Appendiceal diverticulitis: A rare case report highlighting diagnostic challenges and complication risks

Abstract

INTRODUCTION AND IMPORTANCE: Diverticular disease of the appendix is a rare condition often mistaken for acute appendicitis, with most cases diagnosed incidentally during histopathology, underscoring the importance of comprehensive pathological evaluation for accurate diagnosis. CASE PRESENTATION: A 34-year-old male presented with one day of periumbilical pain migrating to the right iliac fossa, without vomiting or bowel changes. Clinical examination revealed tenderness in the RIF. Laboratory tests indicated a syndrome inflammatoire biologique. Ultrasound and CT scans suggested appendicular diverticulitis. Laparoscopic appendectomy confirmed an inflamed diverticulum. The patient had an uncomplicated recovery and was discharged on day 1, with no anomalies noted at one-year follow-up. CLINICAL DISCUSSION: There are two types of appendiceal diverticula: congenital and acquired. Congenital diverticula result from outpouching of all appendiceal layers, while acquired diverticula arise from increased pressure due to factors like fecaliths or tumors. Risk factors for diverticular disease of the appendix (DDA) include male gender and age over 30. Diagnosing appendiceal diverticulitis preoperatively is challenging, often relying on ultrasound and CT findings. Appendicectomy is the preferred treatment, with pathological evaluation necessary for diagnosis. Prophylactic appendicectomy is advised for incidentally detected diverticular disease due to associated risks of perforation and malignancy. CONCLUSION: The differential diagnosis of appendiceal diverticulitis is a rare but significant condition with increased risks of complications and malignancy. Early diagnosis and surgical intervention are crucial for effective management, highlighting the importance of thorough pathological evaluation in confirming the diagnosis.