Diverticulitis Appendicis Vermiformis – A Case Review and Literature Overview

Česká verzia

Authors: L. Lakyová ¹; Ľ. Babjaková ²; M. Chýlová ³; J. Radoňak ¹
Authors place of work: I. chirurgická klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Fakultná nemocnica L. Pasteura Košice, Slovenská republika, prednosta kliniky: prof. MUDr. J. Radoňak, CSc. ¹; Ústav patológie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Fakultná nemocnica L. Pasteura Košice, Slovenská republika, prednosta ústavu: prof. MUDr. A. Böör, CSc. ²; Klinika rádiodiagnostiky a zobrazovacích metód, Lekárska fakulta Univerzity Pavla Jozefa Šafárika Fakultná nemocnica L. Pasteura, Košice, Slovenská republika, prednosta ústavu: doc. MUDr. T. Jurgová, CSc., mim. prof. ³
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 3, s. 136-141.
Category: Monothematic special - Original

Summary

Background:
Diverticulosis and diverticulitis of appendix vermiformis is a rare diagnosis with incidency of 0.004–2%. Because of intermittent pain and atypical problems patients with diverticulitis are surgically intervened later as patients with simplex appendicitis. Complications in regard to perforation of appendix are more frequent in 27% in diverticulitis and mortality of consequent peritonitis is 30 times higher than in simplex appendicitis.

Patients:
Authors present 0.1% incidency of diverticulitis of appendix in the group of 1496 patients with appendicitis. The case involved a man and a woman (age 59 and 61). In clinical picture predominated pain with the duration of two and three days with maximum in right lower abdomen. Patients showed no febrility, one of them had anorexia and constipation, one of them suffered from diarrhea. Mantrels score reached 5 and 7 points. In laboratory parameters elevated inflammatory markers (Leu: 11.5x10⁹/l, 11.44x10⁹/l; CRP: 182 mg/l, 96.3 mg/l) were detected. Ultrasonographic examination determined the diagnosis of subacute appendicitis in one case, a perforation of sigmoid diverticle in the second case. Appendectomy was performed in both patients, there was a finding of gangrenous and phlegmonous appendicitis. In both patients, a correct diagnosis of diverticulitis was determined only through histopathological examination

Conclusion:
Clinical and laboratory examinations did not showed a difference between progress of disease of diverticulitis and simplex appendicitis. In comparison to a control group, only a higher CRP was determined and also a 35 years higher age average. In neither case did the USG examination determine the exact diagnose. Urgent surgical operation prevented frequent complications presented in the literature.

Key words:
divertickel appendicis – diverticulitis – perforation – acute abdomen

Zdroje

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