2024 Volume 49 Issue 2 Pages 60-65
A 46-year-old man presented with right lower abdominal pain. Conservative management for acute appendicitis was initiated by the physicians. On the next day, signs of peritoneal irritation were observed in the right lower abdomen, prompting a referral of the patient to our department, where he underwent an emergency operation, with a suspicion of appendiceal perforation.
During the surgery, the appendix was observed to be swollen and adherent to the terminal ileum and retroperitoneum. Upon grasping the mesoappendix, a small amount of purulent fluid was released. However, no abscess had formed in the abdominal cavity. Therefore, laparoscopic appendectomy was performed. Macroscopically, a diverticulum was present on the mesenteric side of the middle portion of the appendix without perforation of the diverticulum nor abscess formation. Histopathological examination revealed that the appendiceal diverticulum was a true diverticulum with a muscular layer, and severe neutrophilic infiltration was observed at the tip of the diverticulum, leading to a diagnosis of penetrated true appendiceal diverticulum. The patient had an uneventful postoperative course and was discharged on the fifth day after surgery.
Appendiceal diverticula are rare diseases, and the true diverticula of appendix are even rarer. We report our case with a review of 28 cases reported in Japanese literature.
