Abstract
A 53-year-old man was admitted to our hospital on an emergency basis with right lower quadrant pain that developed one day after the onset of upper abdominal pain. Blood tests on admission showed a white blood cell (WBC) count of 15,200/mm3 and a C-reactive protein (CRP) level of 7.56 mg/dL, indicating inflammation. Abdominal contrast-enhanced CT showed thickening and a tumor in the intestinal wall of the ileocecal region and an abscess cavity around the appendix. The patient was diagnosed as having acute appendicitis with tumor formation, and a laparoscopic interval appendectomy (lapIA) was performed. A tumor approximately 1 cm in size was detected on the mesenteric side of the base of the appendix, and a histopathological diagnosis of a true diverticulum with a muscle layer was made. The patient was able to resume eating the day after surgery, and he was discharged three days postoperatively after an uneventful course. True diverticulum of the appendix is a rare disease, and this is only the 12th case reported in Japan. In diverticulum of the appendix, inflammation is often followed by perforation. Abscesses are therefore commonly observed in the ileocecal region on initial examination, and highly invasive surgery, such as ileocecal resection, is often required. In this case, lapIA was considered useful as an alternative to these procedures.
