Diverticular Disease of the Vermiform Appendix - Is it a Distinctive Clinico- Pathological Entity?

Background: Diverticular disease of the appendix [DDOA] is a rare occurrence. Although acquired in nature, its impact on the disease process of appendicitis isnot well-defined. The purpose of the current study is to include a comprehensive clinico-pathological definition of the disease through aretrospective single-center cohort analysis with a prospective pathological re-evaluation. Methods: A retrospective analysis of post-appendectomy patients over a period of 16 years [2000-2015] was carried out. Patients with DDOA were identifiedand compared to a control group of patients with acute appendicitis. Histology was re-evaluated prospectively by a senior pathologist. Primarymeasures of the outcome included clinical and surgical differences. Pathological macroscopic differences between the two groups and acomprehensive description of the DDOA itself were performed. Results: 6846 post appendectomy patients were operated on during the study period, and 127 [1.9%] were diagnosed with DDOA. The DDOA groupshowed significantly higher age, longer duration of complaints, and a different clinical presentation. Operative time was significantly longer in thestudy group and had higher rates of severe postoperative complications such as postoperative bleeding, need for ICU recovery, and need forpostoperative mechanical ventilation. All diverticula were pseudo-diverticula and were significantly shorter and wider. Multivariate analysisshowed that age, length, and width of the appendix were independently associated with DDOA. Conclusions: The results of this study suggest that DDOA is an independent clinical entity, showing differences in etiology, clinical presentation, andpostoperative outcome. Prospective studies are needed to assess whether the preoperative diagnosis is feasible and will change conventionalsurgical management.