Browsing by Author "Eņģelis, Arnis"

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    ACUTE APPENDICITIS IN PAEDIATRIC PATIENTS WITH DELTA AND OMICRON VARIANTS OF SARS-COV-2 : CASE SERIES
    (2024-12-01) Eņģelis, Arnis; Smane, Liene; Zviedre, Astra; Ķīvīte-Urtāne, Anda; Zurmutai, Timurs; Pavāre, Jana; Bormotovs, Jurijs; Kakar, Mohit; Pētersons, Aigars; Department of Paediatric Surgery; Department of Paediatrics; Department of Public Health and Epidemiology; Department of Anaesthesiology, Intensive Care and Clinical simulations
    COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is generally milder in children. Acute appendicitis (AA) is a common diagnosis in children, but greater understanding is needed for more adjusted treatment of these patients when in conjunction with acute COVID-19 infection. We provide a retrospective case series study of comparison of patients with AA and positive SARS-CoV-2 Delta (B.1.671.2) and Omicron (B.1.1.529) variants. There were 16 paediatric patients admitted to a tertiary hospital with suspected acute appendicitis and COVID-19. Compared with the Delta variant (B.1.617.2), children infected with Omicron variant (B.1.1.529) of SARS-CoV-2 infection were more likely to have fever (p = 0.04) and pain migration to the right lower quadrant (RLQ) (p = 0.02). Further studies are needed to characterise the differences between SARS-CoV-2 variants (Delta vs Omicron) in cases of acute appendicitis in children.
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    Correlation of Acute Appendicitis and Acute Mesenteric Lymphadenitis with the Changes of Serum Cytokines in Children. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    The Aim of the study. To analyse the incidence changes for Acute Appendicitis (AA) and Acute Mesenteric lymphadenitis (AML), and to ascertain the compatibility of hospital admission and discharge diagnosis, as well as to investigate cytokine group serum inflammation mediator (CGSIM), epithelial growth factor (EGF), interleukine (IL)-10 IL-12 (p 70), IL-1β , IL-4, IL-6, IL-17, IL-8, monocyte hemotaxis protein 1 (MCP-1), tumour necrosis factor α (TNF-α) differential diagnostic value and to evaluate the connection between biomarkers and other diagnostic methods in case of AA and AML in children. Methods. Mixed type prospective case-control study. In the retrospective part of the thesis, data regarding incidence of AA and AML have been analysed, in time period from year 2010 until year 2013. A retrospective analysis for patients (n = 1228) in the age group from 0 to 18 years during first time hospital admissions Children’s Clinical University Hospital with suspicion of AA and admission and discharge diagnosis compatibility has been carried out (01.10.2010 – 01.10.2013). The prospective part of the study includes 57 patients (31 with AA and 26 with AML), that were compatible with the inclusion criteria, with addition of using control group (n = 17) for establishing CGSIM reference value. The main results of the study. During the time period (2010 – 2013) the incidence of AA in children (7–18 years of age) was on average diminished by 2%, however, the incidence for AML has risen on average by 5.8%. Hospital data revealed, that there is inconsistency of 76.2% of cases admission and discharge diagnosis for patients with suspicion of AA in the age group until 18 years. Comparing the clinical signs of the patients symptoms like nausea, vomiting, abdominal wall rigidity, and rebound tenderness they were more compatible with AA comparing to AML. The results of CGSIM and the rest of diagnostic methods revealed, that the diagnostic accuracy of AA increases to 89.5%, if the patients are clinically evaluated for Alvarado score ≥ 7 and laboratory criteria, taking in account cut-off values of these variables – WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. In the case of Alvarado score being ≥ 7, IL-6 with cut-off value in serum ≥ 4.3 pg/mL and additional ultrasound examination, combination of these criteria showed a 100% specificity and 100% PPV during precision of AA diagnosis. During analysis of CGSIM concentration changes in case of complicated and uncomplicated AA, inflammation marker, such as IL-6, IL-8, MCP-1, CRP, increased concentration was established in case of complicated AA. The serum level of IL-6 with cut-off level of ≥ 36.2 pg/mL, IL-8 ≥ 12.3 pg/mL and MCP-1 ≥ 400.2 pg/mL indicates the presence of complicated AA. Correlation analysis of IL-6 revealed a medium close connection between IL-8 and MCP-1 in case of AA. Conclusions. CGSIM concentration level varies in case of AA and AML in children, age group from 7 to 18 years. The main CGSIM in previously mentioned disease differential diagnosis is IL-6, that, together with other examination methods increases the diagnostic accuracy of AA. Pending clinical evaluation of children with AA and AML and establishing further tactic for prognosis and action of AA, patients should be evaluated using Alvarado score of ≥ 7 together with laboratory findings, taking into account the WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. Based on the results of the study, an algorithm suitable for AA prognosis and action in children in age group from 7 to 18 years was established to be used in hospital admission wards and out-patients units.
