Abstract
Appendiceal diverticulitis is a relatively rare disorder that is difficult to diagnose preoperatively. We herein report a patient who underwent surgery after being diagnosed preoperatively on abdominal CT with appendicitis complicated by appendiceal diverticulitis and then discuss the literature. The patient was a 54-year-old man with a chief complaint of right lower quadrant pain. On palpation, tenderness, rebound tenderness, and abdominal quarding were observed around McBurney's point. Body temperature was 37.7°C, the leukocyte count was 15,900/μl, and the CRP was 3.1mg/dl. CT showed multiple diverticula of the cecum, an enlarged appendix with multiple diverticula, and opacity of fat tissue. Based on these findings, the patient was diagnosed as having appendicitis complicated by appendiceal diverticulitis and underwent surgery. Part of the appendiceal diverticula had perforated, and the patient had localized peritonitis due to acute phlegmonous appendicitis complicated by appendiceal diverticulitis. The perforation rate in appendiceal diverticulitis has been reported to be high (27-66%), over four times the rate in acute appendicitis. Due to the high rate of peritonitis and the high susceptibility to abscess formation and perforation, symptomatic patients diagnosed with appendiceal diverticultis associated with acute appendicitis on CT or by other means should be treated with surgery rather than conservative therapy, regardless of the degree of inflammation.
