Diverticular Disease of the Appendix: A Rarely Identified Pathology Prior to Surgery

TL;DR

A rare condition called diverticular disease of the appendix was identified after surgery in a patient initially thought to have appendicitis.

Contribution

The paper highlights the importance of recognizing DDA intraoperatively and suggests managing it with appendectomy.

Findings

DDA is often identified intra- or postoperatively and is associated with higher risks of perforation and malignancy.

The case suggests that simple appendectomy is sufficient when DDA is identified during surgery.

Early identification of DDA remains a clinical challenge.

Abstract

Diverticular disease of the appendix (DDA) remains a rare and poorly understood entity. We present a female patient in her 30s who initially presented for what was believed to be tip appendicitis after imaging. The patient was brought to the operating room (OR) for a laparoscopic appendectomy, and pathology, five days postoperatively, revealed acute appendicitis with DDA. While the patient’s abdominal pain had resolved by this time, her case brings into question how DDA should be managed. DDA holds a greater risk of perforation and has a high association with malignancy. Given its significant association with primary appendiceal malignancy, increased risk of perforation, diverticulitis, and chronic abdominal pain, DDA should be managed with a simple appendectomy when identified intraoperatively. The majority of cases are identified intra- or postoperatively. Future directions include whether a hemicolectomy should be performed if DDA is found. However, failure of early identification remains a current clinical weakness.

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