complicated diverticular disease of the appendix from LAMNs and emphasises the difficulties experienced by diagnostic pathologists in diagnosing complicated appendiceal diverticulosis. This is important as LAMNs have a significant risk of transcoelomic spread, whilst complicated appendiceal diverticulosis has no such risk. This article is protected by copyright. All rights reserved.
Article
Purpose : To clarify clinical features of appendiceal diverticulitis comparing with acute appendicitis. Methods : Among a series of 428 patients who underwent appendectomy for preoperative diagnosis of acute appendicitis or appendiceal diverticulitis and had comprehensive preoperative blood data, 344 patients histopathologically diagnosed with appendiceal diverticulitis (n=20) or acute appendicitis (n=324) were enrolled in the study. Clinical factors, including age, sex, body height, body weight, body mass index (BMI), association of abscess or perforation, and blood data taken immediately before surgery, were comparatively investigated between the two groups. Results : White blood cell count, neutrophil/lymphocyte ratio, alanine aminotransferase (ALT) in the appendiceal diverticulitis group were significantly lower than those in the acute appendicitis group (p<0.05), although there was no significant difference in age, sex, and BMI between the two groups. Total protein in the former group was higher than that in the latter group (p<0.05). Multivariate analysis showed that lower preoperative serum albumin, elevated ALT, and pathological appendiceal diverticulitis were significant independent factors for association of abscess or perforation. Prevalence of abscess or perforation in the appendiceal diverticulitis group was significantly higher than that in acute appendicitis group (30% vs 12%, relative risk : 2.5, odds ratio : 4.22, 95% confidence interval : 1.27-13.11, p=0.021). Conclusions : Appendiceal diverticulitis was more often associated with abscess or perforation despite with lower inflammatory reaction than acute appendicitis.
Article
Diverticulum of the appendix has been often reported in Europe and the United States. However, in Japan, only 44 cases have appeared in the literature and only 4 of them were diagnosed as diverticulum of the appendix before surgery. Five patients diagnosed a having diverticulum of the appendix are presented in this report: Case 1. A patient diagnosed as having appendicitis underwent surgery. A diverticulum was found in resected specimen of the appendix. Case 2. After a diagnosis of appendicular diverticulum was made by barium enema examination, appendectomy was performed. The others (cases 3-5) were diagnosed by barium enema examination. The number of cases without symptoms is considered to increase with careful investigation, and we suggest that surgery may not be required in such cases.
Article
A 56-year-old man visited our hospital with the chief complaint of gradually intensifying right lower quadrant abdominal pain. The abdomen was flat and soft, but there was tenderness in the right lower quadrant. Abdominal computed tomography showed a swollen appendix up to 8 mm in diameter with grape-like “multiple diverticula. The patient was diagnosed as having acute appendicitis with appendiceal diverticulosis, and underwent appendectomy. Multiple diverticula were detected in the enlarged appendix, but no perforation and abscess were found. Pathological examination indicated multiple true diverticula with muscle layer and infiltration of chronic inflammatory cells mainly composed of lymphocytes and plasmacytes at the body of appendix and diverticula. Histopathological diagnosis was appendicitis with true diverticulitis of the appendix. Diverticulosis of the appendix is a relatively rare entity. The majority are pseudodiverticula and true diverticula are very rare. We present a case of true diverticulosis of the appendix diagnosed preoperatively, with a review of the literature.
Chapter
Die Appendix ist in der Regel 6–10 (Grenzwerte: 0,5–35) cm lang und hat einen mittleren äußeren Durchmesser von weniger als 1 (bis maximal 3) em2,9. Sie geht gewöhnlich seitlich aus dem Zökum ab, wobei sich das Lumen abrupt verengt (Zylinderform). Die Trichterform mit Abgang der sich konisch verjüngenden Appendix vom tiefsten Punkt des Zökum aus ist hingegen selten (2–3% der Erwachsenen)3. Der Zugang zur Appendixlichtung wird (inkonstant) durch eine klappenartige Schleimhautfalte (Gerlach-Klappe) markiert.
