Appendiceal diverticular disease

Summary Introduction As a rule, diverticulosis of the appendix is identified incidentally during a pathological examination after an appendectomy. The disease is rare and easily ignored. Only one case has been reported in Taiwan. Aim In this study, we retrospectively reviewed the medical records of patients who had undergone appendectomy at the Ton Yen General Hospital, a local hospital in Taiwan. Methods From June 2004 to May 2012, 10 patients with appendiceal diverticulosis were documented. Their clinical presentations, laboratory data, and pathological characteristics were analyzed. Results All patients were diagnosed after their operations. The incidence rate was 0.88% (10/1131). The patients comprised eight men and two women. The age distribution was 22–71 years with an average of 39.2 years. All diverticula were acquired, not congenital. Eight patients presented with acute appendicitis and diverticulitis, one patient presented with a normal appendix and acute diverticulitis, and one patient presented with periappendicitis with a noninflammatory diverticulum. Three patients also presented with mucoceles, one patient with a hyperplastic polyp, and two patients had a severe case of inflammation with epithelial regenerative atypia and mild dysplasia. The number of diverticula for each patient ranged from one to six. Multiple diverticula were present in 80% of the patients. In 90% of the patients, the diverticula were located in the distal portion of the appendix. Perforation was noted in seven (70%) patients. Conclusion The diverticula could have been preoperatively diagnosed with careful differentiation of the clinical presentations. High-resolution ultrasound or CT scans may facilitate diagnosis. The recommended treatment for asymptomatic appendiceal diverticulosis is prophylactic appendectomy because of the high perforation rate and a significant association with neoplasia. Once a surgical specimen is obtained, we advise conducting a thorough pathologic examination and securing additional sections to identify a greater number of diverticula, perforations, and associated neoplasms.