Case report:

A 46-year-old woman had history of endometriosis, fibromyalgia and multiple abdominal operations including gastric lap band, abdominoplasty, hysterectomy, cholecystectomy and umbilical hernia repair.

She reported right lower quadrant pain that was constant and she had repeated urinary tract infections.

Physical exam was only remarkable for her multiple surgical scars and right lower quadrant tenderness.

CT imaging done at request of another service showed thickening of the tip of the appendix raising concern for carcinoid tumor or chronic appendicitis.

At exploratory laparoscopy, she had an abnormal appearing appendix as well as a Meckels diverticulum which also appeared abnormal. Both structures were removed. The operative impression was that both the appendix and the Meckels had diverticula. This impression was confirmed by pathological examination.

She has been seen postoperatively and is not complaining of the same RLQ pain.

Figure 1

Operative specimens appendix and Meckels Diverticulum. The tip of the forceps is next to an appendiceal diverticulum. The diverticulum arising from the Meckels is apparent.

Figure 2

Figure 3

Figure 4

Photomicrographs showing diverticular outpouchings of the Meckels and appendix. The diverticula were pseudodiverticula with only a muscularis propria muscular lining.

Discussion:

Diverticulum of the appendix can be in the form of a true or false diverticulum.

Both are rare but pseudodiverticula may occur in 1.4% of appendix specimens. Diverticula can be found incidentally in appendix removed for typical appendix. However, these diverticula can also be associated with diverticulitis or perforation. (1,2)

Abnormalities of Meckels diverticula range from ectopic tissue to ulceration and perforation to  intussusception. Other conditions include neoplasm and foreign body. Meckels diverticulitis is probably the commonest presentation in adults. Additionally, duplication of Meckels diverticulum has been reported. (3,4) Shen reported a case of Meckels diverticulum with multiple sprouts at the tip in a child. (5) We have not found any report of true or false diverticula arising from a Meckels Diverticulum.