Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3921-3927
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3921
Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis
Daisuke Ito, Kenji Miki, Shimizu Seiichiro, Shojiro Hata, Kaoru Kobayashi, Masanori Teruya, Michio Kaminishi
Daisuke Ito, Kenji Miki, Shojiro Hata, Kaoru Kobayashi, Masanori Teruya, Michio Kaminishi, Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo 187-8510, Japan
Shimizu Seiichiro, Department of Pathology, Showa General Hospital, Tokyo 187-8510, Japan
Author contributions: Ito D, Miki K, Hata S and Kobayashi K research concept and design, collection and assembly of data; Seiichiro S collection and analysis of data; Teruya M critical review of the manuscript; Kaminishi M final approval of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daisuke Ito, MD, Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan. itoudaisuke5995@yahoo.co.jp
Telephone: +81-42-4620052 Fax: +81-42-4647912
Received: June 29, 2014
Peer-review started: June 30, 2014
First decision: July 21, 2014
Revised: September 11, 2014
Accepted: October 20, 2014
Article in press: October 21, 2014
Published online: April 7, 2015
Abstract

AIM: To study the clinical features and computed tomography (CT) findings of appendiceal diverticulitis vs acute appendicitis.

METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy in our institution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.

RESULTS: Among 451 patients, 44 (9.7%) were diagnosed to have appendiceal diverticulitis and 398 (86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older (59 vs 37 years, P < 0.001) and had a longer duration of the illness (4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher (68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients (52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix (84% vs 12%, P < 0.001), absence of appendicolith (92% vs 52%, P = 0.005), and formation of abscess (68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients (24%).

CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.

Keywords: Appendiceal diverticulitis, Acute appendicitis, Computed tomography, Appendectomy, Diverticulosis

Core tip: To study the clinical features and computed tomography (CT) findings of appendiceal diverticulitis, we retrospectively reviewed 451 patients who had undergone appendectomy in our institution. Among 451 patients, 44 (9.7%) were diagnosed with appendiceal diverticulitis. Patients with appendiceal diverticulitis were older and had a longer duration of illness. Perforation rates in patients with appendiceal diverticulitis were higher. CT findings suggestive of appendiceal diverticulitis included the absence of a fluid collection in the appendix, absence of an appendicolith (92% vs 52%, P = 0.004), and abscess formation. These findings make it possible to clinically differentiate appendiceal diverticulitis from acute appendicitis.