Two cases of True Diverticulosis of the Appendix

Abstract

We report two rare cases of true diverticulosis of the appendix. Case 1: A 65-year-old man visited our hospital complaining of right lower abdominal pain. Abdominal computed tomography (CT) showed swelling of the appendix and the patient was admitted with the suspected diagnosis of acute appendicitis. On the 2nd hospital day, emergency laparoscopic appendectomy was performed, because antibiotic therapy proved ineffective. Case 2: A 56-year-old man with complicated appendicitis was transferred to our hospital from another hospital because of worsening of the condition over a period of eight days. He complained of right lower abdominal pain and examination revealed muscle guarding. Abdominal CT revealed appendicitis with abscess formation and emergency open appendectomy was performed. In both cases, the resected specimen showed diverticulosis and pathological examination indicated acute inflammation of the true diverticula. Especially in Case 2, histopathological examination revealed diverticulitis with perforation. A review of the literature revealed that true diverticulosis of the appendix is rare, with only 16 cases reported in Japan. Although these previous reports suggested that diverticulosis of the appendix is highly prone to perforation in the presence of acute inflammation, we considered that differential diagnosis from acute appendicitis is difficult preoperatively in the presence of complicating diverticulitis.