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    Different Cytokine Profiles in Children with Acute Appendicitis and Acute Mesenteric Lymphadenitis
    (2015-12-01) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris; Jurka, Antra; Zīle, Irisa; Pētersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    The aim of this study was to investigate the role of serum cytokines in the diagnosis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). Data were collected prospectively on 7 to 18 year old children (October 2010 - October 2013): 31 patients with AA, 26 patients with AML, and 17 patients with elective non-inflammatory surgical disease were selected as controls. Serum levels of IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α were measured. Patients with AA had significantly increased serum levels of IL-6(1) (z = -3.72; p = 0.0002) and IL-10(1) (z = -2.81; p = 0.005) compared to AML before any treatment. The consecutive measurements of MCP-1 in serum demonstrated a significant difference within 72 hours in the AA group (Wilks' Lambda test 0.80; F(2;29) = 3.5; p = 0.04) and also in the AML group (Wilks' Lambda test 0.70; F(2;24) = 5.0; p = 0.01). The increased values of IL-6 and IL-10 were the most reliable cytokines one hour before surgical intervention for patients with AA. MCP-1 values changed significantly within 72 hours after patient hospitalisation but did not differ between the groups, and could not be a helpful serum biomarker in distinguishing patients with AA and AML.
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    Gallbladder Interleukins in Children with Calculous Cholecystitis
    (2021-09) Deņisova, Arina; Pilmane, Māra; Eņģelis, Arnis; Pētersons, Aigars; Institute of Anatomy and Anthropology; Department of Paediatric Surgery
    Calculous cholecystitis connects to inflammation and various complications. It is a common disease in the paediatric population, yet it is still uncertain how inflammation factors are involved in its morphopathogenesis. Twenty calculous cholecystitis surgery tissue samples were obtained from 20 children. As a control, seven unaffected gallbladders were used. Tissues were immunohistochemically stained for IL-1α, IL-4, IL-6, IL-7, IL-8, IL-10, and IL-17A, and the slides were inspected by light microscopy. To evaluate statistical differences and correlations between interleukins, Mann–Whitney U and Spearman’s tests were used. Statistically significant difference between patient and control gallbladder epithelium was for IL-1α and IL-17A, but connective tissue—IL-1α, IL-4, IL-6, IL-7, IL-8, and IL-17A positive structures. A strong positive correlation in patients was detected between epithelial IL-1α and IL-1α in connective tissue, epithelial IL-6 and IL-7, IL-6 and IL-17A, IL-7 and IL-10, IL-7 and IL-17A, as well as between IL-6 and IL-7, IL-7 and IL-10 in connective tissue. The increase of IL-1α, IL-4, IL-6, IL-7, IL-8 and IL-17A positive structures suggests their role in the morphopathogenesis of calculous cholecystitis. The correlations between interleukins in epithelium and in connective tissues prove that the epithelial barrier function and inflammatory response in deeper layers are sustained through intercellular signalling pathways.