Article
Objective: Diverticulosis of vermiform appendix (DVA) is a rare condition. It is usually diagnosed on barium enema, after appendectomy or by studying autopsy specimens. We report the first case of DVA diagnosed by colonoscopy. We also evaluated 1735 cases of DVA and performed qualitative meta-analysis (QMA) on the subject of DVA. Methods: 63 year old man with hematochezia was evaluated with colonoscopy. There was left colon diverticulosis, internal hemorrhoids and a benign colon polyp; the scope was passed onto the appendicular ostium. In the lumen of the appendix openings of two diverticula were seen. PubMed Search for DVA without time or language barrier was carried out. To facilitate QMA, summary sheets of publications were created. QMA was performed using the well-established methods of Qualitative Research e.g. Diagramming, Theme Repetition, Theme Saturation and Investigator Reflexivity. Results: The search produced 1735 cases of DVA for QMA. Among those patients where gender information was available, 61.6% were men. Single diverticulum was reported in 46.2%; multiple diverticula were seen in 53.8%; the mean age was 48.6 years. Incidence of DVA was 0.4% to 2.0%. Majority are acquired type (pseudo-diverticula) which explains the higher perforation rate. The question of prophylactic appendectomy in DVA is controversial. Conclusion: We report the first case of DVA diagnosed by colonoscopy. The prevalence of DVA is 0.4% to 2.0%. There is a slight male predominance. Majority are acquired type. Compared to usual appendicitis, diverticulitis in DVA occurs at a later age and incidence of perforation is higher. © 2011 Japan International Cultural Exchange Foundation & Japan Health Sciences University.
Article
A 82-year-old woman seen for lower abdominal pain was found in computed tomography to have a grape-like cystic mass with increased fat density below the ileocecal region. We conducted appendectomy under a diagnosis of acute appendicitis or appendiceal tumor. Resected specimen showed diverticulosis. Pathological examination indicated acute inflammation only at the tip of the appendix, and chronic inflammation at the true diverticulosis. True diverticulosis is rare, with only 6 cases reported in the Japanese literature. Some investigators recommend prophylactic appendectomy for asymptomatic appendiceal diverticulosis because it is highly prone to perforate in the presence of acute inflammation. This opinion has been based on inaccurate citation from outdated literature, acute appendicitis has equivalent risk of perforation among aged patients 65 years and older. We hold that no reason exists for prophylactic appendectomy in asymptomatic appendiceal diverticulosis.
Article
Diverticulitis has long been known to affect the right colon, and in recent years, our understanding has evolved in regard to the underlying cause. Appendiceal diverticulitis has yet to gain widespread recognition despite the fact that it was first described in 1893. Commonly dismissed by surgeons and pathologists as a variant of true appendicitis, appendiceal diverticulitis is a discrete clinical process that must be considered in the appropriate setting. We describe a case of appendiceal diverticulitis in a previously healthy 59-year-old man and review the literature.
Article
Background: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. Objective: To compare AA versus AD. Methods: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. Results: We included 449 patients, 442 typical AA (98.5%) and 7AD (1.5%). DA was more frequent in women (57%) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61%) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1% (range 84.6 to 89.6%) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6% (range 75.1 to 86.4%) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43%) and 80 AA (18%). Conclusion: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.
Article
Pseudodivertikel der Appendix sind selten. Histologisch handelt es sich um Mukosahernien durch Lücken in der Muskulatur. Häufig findet sich im Bereich eines derartigen Schleimhautvorfalles ein Gefäßdurchtritt. Die Pseudodivertikel neigen zu entzündlichen Komplikationen.
Article
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The authors present three cases report of appendicular diverticulum with associated diverticulitis, one of them asymptomatic. The clinical distinction between acute apendicitis and apendical diverticulitis is very difficult, the later usually with earlier suppuration. The are no consensus regarding preventive surgery for apendical diverticulitis. It is possible that incidence of apendicular diverticulum depends on careful anatomopathological exams.
Article
PurposeDiverticulosis is defined by the presence of diverticula along any segment of the GI tract. Diverticulosis and its associated complications may involve the appendix. The imaging and histological findings of 21 cases of diverticulitis of the appendix are reviewed.
Article
Vermiform appendix is an unusual site of diverticulosis. We present 3 examples of this entity and briefly review its pathogenesis and clinical significance. As a general rule, appendiceal diverticula are multiple, acquired naturally, and rarely associated with complications.
Article
Appendiceal diverticulitis is a rare pathologic entity that usually simulates acute appendicitis. However, it can present as a separate clinical entity that should be part of the differential diagnosis of right lower quadrant abdominal pain. Pre-operative diagnosis is rarely described but is important in preventing perforation and subsequent abdominal sepsis. We present a case of an atypical right iliac fossa pain syndrome caused by histologically proven appendiceal diverticulitis, pre-operatively diagnosed by computed tomography.
