Description

Appendiceal diverticulosis is a rare occurrence, with a quoted incidence of 0.004–2% of surgical appendectomy specimens.1^–3 It is a recognised differential consideration in patients presenting with lower abdominal pain or in cases of suspected appendicitis. The patients are usually asymptomatic, occasionally incidentally discovered intraoperatively or during imaging studies (fig 1). Approximately two thirds of these patients go on to develop diverticulitis of the appendix.1^,3 This has been described with a rather different clinical picture from acute appendicitis; the patients are in a slightly older age group with an average age of 38.8 years as opposed to 19.5 years,1 and the pain is more intermittent with a more insidious course.1^,2 Higher risks of serious complications such as early perforation, haemorrhage and pseudomyxoma peritonei have been reported with appendiceal diverticulitis.1^–3 Hence, prophylactic appendectomy has been proposed as a treatment option.2

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Figure 1

Images taken from a barium enema study, demonstrating multiple colonic diverticula including that of the vermiform appendix. The patient was an asymptomatic 62-year-old Chinese man who presented with a positive faecal occult blood test.

The diverticula are more commonly of the acquired form (pseudodiverticula),1^–3 and is differentiated from the rare congenital diverticula by the content of their wall. Pseudodiverticula contains only mucosa, submucosa and serosa, whereas that of the congenital diverticula contains all layers of bowel wall. Muscular weakness or defect may contribute to the formation of pseudodiverticula, whereas the congenital form is associated with chromosomal abnormalities.2^,3 Both forms are more common in men.1^,3