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    Immunohistochemical Study of Choledochal Cyst Wall
    (2010) Ozoliņa, Linda; Pilmane, Māra; Eņģelis, Arnis; Institute of Anatomy and Anthropology
    Introduction. Choledochal cysts are rare congenital anomalies that appear as localized cystic or fusiform biliary tree dilatations. Choledochal cyst is a rare congenital anomaly with a reported incidence of 1 in 100,000–150,000 live births (7). Nearly 25% of choledochal cysts are diagnosed in the first year of life and 60% in the first decade, but 20% detected are after the age of 20 years (12). Aim of the Study. The pathogenesis of choledochal cysts remains still unknown. The aim of this study was to examine relative distribution of growth factors, neuropeptide–containing innervation and apoptosis in the choledochal cyst wall. Materials and methods. Histopathological study of choledochal cyst wall was conducted on four patients aging from six months till 14 years. Tissues were processed for haematoxylin – eosin staining, immunohistochemistry for PGP 9.5, NGFR, NF, VEGF, CGRP and TUNEL method. Results. In overview sections we observed granulation tissue, blood vessel sanguineness and inflammatory infiltrate. Fibromuscular coat was thickened showing thick collagen bundles and dispersed smooth myocytes. Serosa was present in one case, all the rest demonstrated adhesions with dilated blood vessels and perivascular infiltrate. PGP 9.5 – containing nerve fibers and nerve fiber bundles were mostly observed in moderate and large amounts. NGFR in large amount was seen in nerve fiber bundles and nerve fibers among smooth muscle cells in the wall of small blood vessels. NF positive structures – nerve fibers and nerve fiber bundles – were found in moderate amount, except one case were the expression was very low. CGRP was found in neuroendocrine cells, nerve fiber bundles, leukocytes, inflammatory cells and endoteliocytes. Expression varied from low to moderately high. VEGF expression in most patient material was negative. Apoptosis was observed in inflammatory cells and epiteliocytes, showing large amount of positive structures. Conclusions. The amount of PGP 9.5 and CGRP demonstrates relatively good cyst wall innervation. Marked expression of NGFR proves still existing neuronal growth stimulation despite relatively unchanged neuronal cytoskeleton. Negative expression of VEGF proves lack of ischemia. Apoptosis mainly affects inflammatory cells and epiteliocytes, while the choledochal cyst wall presumably is composed of functionaly viable tissue.
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    Microbiota Assessment of Pediatric Simple and Complex Acute Appendicitis
    (2022-09) Kakar, Mohit; Reinis, Aigars; Kroiča, Juta; Eņģelis, Arnis; Broks, Renārs; Asare, Lāsma; Vermeulen, Marelize; Senica, Simone Oliver; Saxena, Amulya; Pētersons, Aigars; Department of Paediatric Surgery; Department of Biology and Microbiology; Statistics Unit
    Background and Objectives. The aim of this study is to determine the prevailing microbiota in samples from pediatric patients with acute appendicitis, as well as evaluate the antibacterial sensitivity of the isolated microorganisms, comparing the data obtained with the clinic's antibacterial therapy guidelines. Materials and Methods. The study group consisted of 93 patients between the ages of 7 and 18. All patients underwent a laparoscopic or conventional appendectomy. The children were hospitalized with signs and symptoms suggestive of acute appendicitis. Microbiological cultures from the appendix and abdominal cavity were collected intraoperatively. Results. E. coli was identified in most cases irrespective of the clinical presentation of acute appendicitis. Most strains were susceptible to ampicillin and amoxicillin/clavulanic acid. Five strains of E. coli produced extended spectrum beta-lactamase (ESBL). Pseudomonas aeruginosa (P. aeruginosa) was the second most commonly isolated causative agent. Furthermore, it was common in cases of acute complex appendicitis. Most strains of P. aeruginosa were resistant to amoxicillin/clavulanic acid, ertapenem, ampicillin and cefotaxime, yet were susceptible to ceftazidime. Regardless of the clinical presentation, the samples yielded mixed isolates. Conclusion. E. coli is the main causative agent of acute appendicitis in the pediatric population displaying susceptibility to various antibiotics. P. aeruginosa was more prevalent in cases of acute complex appendicitis. P. aeruginosa isolates were susceptible to ceftazidime; however, they were resistant to cefotaxime, which should, therefore, be removed from guidelines for empirical antibacterial treatment of acute appendicitis due to phenotypic resistance of P. aeruginosa. We recommend antibiotics with distinct implementation to avoid antibiotic resistance.