Article
Appendiceal diverticulitis has been difficult to distinguish from acute appendicitis clinically and radiologically. The purpose of this study was to describe multidetector computed tomography (MDCT) features of cases of pathologically proved appendiceal diverticulitis at our institution over a 36-month period. Seven of 156 patients who underwent appendectomy with the preoperative diagnosis of acute appendicitis were pathologically diagnosed with appendiceal diverticulitis. Two radiologists reviewed the MDCT images for these 7 patients. On MDCT, a total of 8 inflamed diverticula were visualized as small fluid-filled luminal structures with thick enhanced walls or as solid enhanced masses protruding from the appendix for 6 of 7 patients. For 2 of these 6 patients, MDCT revealed a total of 5 normal diverticula visualized as small air-filled luminal structures with thin walls. For 1 of the 7 patients, neither inflamed or normal diverticula could be identified on MDCT. MDCT revealed appendiceal wall thickening with a tiny or no luminal fluid collection for 5 patients and with a moderate fluid collection for 1 patient, and a normal appendiceal wall for 1 patient. Our results suggest that MDCT can reveal appendiceal diverticula and has potential in the preoperative diagnosis of appendiceal diverticulitis.
Article
A 50-year-old woman who was given a diagnosis of acute appendicitis was referred to our hospital. Because an abdominal enhanced CT revealed a dilated and cystic lesion in the appendix, operation was performed under the diagnosis of the suspicion of acute appendicitis or appendiceal mucocele. We performed laparoscopic cecal resection because of the intraoperative diagnosis of intussusception of the appendix. On the resected specimen, an elevated lesion was identified near the base of appendix. Histopathologically it was shown to be a true diverticulum in which the proper muscle layer are intact. To the best of our knowledge, this is the first report of true diverticulosis of the appendix with intussusception in the Japanese literature.
Article
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De Garengeot's hernia-a rare finding occurring mostly in women-is defined by the presence of the vermiform appendix within the sac of a femoral hernia. The incidence of appendicitis is rarer still, with less than a 100 cases reported to date. We present a unique case of an 84-year-old male patient with perforated appendiceal diverticulitis within a De Garengeot's hernia causing abscess and necrotizing infection of the overlying soft tissues.
Article
Low-grade appendiceal mucinous neoplasms may rupture and seed the peritoneum with bland neoplastic mucinous epithelium resulting, when grossly evident, in the well-known process pseudomyxoma peritonei. Appendiceal diverticula may also rupture, resulting in mucin on the appendiceal serosa, which may raise concern for an underlying appendiceal mucinous neoplasm. We report 11 cases of ruptured appendiceal diverticula that were initially either misdiagnosed as appendiceal mucinous neoplasms, raised concern for a neoplasm, or were thought to exhibit localized pseudomyxoma peritonei. Two cases showed eversion of the appendiceal lining onto the serosa; 1 showed collision between the diverticulum and endosalpingiosis, and 3 had rare nonneoplastic epithelial cells in extra-appendiceal mucin. Most cases showed mucosal hyperplasia, mild crypt disarray, and variable reactive atypia. Eight cases had mucosal neuromas or other neural changes. None of the patients progressed to pseudomyxoma peritonei during the follow-up interval (mean 23 mo). Pathologists should be aware that ruptured appendiceal diverticula may be associated with serosal mucin and even extra-appendiceal epithelium. Failure to distinguish this process from a mucosal neoplasm with rupture may result in unnecessary therapy and cause the patient undue alarm.
Article
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Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare. Appendiceal diverticulosis is usually an incidental finding and clinically asymptomatic. When symptomatic, it is usually complicated by acute or chronic diverticulitis with or without acute appendicitis. It presents with atypical abdominal signs and symptoms, mostly in adult males. Appendiceal diverticulitis is a distinct entity with several clinical and pathological differences from acute appendicitis. It has a more rapid progression to perforation and a higher rate of mortality. Therefore, appendiceal diverticulitis should be considered in the clinical differential diagnosis, especially in adult males with chronic abdominal pain. Appendiceal diverticulosis demonstrates a significant association with obstructing or incidental appendiceal neoplasms. It may play an important role in the development of pseudomyxoma peritonei, which is associated with appendiceal mucinous tumors. Therefore, meticulous gross examination and thorough histological examination of the entire appendicectomy specimen are essential. When discovered either by preoperative radiological investigations or during an exploratory operation, prophylactic appendicectomy is advocated to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm.
Article
The pathological changes occurring in a series of 1000 consecutive appendicectomies are reviewed. Normal appendix was diagnosed in 14% of cases, while 561 (56%) exhibited acute appendicitis; 53 (5%) had chronic inflammatory infiltrate associated with obliteration of the lumen of the tip of the appendix. Epithelial abnormalities included carcinoid tumours (1.4%), and primary appendiceal adenocarcinoma (1 case). There were a large variety of other abnormalities found and each one is briefly described.
