Acute appendicitis without appendicitis

Abstract

Introduction: A clinical, imaging, and laboratory constellation for acute appendicitis requires operative treatment to avoid life-threatening complications such as perforation and peritonitis. The latter, in turn, are an absolute indication for surgical intervention. Although it does not change the operative approach, in rare cases, the cause of the condition is appendicular diverticulitis—usually an incidental, pathological diagnosis with a literature frequency of 0.004–2.1%. The differential diagnosis of diverticula of the appendix in patients with acute appendicitis is important because of the higher risk of developing the above complications, but also because of primary neoplasms of the appendix. The latter are rare Tu with a frequency of 0.2–0.5% of all GIT neoplasms. Among them, carcinoids are the most common and are characterized by slow growth and a long asymptomatic course. However, they often present with the picture of acute appendicitis with/without perforation, abscess or peritonitis.
Materials, Methods and Results: The study was single-center, retrospective. Three patients with histologically verified appendicular diverticulitis with perforation and periappendicular abscess are presented, necessitating laparoscopic appendectomy (1 case), conventional appendectomy (1 case), right hemicolectomy (1 case). Adenocarcinoma of the appendix was proven in two patients with laparoscopic appendectomy.
After verification of the permanent histological result and after discussion with the hospital Oncology Committee in the first case, the operation performed was determined to be sufficient in view of the oncological radicality. In the second case, reoperation with right hemicolectomy was recommended for histological evidence of T3 adenocarcinoma of the appendix. An appendicular mucocele was pathologically proven in one of the patients after laparoscopic appendectomy.
Conclusion: The differential diagnosis of diverticulitis of the appendix in patients with acute appendicitis is important due to the higher risk of developing the above complications, but also because of primary neoplasms of the appendix. The latter are rare Tu with a frequency of 0.2-0.5% of all GIT neoplasms, which can also present with the picture of acute appendicitis with/without perforation, abscess or peritonitis.