Refining the Diagnosis of Appendiceal Diverticulitis: An Intraoperative Protocol for Surgical Precision and case report

Introduction Appendiceal diverticulitis is an uncommon pathology known by the acute inflammation of a diverticulum emerging from the vermiform appendix. A true appendiceal diverticulum refers to a protrusion involving all layers of the appendix. A 2021 case report (3) showed approximately 50 cases published to date. This pathological anatomic variant increases the risk of appendiceal neoplasms, principally neuroendocrine tumors (48%) (5), which makes a detailed pathological analysis important after surgery. The purpose of this research is to analyze the diagnosis of appendiceal diverticulitis by a case report and establish an intraoperative algorithm to accurately identify this type of diverticulum, optimizing surgical decision-making. Case report A 26-year-old woman from Florencia, Colombia, treated at Corpomedica clinic (rural area), presented a 36-hour history of right lower abdominal pain without vomiting or fever. Abdominal ultrasound revealed no significant findings. Due to inadequate pain progression, the patient was transferred to the operating room for intervention. Dissection revealed a firm, 2.5 cm mass at the base, immobile, with a contained 5 mm perforation and minimal contamination. Pathology reports a cecal appendix accompanied by a true diverticulum with acute diverticulitis. Conclusion Like appendiceal diverticulitis, most of these neoplasms are detected incidentally in a surgical specimen after an appendectomy for suspected appendicitis (13). Their intraoperative differentiation is of great importance since their management varies considerably and impacts the patient's disease burden and quality of life. Further studies are needed to standardize its timely diagnosis in order to avoid patient morbidity and mortality.