Article
Bowel perforation is an infrequent complication of neonatal Hirschsprung disease, attributed to distal functional obstruction and proximal luminal distention causing ischemic necrosis of the bowel wall. Neonatal appendiceal perforation with Hirschsprung disease has been reported with abscess formation and, also, without significant gross inflammation. Pseudodiverticula of the appendix have occurred in adults with or without inflammation and with or without associated appendicitis or perforation with periappendicitis. Increased intraluminal distension and muscular contraction have been implicated in the pathogenesis. We are not aware of previous reports on pseudodiverticulum of the appendix in infants. A patient with total ganglionosis of the colon with appendiceal pseudodiverticulitis and periappendicitis is presented.
Article
The incidence, clinical features and pathology of nine cases of diverticula of the appendix in Malaysians are reported. The findings are discussed and compared with those previously reported. The pathogenesis of the lesion in eight cases is unknown. The rare association of lumenal obstruction by a carcinoid tumour and diverticulum formation in the appendix is seen in one case.
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We have discussed a case of appendiceal diverticulitis diagnosed at laparotomy, and reviewed the histologic and clinical findings. Although infrequently encountered, appendiceal diverticulitis must be entertained in the differential diagnosis of pain in the right lower quadrant, especially in the adult patient.
Article
A case of appendicitis that was associated with a rare congenital diverticulum of the appendix is presented, along with the results of a retrospective study of diverticulosis of the appendix over a 10-year period. The incidence of the condition in this series (0.65%) is similar to other published series; however, two cases involved rare congenital diverticula--only 43 of such cases have been previously recorded in the medical literature world-wide. The average age of patients who present with acute appendicitis with acquired diverticula (37.8 years) is greater than that of patients without the condition. The perforation rate of an inflamed appendix when diverticula were present (27%) was higher than when no diverticula existed (6.6%). Because of the earlier and higher perforation rate, it is proposed that appendicectomy be performed if an appendix with diverticula is found during the course of a laparotomy for some other condition.
Article
This paper presents a study of diverticulosis of the vermiform appendix in patients with cystic fibrosis. The records of two hospitals were reviewed. A total of 39 autopsy specimens and 18 surgical specimens were obtained. Diverticulosis of the appendix was found in 14 per cent (eight of 57) of all appendices. Two of these cases also showed diverticulitis. These results stand in contrast to the incidence of diverticulosis of the appendix in the general population, which has been measured at 1 to 2 per cent in various reviews.
Article
The classification, incidence, and pathogenesis of diverticula of the appendix are discussed. Review of the literature reveals 1,373 instances of appendiceal diverticula. Forty-three were “true” or congenital diverticula, and 1,330 were “false” or acquired diverticula. Twenty-four additional cases from the University of Michigan Medical Center are described.
Article
The clinical course of a patient with perforated diverticulitis of the terminal ileum is described and six other reports in the literature are reviewed. The acute symptoms and signs simulate those of acute appendicitis, although two patients were seen with a less acute stage of disease; one had an enterovesical fistula and one (our patient) a walled-off abscess. Primary resection with ileotransverse colostomy is probably the preferred treatment, but mortality and morbidity have been significant.
Article
The vermiform appendix can be the site of development of diverticula which may suffer either inflammatory complications with or without appendicitis or may only be an incidental finding in an uninflamed appendix. This is a retrospective study of 10 of 575 cases of consecutive appendices removed and examined within a year, with single or multiple appendiceal diverticula with diverticulitis and peridiverticulitis. In six of the 10, the lumen of the appendix did not show any inflammatory changes. In conclusion, one could assume that inflammatory complications of the appendiceal diverticula, although they may mimic acute appendicitis, are quite distinct clinical entities. Acute appendicitis in the presence of appendiceal diverticula may carry an earlier and higher rate of perforation and appendiceal diverticula, as an incidental finding, may justify appendectomy on occasion.
Article
A case of diverticulosis of the appendix is described. The clinical significance is discussed.
Article
Appendiceal diverticulitis as the etiology of right lower quadrant pain is an uncommon entity in younger populations. The incidence is <1 per cent among patients under 30 years of age undergoing appendectomy. Herein, we present a case of a 17-year-old male with perforated appendiceal diverticulitis. The history, physical findings, diagnosis, and treatment are outlined. Additionally the literature concerning appendiceal diverticulitis is reviewed.
