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International Journal of Colorectal Disease

, Volume 33, Issue 11, pp 1569–1574 | Cite as

Clinical significance of appendiceal diverticulum: a significant marker for appendiceal neoplasia in Australian patients

  • Daniel Leonard Chan
  • Christopher Lim
  • Arsalan Bakhtiar
  • Matthew Khoury
  • Michelle Smigelski
  • Dean Yeh
  • Praveen Ravindran
Original Article
  • 68 Downloads

Abstract

Introduction

Diverticula of the appendix (DA) have a reported incidence of up to 2.1%. They are primarily detected incidentally, through imaging and intraoperative or histologic diagnosis. This study’s objective was to examine the prevalence of DA, and its relationship with inflammation and neoplasia, as well as review the literature with respect to clinical outcomes and ability to identify DA preoperatively.

Methodology

A retrospective search of all patients undergoing an appendicectomy for right lower quadrant pain at a single institution between 2004 and 2017 was conducted. Histopathology reports for evidence of DA, location of the DA, presence of inflammation, and any relationship between DA and neoplasms (adenoma, carcinoma, carcinoid, lymphoma, and mucinous neoplasm) within the appendix were reviewed. Clinical notes, operative records, and preoperative imaging were also reviewed.

Results

Two thousand seven hundred eleven patient were included in the study, with a mean age of 34 years, with acute appendicitis found in 82.5%. 31.6% of patients with DA had associated inflammation of the DA. DA was present in 57 patients (2.1%), with 55 patients in the total cohort having neoplasia (2.0%). Patients with DAs were ten times more likely to have appendicular neoplasm than patients without a DA (17.5 vs 1.8%; p < 0.0001, OR 11.8 95%, CI 5.6–24.8).

Conclusion

This is the first Australian study demonstrating DAs are a significant marker of appendiceal neoplasm. Appendicectomy in all incidentally discovered diverticulum should be considered. Due to a paucity of data, research is required into this area to assess for the need for endoscopy following diagnosis.

Keywords

Appendix Diverticulum Neoplasms General surgery Appendectomy 

Notes

Compliance with ethical standards

Ethics approval was granted by the South Western Sydney Local Health District Human Research Ethics Committee, reference LNR/17/LPOOL/300, and this study was performed in accordance with standards laid down in the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Crown 2018

Authors and Affiliations

  1. 1.Department of SurgeryCampbelltown HospitalSydneyAustralia
  2. 2.Faculty of Medicine, Department of SurgeryUniversity of New South WalesSydneyAustralia
  3. 3.Western Sydney UniversitySydneyAustralia
  4. 4.The MARCS Institute for Brain, Behaviour and DevelopmentPenrithAustralia
  5. 5.Department of SurgeryLiverpool HospitalLiverpoolAustralia

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