Objectives

Ultrasound and computed tomography imaging of appendiceal divericulosis in patient with acute appendicitis.

Background

Divertivulosis of the appendix is a rare pathology and usually found in male of age >30 years old and divided to true and pseudodiverticulosis, acquired and congenital types. Clinically it may be asymptomatic or presented with chronic and intermitted abdominal pain, with some differences from acute appendicitis.

There are 4 subtypes of appendiceal diverticulitis:

1 Normal appendix with inflammated diverticuli

2 Acute diverticulitis with surrounding appendicitis

3 Conventional inflammation of appendix with incidental uninvolved diverticulum

4 Incidental diverticulum without inflammation of the appendix

Imaging findings OR Procedure findings

Diagnosis based on clinical evaluation; however ultrasound scan is very useful revealing usually small diverticuli of 2-5mm, larger diverticuli 1-3cm may also occur, rarely they are >8cm. In case of doubt, computer tomography can clear the picture.

Conclusion

Appendiceal diverticulosis should be kept in mind of a doctor because the correct diagnosis is very important, not only to prevent serious complications as perforation, with high mortality, but also appendiceal diverticulosis appears to be associated with neoplasm like carcinoid tumors or mucinous adenomas. For that reason appendectomy must be performed for symptomatic diverticulitis or appendicitis. However, if the patient is asymptomatic prophylactic elective appendectomy is preferred, with histological examination of the specimen.