It is not always appendicitis

Acute Perforated Appendicitis Associated with Appendiceal Diverticulitis in a Young Man: A Case Report with Literature Review

BACKGROUND Diverticulosis of the vermiform appendix is rare. In patients who present with appendicitis, appendiceal diverticulitis as a cause due is also rare. We report the case of a 35-year-old man who presented with typical symptoms and signs of acute appendicitis, which was confirmed by histopathology to be due to perforated acute appendiceal diverticulitis. CASE REPORT A 35-year-old man presented to our Emergency Department with a 1-day history of right lower-quadrant abdominal pain that radiated to the left lower quadrant, which was associated with fever, vomiting, and abdominal distention. Biochemical analysis revealed mild leukocytosis. Computed tomography (CT) revealed signs of acute perforated appendicitis and early mass formation. The patient underwent laparoscopic appendectomy. Histopathological examination revealed appendiceal diverticulitis (pseudo-diverticulum). CONCLUSIONS Appendiceal diverticulitis is a rare surgical entity and is often an overlooked diagnosis. The differential diagnosis of appendiceal diverticulitis in patients presenting with signs of acute appendicitis is important as it is associated with a higher rate of complications such as perforation and an increased risk of appendiceal neoplasms. Appendectomy is a safe and appropriate treatment for appendiceal diverticulitis.

Grading of Internal Carotid Artery Stenosis:Comparative Analysis of Different Flow Velocity Criteria and Multidetector Computed Tomographic Angiography

PURPOSE

To evaluate multidetector computed tomographic angiography (CTA) versus published color Doppler sonography (CDS) velocity criteria in the grading of internal carotid artery (ICA) stenosis.

METHODS

Sixty-eight consecutive patients (50 men; mean age 70.2 +/- 8.1 years, range 51- 85) with known ICA stenosis and complete CTA and CDS data for 127 carotid arteries were enrolled in this retrospective analysis. The degree of stenosis was determined using CDS velocities according to 5 published sets of criteria, as well as the criteria used at the authors' institution. These outcomes were then correlated using kappa-statistics with the results of multidetector CTA according to NASCET.

RESULTS

The best overall agreement was achieved applying the criteria sets of Hwang (kappa = 0.70) and AbuRahma (kappa = 0.68). All 5 occlusions were correctly identified with both modalities. CTA detected 73 ICA stenoses > 70%; the best correlation was with the application of Hwang criteria, which correctly identified 69 (94.5%) > 70% stenoses. In order of increasing tendency to underscore the grade of stenosis, the corresponding results for the other criteria sets were 62 (84.9%) for Mittl, 59 (80.8%) for AbuRahma, 55 (75.3%) each for Nicolaides and Filis, and 50 (68.5%) for Nederkoorn. CTA detected 85 stenoses >50%; the sensitivity of all applied CDS criteria sets exceeded 90%.

CONCLUSION

Grading of ICA stenosis > 70% with CDS and CTA results in clinically relevant discrepancies, with higher grades of stenoses assessed by CTA. The choice of CDS grading criteria is of significant clinical importance, especially in the identification of high-grade ICA stenosis.