Abstract
Diverticulitis of the appendix is reported relatively rarely in Japan, and a preoperative diagnosis is difficult. A 66-year-old man was diagnosed with oropharyngeal cancer and underwent chemotherapy. He began to experience abdominal pain 6 days later and pain in the right lower quadrant 4 days thereafter. Blood tests at this time revealed a white blood cell count of 1,800/µl and a C-reactive protein level of 16.0mg/dl. Abdominal computed tomography showed multiple diverticula and inflammation in the appendix, and diverticulitis of the appendix was diagnosed. On the same day, laparoscopic appendectomy was performed. The histological diagnosis was pseudodiverticulum and diverticulitis of the appendix. The postoperative course was uneventful. In Europe and the United States, asymptomatic patients diagnosed with diverticulitis of the appendix generally undergo preventive surgery because of the high reported perforation rate. In Japan, a standard treatment course has not been established. For symptomatic patients, we believe that surgery should be chosen over medication because of the high perforation rate. In this case, the patient received a second course of chemotherapy. Diverticulitis of the ascending colon with abscess formation and leukocytopenia was diagnosed six days later. Patients with compromised immune function should be managed with additional care.
