Diverticulitis Appendicis Vermiformis – A Case Review and Literature Overview

Czech version

Authors: L. Lakyová ¹; Ľ. Babjaková ²; M. Chýlová ³; J. Radoňak ¹
Authors‘ workplace: I. chirurgická klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Fakultná nemocnica L. Pasteura Košice, Slovenská republika, prednosta kliniky: prof. MUDr. J. Radoňak, CSc. ¹; Ústav patológie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Fakultná nemocnica L. Pasteura Košice, Slovenská republika, prednosta ústavu: prof. MUDr. A. Böör, CSc. ²; Klinika rádiodiagnostiky a zobrazovacích metód, Lekárska fakulta Univerzity Pavla Jozefa Šafárika Fakultná nemocnica L. Pasteura, Košice, Slovenská republika, prednosta ústavu: doc. MUDr. T. Jurgová, CSc., mim. prof. ³
Published in: Rozhl. Chir., 2009, roč. 88, č. 3, s. 136-141.
Category: Monothematic special - Original

Overview

Background:
Diverticulosis and diverticulitis of appendix vermiformis is a rare diagnosis with incidency of 0.004–2%. Because of intermittent pain and atypical problems patients with diverticulitis are surgically intervened later as patients with simplex appendicitis. Complications in regard to perforation of appendix are more frequent in 27% in diverticulitis and mortality of consequent peritonitis is 30 times higher than in simplex appendicitis.

Patients:
Authors present 0.1% incidency of diverticulitis of appendix in the group of 1496 patients with appendicitis. The case involved a man and a woman (age 59 and 61). In clinical picture predominated pain with the duration of two and three days with maximum in right lower abdomen. Patients showed no febrility, one of them had anorexia and constipation, one of them suffered from diarrhea. Mantrels score reached 5 and 7 points. In laboratory parameters elevated inflammatory markers (Leu: 11.5x10⁹/l, 11.44x10⁹/l; CRP: 182 mg/l, 96.3 mg/l) were detected. Ultrasonographic examination determined the diagnosis of subacute appendicitis in one case, a perforation of sigmoid diverticle in the second case. Appendectomy was performed in both patients, there was a finding of gangrenous and phlegmonous appendicitis. In both patients, a correct diagnosis of diverticulitis was determined only through histopathological examination

Conclusion:
Clinical and laboratory examinations did not showed a difference between progress of disease of diverticulitis and simplex appendicitis. In comparison to a control group, only a higher CRP was determined and also a 35 years higher age average. In neither case did the USG examination determine the exact diagnose. Urgent surgical operation prevented frequent complications presented in the literature.

Key words:
divertickel appendicis – diverticulitis – perforation – acute abdomen

Sources

1. Lamps, L., Gray, F. G., Dilday, B. R, Washington, M. K. The Coexistence of Low-Grade Mucinous Neoplasms of the Appendix and Appendiceal Diverticula: A Possible Role in the Pathogenesis of Pseudomyxoma Peritonei. Mod. Pathol., 2000; 13, 5 : 495–501.

2. Kabiri, H., Clarke, L. E., Tzarnas, C. D. Appendiceal diverticulitis. Am. Surg., 2006; 72 : 221–223.

3. Majeski, J. Diverticulum of the vermiform appendix is associated with chronic abdominal pain. Am. J. Surg., 2003; 186, 2 :129–131.

4. Place, R. J., Simmang, C. L., Huber, P. J. Appendiceal diverticulitis. South Med. J., 2000; 93: 76–79.

5. Kelynack, T. A Contribution to the Pathology of the Vermiform Appendix. London, JK Lewis, Publisher, 1893: 60.

6. Spriggs, E. I, Marxer, A. Intestinal diverticula. Brit. Med. J., 1926; 1, 130.

7. Trollope, M. L., Lindenauer, S. M. Diverticulosis of the appendix: A collective review. Diseases of the Colon & Rectum, 1974; 17, 2 : 200–218.

8. Favara, B. Multiple congenital diverticula of the vermiform appendix. Am. J. Clin. Pathol., 1968; 49: 60–64.

9. Everts-Suarez, E., Noteboom, G. Congenital diverticula of the appendix: a review of the world‘s literature and a report of a case. Pa. Med. J., 1961; 64: 1454.

10. Stout, A. A study of diverticulum formation in the appendix. Arch. Surg., 1923; 6: 793–829.

11. Lee, K. H., Lee, H. S., Park, S. H., Bajpai, V., Choi, Y. S. Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography. J. Comput. Assist. Tomogr., 2007; 31, 5: 763–769.

12. Bianchi, A., Heredia, A., Hidalgo, L. A., García-Cuyąs, F., Soler, M. T. Diverticular disease of the cecal appendix. Cir. Esp., 2005; 77, 2: 96–98.

13. Simpson, J., Lobo, D. N., Spiller, R. C., Scholefield, J. H. Diverticular abscess of the appendix: report of a case and review of the literature. Dis Colon Rectum, 2003; 46, 832–834.

14. Kubota T., Omori T., Yamamoto J., Nagai M. Sonographic findings of acute appendiceal diverticulitis World J. Gastroenterol., 2006; 12, 25: 4104–4105.

15. Barc, J., Rousset, B., Maignien, M., Lu, C. H., Prime-Guitton, J. F. Garcia Diverticula of the appendix and their complications: value of sonography (review of 21 cases). Journal de Radiologie, 2005; 86, 3: 299–309.

16. Jean, C. Diverticules de l’appendice vermiforme. Laval Méd., 1964; 35: 673–701.