Background: Acute appendicitis is considered one of the most frequent causes of abdominal pain and - in the majority - reason for the indication of surgical intervention in adults and children.
In addition to the acute inflammation of appendix vermiformis, there are numerous appendix-related differential diagnoses, which i) can occur in daily clinical practice, ii) can mimic acute appendicitis but they are usually different with regard to its etiopathogenesis, clinical appearance and therapeutic decision-making, and iii) require adequate diagnostic and therapeutic management. The appropriate awareness of and knowledge on that appear essential for clinical care, in particular, under the today’s option to treat uncomplicated acute appendicitis with antibiotics.
Aim: Exemplary illustration of several specific cases with rare appendix vermiformis-associated manifestations of diverse diagnoses (AVAM) to reflect daily clinical, in particular, surgical practice.
Method: Representative scientific case series (design) - including patient-related (etiology, incidence), diagnosis-associated (sex ratio, symptomatology), perioperative, therapeutic (in particular, surgical intervention-related) aspects and early postoperative outcome details, such as morbidity (characterized by general/special complications) and mortality (hospital, 30 d) for each specific diagnosis/entity.
Results (corner points):
- The spectrum of AVAM is broad - all specific diagnoses and entities can mimic acute appendicitis with regard to clinical symptomatology, laboratory parameter profile and (partially) imaging.
- AVAM are dominated by inflammatory and neoplastic entities.
- Specific attention is focussed onto chronic appendicitis, appendicopathy, mucinous appendix carcinoma, acute appendicitis in a femoral or inguinal hernia, twisted “appendix epiploica“, single metastasis of gastric cancer at the appendix, appendagitis epiploica, subhepatic appendicitis, perityphlitic infiltration, neuroendocrine tumor lesion of the appendix, pseudomyxoma peritonei in case of mucinous appendix carcinoma.
- All determined entities required surgical intervention - only in one exceptional case, conservative therapeutic approach was imaginable in definitive diagnosis-finding.
Conclusion: AVAM can have diverse origin and comprise various entities. The competent, consequent, correct and early diagnosis-finding appears decisive with regard to therapy, early postoperative course and (in case of malignant diseases) prognosis.
Histopathology and close interdisciplinary cooperation are - due to AVAM rareness - a substantial prediction for a timely diagnosis-finding, prompt therapeutic decision-making and practical realization as well as - if necessary - subsequent therapeutic steps, possibly using variable modes.
