ﮔﺰارش ﯾﮏ ﻣﻮرد دﯾﻮرﺗﯿﮑﻮﻟﯿﺖ آﭘﺎﻧﺪﯾﺲ

Appendiceal Diverticulitis; A Case Report

دﯾﻮرﺗﯿﮑﻮل آﭘﺎﻧﺪﯾﺲ ﯾﮑﯽ از ﻋﻠﻞ ﻏﯿﺮﺷﺎﯾﻊ درد ﺷﮑﻢ اﺳﺖ ﮐﻪ ﻣﯽﺗﻮاﻧﺪ ﻋﻼﻣﺖدار ﺑﻮده و ﯾﺎ در ﺣﯿﻦ ﺟﺮاﺣﯽ ﯾﺎ ﺑﺎرﯾﻮم اﻧﻤﺎ ﮐﺸﻒ ﺷﻮد. ﺷﯿﻮع دﯾﻮرﺗﯿﮑﻮل آﭘﺎﻧﺪﯾﺲ ﺑﺴﯿﺎر ﭘﺎﯾﯿﻦ ﻣﯽﺑﺎﺷﺪ. ﺑﺎ اﯾﻦ وﺟﻮد ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ رﯾﺴﮏ ﺑﺎﻻﺗﺮ ﭘﺮﻓﻮراﺳﯿﻮن در اﯾﻦ ﻣﻮارد، ﺑﺎﯾﺪ ﻫﻤﻮاره ﻣﺪ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪه و ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﮔﯿﺮد. ﺑﯿﻤﺎر آﻗﺎي 52 ﺳﺎﻟﻪاي ﺑﻮد ﮐﻪ ﺑﻪ ﻋﻠﺖ درد ﺷﮑﻢ ﺑﺎ ﻣﺎﻫﯿﺖ ﮐﻮﻟﯿﮑﯽ در ﻧﺎﺣﯿﻪ دور ﻧﺎف ﺑﻪ اورژاﻧﺲ ﻣﺮاﺟﻌﻪ ﮐﺮده ﺑﻮد. درد ﺑﯿﻤﺎر از ﺑﻌﺪ از ﻇﻬﺮ روز ﻗﺒﻞ از ﻣﺮاﺟﻌﻪ ﺷﺮوع ﺷﺪه و ﺑﻪ ﺗﺪرﯾﺞ اﻓﺰاﯾﺶ ﯾﺎﻓﺘﻪ و ﺑﻪ ﻧﺎﺣﯿﻪ ﺗﺤﺘﺎﻧﯽ راﺳﺖ ﺷﮑﻢ ﺷﯿﻔﺖ ﭘﯿﺪا ﮐﺮده ﺑﻮد. در ﺑﺮرﺳﯽﻫﺎي اﻧﺠﺎم ﺷﺪه ﺑﯿﻤﺎر ﺗﻨﺪرﻧﺲ، ﮔﺎردﯾﻨﮓ، ﻟﮑﻮﺳﯿﺘﻮز و ﺗﺐ داﺷﺘﻪ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻗﺮار ﮔﺮﻓﺖ. در ﺑﺮرﺳﯽ ﭘﺎﺗﻮﻟﻮژﯾﮏ ﺑﯿﻤﺎر آﭘﺎﻧﺪﯾﺴﯿﺖ ﺣﺎد ﭼﺮﮐﯽ ﺑﻪ ﻫﻤﺮاه دﯾﻮرﺗﯿﮑﻮﻟﯿﺖ آﭘﺎﻧﺪﯾﺲ ﮔﺰارش ﮔﺮدﯾﺪ. ﺑﺎ وﺟﻮد آﻧﮑﻪ درﻣﺎن اﯾﻦ ﺑﯿﻤﺎري ﻧﯿﺰ ﻫﻤﺎﻧﻨﺪ آﭘﺎﻧﺪﯾﺴﯿﺖ ﻣﯽﺑﺎﺷﺪ وﻟﯽ ﺑﻪ ﻋﻠﺖ ﻣﻮرﺑﯿﺪﯾﺘﯽ و ﻣﻮرﺗﺎﻟﯿﺘﯽ ﺑﺎﻻﺗﺮ آن ﺑﺎﯾﺪ ﻫﻤﻮاره ﺑﻪ وﯾﮋه در ﺑﯿﻤﺎران ﻣﺴﻦﺗﺮ و اﻓﺮاد ﺑﺎ اﺧﺘﻼﻻت ﺳﯿﺴﺘﻢ اﯾﻤﻨﯽ ﺟﺰو ﺗﺸﺨﯿﺺﻫﺎي اﻓﺘﺮاﻗﯽ ﻣﺪ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﻮد.

Diverticulitis of the appendix is an uncommon cause of right lower quadrant abdominal pain which can be symptomatic or incidentally found during surgery or barium enema. The incidence of appendiceal diverticulitis very low; however, due to their higher risk of perforation, this condition should always be assessed in patients with abdominal pain. A 52-year-old male with periumbilical colicky abdominal pain presented to the emergency department. The pain started from afternoon of the day before admission, aggravated and shifted to the right lower quadrant, gradually. The patient had tenderness, guarding, leukocytosis and fever and eventually underwent surgery. The pathologic evaluation of the appendix reported acute appendicitis with appendiceal diverticulitis. Although treatment of choice in patients with appendiceal diverticulitis is similar to that of appendicitis, which is surgical resection, but this condition should always be assessed particularly in older patients and immunocompromised subjects in whom the morbidity and mortality is higher.