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    Seruma citokīnu pārmaiņas akūta apendicīta un akūta mezenteriāla limfadenīta gadījumā bērniem. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    Darba mērķis. Analizēt akūta apendicīta (AA) un akūta mezenteriāla limfadenīta (AML) incidences izmaiņas Latvijā (2010. – 2013.) un noskaidrot stacionāra iestāšanās un izrakstīšanās diagnožu sakritību, kā arī izpētīt citokīnu grupas seruma iekaisuma mediatoru (CGSIM) (epiteliālā augšanas faktora (EGF), interleikīna (IL)-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-17, IL-8, monocītu hemotakses proteīna 1 (MCP-1), tumora nekrozs faktora alfa (TNF-α)) diferenciāli diagnostisko nozīmi un izvērtēt biomarķieru saistību ar citām diagnostiskām metodēm AA un AML gadījumā bērniem. Darba metodes. Jaukta tipa prospektīvs gadījuma – kontroles pētījums. Retrospektīvajā daļā tika analizēti dati saistībā ar AA un AML saslimstību Latvijā laikposmā no 2010. līdz 2013. gadam. Retrospektīvi tika veikta analīze arī par pirmreizēji hospitalizētajiem pacientiem (n = 1228) vecumā no 0 līdz 18 gadiem VSIA Bērnu klīniskās universitātes slimnīcā (VSIA BKUS) ar aizdomām par AA, lai izvērtētu iestāšanās un izrakstīšanās diagnožu sakritību. Prospektīvajā daļā (01.10.2010. – 01.10.2013.) tika iekļauti 57 pacienti (31 ar AA un 26 ar AML), kuri atbilda iekļaušanas kritērijiem, papildus izmantojot kontroles grupu (n = 17) CGSIM referento vērtību noteikšanai. Darba galvenie rezultāti. Laika periodā (2010. – 2013.) bērniem (7–18 gadi) kopējā saslimstība ar AA vidēji samazinājusies par 2%, tomēr saslimstība ar AML ir pieaugusi vidēji par 5,8%. Stacionāra dati atklāja, ka vidēji 76,2% gadījumu tika konstatēta iestāšanās un izrakstīšanās diagnožu nesakritība pacientiem ar aizdomām par AA vecumā līdz 18 gadiem. Veicot pacientu klīnisko pazīmju salīdzināšanu, slikta dūša, vemšana, pasīva vēdera priekšējās sienas muskulatūras rezistence un pozitīvi vēderplēves kairinājuma simptomi biežāk bija sastopami AA kā AML gadījumā. Rezultātu analīze saistībā ar CGSIM un pārējām diagnostiskajām metodēm atklāja, ka AA diagnostiskā precizitāte palielinās līdz 89,5%, ja pacienti klīniski tiek novērtēti pēc Alvarado skalas ≥ 7 balles un laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības: WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Savukārt, gadījumā, kad pacientam tiek konstatēta Alvarado skalas rezultāts ≥ 7 ballēm, IL-6 ar robežvērtības līmeni serumā ≥ 4,3 pg/mL un papildus tiek izmantots USG izmeklējums, visu šo kritēriju rezultātā tiek iegūts 100% specifiskums un 100% pozitīvā paredzošā vērtība (PPV), atklājot AA. Analizējot CGSIM koncentrācijas izmaiņas komplicēta un nekomplicēta AA gadījumā, tādu iekaisuma marķieru kā IL-6, IL-8, MCP-1 un CRP paaugstināta koncentrācija konstatēta komplicēta AA gadījumā. Serumā IL-6 ar robežvērtību ≥ 36,2 pg/mL, IL-8 ≥ 12,3 pg/mL un MCP-1 ≥ 400,2 pg/mL liecina par komplicēta AA klātbūtni. Korelācijas analīzē IL-6 atklāja vidēji ciešu savstarpējo saistību ar IL-8 un MCP-1 AA gadījumā. Secinājumi. CGSIM koncentrācijas ir atšķirīgas AA un AML gadījumos bērniem vecumā no 7 līdz 18 gadiem. Nozīmīgākais CGSIM