Hospital: HOSPITAL UNIVERSITARIO DE MÓSTOLES.
Aut@r o Autores: M. Torres Isidro, J. Sánchez Dalmau, M. Babarro Peleteiro, C.D. Córdoba Múñoz, S. Gutierrez Salazar, C. Romero Martínez.
A 33 years old female presented to the Radiology Department with the clinical suspicion of acute appendicitis. She had not fever but presented to de Emergency Room with right lower quadrant pain, 12500 leukocites (86% neutrophils) and C-reactive protein of 3 mg/l. The US scan showed a diverticular image at the base of the appendix with local fat inflammatory changes and normal distal diameter of the appendix. In the basis of the clinical and radiological findings, a late venous phase contrast enhanced scan was performed. The findings were similar to those of ultrasonograhy, visualizing a diverticulum with fecoliths at the base of the appendix, local fat stranding and small extraluminal air bubbles as an additional finding. The appendix was diffusely subtle enlarged. Our presumption radiological diagnosis was appendiceal diverticulitis.
Appendiceal diverticulitis (AD) is a rare diagnosis often misdiagnosed as appendicitis because of its similar clinical and imaging findings, however AD tends to be diagnosed later because of its insidious onset. Although their similar treatment with appendicectomy, it is important distinguishing between then because of the higher rates of complications (perforation and abscess formation) and association with neoplasms (carcinoid tumors and mucinous adenomas) in the appendiceal diverticulitis. At CT scan they can be differentiating by the visualization of the inflammed diverticulum, a high rate of perforation, and peri-appendiceal small fluid collections and fat stranding in the AD. It is reported a greater presence of appendicolith in the usual acute appendicitis. In the case we present it is visualized an inflammed diverticulum with local fat stranding and contained perforation in the peri-appendicular fat. It is not seen an appendicolith but it is observed a fecolith inside the diverticulum. Appendicectomy was performed with a pathologic diagnosis of gangrenous appendicitis and no evidence of diverticula. It can be explained because of the presence of severe inflammatory changes that could destroy the diverticula wall and inflammatory changes can extend secondary to the appendix.
We have to suspect appendiceal diverticulitis in the clinical setting of acute appendicitis when radiological images show an inflammed diverticulum at the appendix.
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