Diverticulosis of vermiform appendix; The first case diagnosed by colonoscopy: Evaluation of 1735 cases with meta-analysis

Objective: Diverticulosis of vermiform appendix (DVA) is a rare condition. It is usually diagnosed on barium enema, after appendectomy or by studying autopsy specimens. We report the first case of DVA diagnosed by colonoscopy. We also evaluated 1735 cases of DVA and performed qualitative meta-analysis (QMA) on the subject of DVA. Methods: 63 year old man with hematochezia was evaluated with colonoscopy. There was left colon diverticulosis, internal hemorrhoids and a benign colon polyp; the scope was passed onto the appendicular ostium. In the lumen of the appendix openings of two diverticula were seen. PubMed Search for DVA without time or language barrier was carried out. To facilitate QMA, summary sheets of publications were created. QMA was performed using the well-established methods of Qualitative Research e.g. Diagramming, Theme Repetition, Theme Saturation and Investigator Reflexivity. Results: The search produced 1735 cases of DVA for QMA. Among those patients where gender information was available, 61.6% were men. Single diverticulum was reported in 46.2%; multiple diverticula were seen in 53.8%; the mean age was 48.6 years. Incidence of DVA was 0.4% to 2.0%. Majority are acquired type (pseudo-diverticula) which explains the higher perforation rate. The question of prophylactic appendectomy in DVA is controversial. Conclusion: We report the first case of DVA diagnosed by colonoscopy. The prevalence of DVA is 0.4% to 2.0%. There is a slight male predominance. Majority are acquired type. Compared to usual appendicitis, diverticulitis in DVA occurs at a later age and incidence of perforation is higher.