Case Note Note de cas Diverticulitis of the appendix Martin Friedlich, MD, MSc, MEd;* Neesh Malik, MD;† Martin Lecompte, MD;† Yasmine Ayroud, MD‡ iverticulitis of the appendix is count was elevated; his medical his- diverticula can be classified as con- Dan uncommon cause of right- tory was significant only for sleep ap- genital or acquired. The congenital lower-quadrant pain. Whether it pre- nea. Because his size made him dif- form, which is very rare, is a true di- sents symptomatically or is an inci- ficult to assess, he was scanned with verticulum; the more prevalent ac- dental finding at surgery or barium CT (Fig. 1). The scan confirmed ap- quired form is a false diverticulum on enema, understanding its clinical be- pendicitis, but also showed suspected the mesenteric border of the appendix. haviour is important for its manage- diverticular disease of the appendix. The incidence of diverticula found in ment. We report here a case of ap- After laparoscopic appendectomy, appendectomy specimens ranges from pendiceal diverticulitis including what the pathology report confirmed ap- 0.004% to 2.1%; from routine autop- we believe to be the first reported pendiceal diverticulosis complicated sies, 0.20% to 0.6%.2 case of this condition diagnosed pre- by diverticulitis, peridiverticular ab- Patients with appendiceal divertic- operatively by CT imaging. scess and rupture (Fig. 2). ulitis present at an average age of 38 years.3 It is more common in men Case report Discussion and in patients with cystic fibrosis.2 Curiously, the patient in this case was A large 38-year-old man came to the Appendiceal diverticulitis was first de- also a 38-year-old man with a respir- emergency department with right- scribed in 1893 by Kelynack.1 As with atory condition. lower-quadrant pain. His leukocyte all intestinal diverticula, appendiceal Appendiceal diverticulitis has been FIG. 1. Computed tomographic scan of abdomen showing di- verticular disease of appendix. FIG. 2. Appendiceal diverticulosis. From the Departments of *Surgery, †Radiology and ‡Pathology, University of Ottawa, Ottawa, Ont. Accepted for publication Aug. 12, 2003 Correspondence to: Dr. Martin Friedlich, Ottawa Hospital—General Campus, 501 Smyth Rd. room 2003, Ottawa ON K1H 8L6; fax 613 739-6646; [email protected] 146 J can chir, Vol. 47, N o 2, avril 2004 ' 2004 Canadian Medical Association Diverticulitis of the appendix classified into 4 subtypes.1 Type 1 oc- increasing mortality 30-fold com- the management, as the appendix still curs when a normal-appearing appen- pared with simple appendicitis.1 In should be removed. dix is found with an acutely inflamed addition, several cases of pseudo- diverticulum. Type 2 involves an myxoma peritonei have been reported Competing interests: None declared. acutely inflamed diverticulum with from appendiceal diverticuli.4 This surrounding appendicitis, as seen may make removal of an appendix References in this case. Type 3 is conventional with diverticuli appropriate when appendicitis with an incidental un- found incidentally during surgery or 1. Phillips BJ, Perry CW. Appendiceal diver- ticulitis. Mayo Clin Proc 1999;74:890-2. involved diverticulum. Type 4 is an upon barium enema. 2. Place RJ, Simmang CL, Huber PJ. Ap- incidental appendiceal diverticulum A literature review by the authors pendiceal diverticulitis. South Med J 2000; with no evidence of appendicitis or found no case reference to appendi- 93:76-9. diverticulitis. ceal diverticulitis identifiable on CT. 3. Lock JH, Wheeler WE. Diverticular dis- Acute diverticulitis of the appendix The scans in our case report allowed ease of the appendix. South Med J 1990; 83:350. has been shown to be more than 4 consideration of appendiceal divertic- 4. Lin CH, Chen TC. Diverticulosis of the times as likely as acute appendicitis to ulitis before the operation. Although appendix with diverticulitis: case report. perforate (occurring in 66% of cases), this is of interest, it should not change Chang Gung Med J 2000;23:711-4. Essential reading from CMA Publishing Services • CMAJ • Canadian Journal of Surgery • Clinical and Investigative Medicine • Journal of Psychiatry & Neuroscience For information contact CMA Member Service Centre 888 855-2555 [email protected] Can J Surg, Vol. 47, No. 2, April 2004 147.