![]() ![]() Here, we report a case of an elderly woman who was incidentally found to have FO of an appendiceal diverticulum after laparoscopic appendectomy for a suspected mucocele neoplasm of the appendix. Many cases of FO of the appendix can also mimic appendicitis-like symptoms. Repetition of this subclinical inflammatory process yields fibrosis as an end-product. This process causes hyperplasia of the neuroendocrine cells in the lamina propria and submucosa of the appendix wall. The pathogenesis of this phenomenon is unknown however, various studies hypothesize the etiology as secondary to recurrent lapses of inflammation. He examined the specimens under electron microscopy, which discovered the cells to contain secretory granules of serotonin and somatostatin in their cytoplasm. įibrous obliteration (FO) is a proliferative lesion that was first described by Masson in 1928. The current evidence is limited to only case reports and retrospective studies however, the current recommendation is to pursue appendectomy as DA increases the risk for future appendiceal perforation and coexisting appendiceal neoplasms. Diagnosis can also be attained through barium enema if there is suspicion of DA in the clinical setting. Most cases of DA are discovered incidentally during post-operative histopathologic evaluation of the specimen or during intra-operative laparoscopy. ĭA can be completely asymptomatic or present similarly to acute appendicitis if the diverticulum becomes inflamed. The acquired form is more prevalent and consists only of mucosal herniations through a muscular defect on the mesenteric border of the appendix, constituting a false diverticulum. The congenital form is extremely rare and consists of herniation of all layers of the appendiceal wall, constituting a true diverticulum. Since it was first characterized in 1893, this condition has been characterized as either congenital or acquired. If DA is discovered early with non-invasive imaging, surgical excision should be performed prophylactically as an association with an increased risk of perforation and neoplastic progression has been found.ĭiverticulosis of the appendix (DA), or appendiceal diverticular disease (ADD), is a rare occurrence with an incidence ranging from 0.004% to 2.1%. This may be the first case of diverticulosis of the appendix with FO in the English medical literature. An extensive literature search was performed, which revealed no other cases of FO of appendiceal diverticula. We suspect the chronic nature of her disease course may have led to the FO of the diverticulum. The histologic evaluation of the specimen demonstrated a diverticulum at the distal end of the appendix with FO of the lumen. The patient underwent laparoscopic appendectomy for suspicion of malignancy. We report a case of a 75-year-old female with a history of chronic, intermittent abdominal pains who presented to the general surgery clinic after an abnormal thickening of the appendix was discovered on abdominal and pelvic computed tomography imaging. Fibrous obliteration (FO) is a histologic finding indicative of cellular proliferation secondary to relapses of subclinical inflammatory processes. Some cases are discovered after presenting with similar symptomatology to acute appendicitis, whereas other cases may be completely silent. Diverticulosis of the appendix (DA) is rare and frequently found incidentally.
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