A Case of Difficult-to-diagnose Acute Abdomen that Demonstrated Onset of Perforation of the Appendiceal Diverticulum

Abstract

An 86-year-old woman came to our hospital with right lower quadrant abdominal pain and was examined for suspected acute appendicitis. Abdominal CT scan revealed dilatation of the cecum, however, neither swelling of the appendix nor abdominal free air was detected. Thus the initial diagnosis was made as fecal ileus, but contradictory to acute appendicitis, and a conservative treatment was conducted. Two days after admission, an abdominal CT scan was performed again because of persistent abdominal pain, and swelling of the appendix was then detected. An appendectomy was performed under the diagnosis of acute suppurative appendicitis, although perforation of the appendix was observed intraoperatively. Histology of the surgical specimen revealed perforation of the appendiceal diverticulum as well as acute phlegmonous appendicitis. We report herein on a case of perforated appendiceal diverticulum in which difficulty was encountered in the diagnostic process.