Article
Although acute appendicitis is the most common disease of the appendix, the appendix can be involved by a wide range of diseases. Diseases other than acute appendicitis may produce signs and symptoms indistinguishable from those of acute appendicitis. Computed tomography (CT) can provide important information for diagnosis and evaluation of appendiceal diseases. The various CT and histologic features of appendiceal benign and neoplastic diseases are discussed, illustrated, and correlated in this article. Radiologists need to understand the full spectrum of appendiceal abnormalities, their underlying pathologic changes, and associated CT imaging findings.
Article
Diverticulum of the vermiform appendix is rarely encountered. Previous reports in the literature indicate that appendiceal diverticulum without inflammations are asymptomatic. During the past 10 years, 217 patients have been evaluated in our office for chronic lower abdominal pain. Six patients in this group were unusual in that no diagnosis could be made after a complete history, physical examination, and multiple imaging and laboratory studies. Each patient had a normal computed tomography scan of the abdomen, upper endoscopy, colonoscopy, barium enema, and small bowel enteroclysis. Each of the 6 patients underwent an exploratory laparoscopy and appendectomy. All 6 patients in this series had acquired diverticulum of the appendix with inspissated intraluminal secretions without histological evidence of inflammation. The age range was 37 to 57 years. Most patients were male, and most had a single diverticulum projecting into the mesoappendix. All 6 patients had complete resolution of their chronic abdominal pain after the laparoscopic appendectomy. An unusual cause of mild chronic abdominal pain can be the presence of appendiceal diverticulum with inspissated intraluminal secretions. The evaluation of these patients is usually normal. Exploratory laparoscopy with appendectomy should be the final evaluation for patients with mild chronic abdominal pain.
Article
A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis. Congenital abnormalities of the appendix are rare; the two most commonly reported are congenital absence and appendiceal duplication. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma; nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Lymphoma affects the appendix exceptionally; in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Secondary involvement of the appendix by leukemia has been reported. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.
Article
Diverticulosis is defined by the presence of diverticula along any segment of the GI tract. Diverticulosis and its associated complications may involve the appendix. The imaging and histological findings of 21 cases of diverticulitis of the appendix are reviewed. Sonography, because of its high spatial resolution, is an ideal imaging technique to diagnose diverticulitis of the appendix. Similar to diverticulosis of the large bowel, diverticula of the appendix correspond to pseudo-diverticula composed of mucosa and sub mucosa herniating through the muscular layer. Chronic inflammatory changes affect the surrounding appendicular wall, as confirmed by histological examination. Clinical symptoms range from chronic right lower quadrant abdominal pain to acute appendicitis and even peritonitis. Based on this retrospective analysis of 21 cases, it is possible to describe the specific and sensitive imaging findings for diagnosis of simple and complicated forms of diverticulitis of the appendix. Surgery is the treatment of choice because of the high risk of perforation.
Article
The incidence of appendiceal diverticulitis in pathologic specimens is 0.004 to 2.1 per cent and is unusual in younger patients. Despite being first described in 1893, this condition is commonly dismissed by surgeons and pathologists as a variant of true appendicitis. However, appendiceal diverticulitis is a discrete clinical process that must be considered in the appropriate setting because of the much higher risk of perforation. The average age is older, the pain is often intermittent, and although it can be localized in the right lower abdominal quadrant, it is of longer duration. Although no further treatment in addition to appendectomy is needed, it is important that surgeons be aware of this condition, as the clinical presentation can be different from the classical acute appendicitis picture. Patients often seek medical treatment much later than those with classic appendicitis, and if there is a delay in establishing the correct diagnosis, perforation within the mesentery is found at the time of operation. Also, it is often mistakenly identified as carcinoma and it has higher rate of perforation and a longer convaslescence. We describe a case of a 42-year-old man and review the literature.
Article
The subject of diverticulum formation in the appendix has apparently aroused the interest of but few writers in Europe and America. It seems rather astonishing in these days of experimental investigation of almost every conceivable subject that this interesting, if relatively unimportant, process has never, so far as I can ascertain, been produced or studied experimentally. Hypotheses have been based on morphologic observations of the appendix itself, together with the application to the appendix of a few experiments made in the large and small intestine. The results are unsatisfactory because some of them, reported by earlier observers, either could not be reproduced, or produced entirely different and contradictory results, when repeated by others.It seems, therefore, that this condition deserves further investigation, particularly so inasmuch as I have become convinced during the past year that the condition is not nearly so infrequent as the few reported cases would lead one
Diverticulosis and Diverticulitis of the vermiform appendix.
  • Rabinovitch J
  • Arlen D
  • Barnett T
  • Duclo R
  • Rabinovitch P
A Contribution to the Pathology of the Vermiform Appendix
  • Kelynak