minēto slimību diferenciālajā diagnostikā ir IL-6, kas kopā ar citām izmeklēšanas metodēm paaugstina AA diagnostisko precizitāti. Izvērtējot bērnus ar AA un AML un nosakot turpmāko AA prognozēšanas un rīcības taktiku, pacientam būtu jānovērtē klīniskais stāvoklis pēc Alvarado skalas ar rezultāta ≥ 7 ballēm kopā ar laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības – WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Pamatojoties uz pētījuma rezultātiem, izstrādāts slimnīcu NMPN un ambulatoram aprūpes etapam piemērots AA prognozēšans un rīcības algoritms bērniem ar AA un AML vecumā no 7–18 gadiem.
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    Seruma citokīnu pārmaiņas akūta apendicīta un akūta mezenteriāla limfadenīta gadījumā bērniem. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    Darba mērķis. Analizēt akūta apendicīta (AA) un akūta mezenteriāla limfadenīta (AML) incidences izmaiņas Latvijā (2010. – 2013.) un noskaidrot stacionāra iestāšanās un izrakstīšanās diagnožu sakritību, kā arī izpētīt citokīnu grupas seruma iekaisuma mediatoru (CGSIM) (epiteliālā augšanas faktora (EGF), interleikīna (IL)-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-17, IL-8, monocītu hemotakses proteīna 1 (MCP-1), tumora nekrozs faktora alfa (TNF-α)) diferenciāli diagnostisko nozīmi un izvērtēt biomarķieru saistību ar citām diagnostiskām metodēm AA un AML gadījumā bērniem. Darba metodes. Jaukta tipa prospektīvs gadījuma – kontroles pētījums. Retrospektīvajā daļā tika analizēti dati saistībā ar AA un AML saslimstību Latvijā laikposmā no 2010. līdz 2013. gadam. Retrospektīvi tika veikta analīze arī par pirmreizēji hospitalizētajiem pacientiem (n = 1228) vecumā no 0 līdz 18 gadiem VSIA Bērnu klīniskās universitātes slimnīcā (VSIA BKUS) ar aizdomām par AA, lai izvērtētu iestāšanās un izrakstīšanās diagnožu sakritību. Prospektīvajā daļā (01.10.2010. – 01.10.2013.) tika iekļauti 57 pacienti (31 ar AA un 26 ar AML), kuri atbilda iekļaušanas kritērijiem, papildus izmantojot kontroles grupu (n = 17) CGSIM referento vērtību noteikšanai. Darba galvenie rezultāti. Laika periodā (2010. – 2013.) bērniem (7–18 gadi) kopējā saslimstība ar AA vidēji samazinājusies par 2%, tomēr saslimstība ar AML ir pieaugusi vidēji par 5,8%. Stacionāra dati atklāja, ka vidēji 76,2% gadījumu tika konstatēta iestāšanās un izrakstīšanās diagnožu nesakritība pacientiem ar aizdomām par AA vecumā līdz 18 gadiem. Veicot pacientu klīnisko pazīmju salīdzināšanu, slikta dūša, vemšana, pasīva vēdera priekšējās sienas muskulatūras rezistence un pozitīvi vēderplēves kairinājuma simptomi biežāk bija sastopami AA kā AML gadījumā. Rezultātu analīze saistībā ar CGSIM un pārējām diagnostiskajām metodēm atklāja, ka AA diagnostiskā precizitāte palielinās līdz 89,5%, ja pacienti klīniski tiek novērtēti pēc Alvarado skalas ≥ 7 balles un laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības: WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Savukārt, gadījumā, kad pacientam tiek konstatēta Alvarado skalas rezultāts ≥ 7 ballēm, IL-6 ar robežvērtības līmeni serumā ≥ 4,3 pg/mL un papildus tiek izmantots USG izmeklējums, visu šo kritēriju rezultātā tiek iegūts 100% specifiskums un 100% pozitīvā paredzošā vērtība (PPV), atklājot AA. Analizējot CGSIM koncentrācijas izmaiņas komplicēta un nekomplicēta AA gadījumā, tādu iekaisuma marķieru kā IL-6, IL-8, MCP-1 un CRP paaugstināta koncentrācija konstatēta komplicēta AA gadījumā. Serumā IL-6 ar robežvērtību ≥ 36,2 pg/mL, IL-8 ≥ 12,3 pg/mL un MCP-1 ≥ 400,2 pg/mL liecina par komplicēta AA klātbūtni. Korelācijas analīzē IL-6 atklāja vidēji ciešu savstarpējo saistību ar IL-8 un MCP-1 AA gadījumā. Secinājumi. CGSIM koncentrācijas ir atšķirīgas AA un AML gadījumos bērniem vecumā no 7 līdz 18 gadiem. Nozīmīgākais CGSIM minēto slimību diferenciālajā diagnostikā ir IL-6, kas kopā ar citām izmeklēšanas metodēm paaugstina AA diagnostisko precizitāti. Izvērtējot bērnus ar AA un AML un nosakot turpmāko AA prognozēšanas un rīcības taktiku, pacientam būtu jānovērtē klīniskais stāvoklis pēc Alvarado skalas ar rezultāta ≥ 7 ballēm kopā ar laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības – WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Pamatojoties uz pētījuma rezultātiem, izstrādāts slimnīcu NMPN un ambulatoram aprūpes etapam piemērots AA prognozēšans un rīcības algoritms bērniem ar AA un AML vecumā no 7–18 gadiem.
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    Surgical and non-surgical treatment of paediatric appendicitis : can algorithms help us to predict perforation?
    (2022-12-10) Eņģelis, Arnis; Kakar, Mohit; Zviedre, Astra; Laizāns, Paulis; Zurmutaī, Timurs; Bormotovs, Jurijs; Pētersons, Aigars; Department of Paediatric Surgery; Department of Doctoral Studies
    The recent interest in and evidence of non-surgical treatment with antibiotic therapy has led to the recurring issue of differentiating acute no-complicated appendicitis (AnA) and acute complicated appendicitis (AcA) when these are presented in an emergency department. To create the initial version of an acute appendicitis (AA) diagnostic and treatment algorithm, we analysed treatment results of 178 children with AnA and AcA treated at the Children's Clinical University Hospital in Rīga, in the period between 2010 and 2013. Evaluation of the clinical symptoms, laboratory and radiological findings was included in development of the algorithm. The algorithm was created in 2016 and accepted by the hospital administration. We present the algorithm's updated version of 2020. The introduction of diagnostic scores and algorithms has standardised and improved the diagnosis of paediatric AA. New diagnostic tests with higher sensitivity and specificity may improve the accuracy of diagnostic algorithms. Measuring multiple effective biomarkers simultaneously may improve the accuracy of diagnostic algorithms and predict the severity of paediatric AA. Machine learning algorithms may be able to process a much larger amount of data and provide a faster conclusion, helping the surgeon make the right decision in diagnosing appendicitis in children and prevent unnecessary surgery.
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    Torsion of the Diverticulum of the Appendix
    (2011) Eņģelis, Arnis; Zviedre, Astra; Pilmane, Māra; Pētersons, Aigars; Rīga Stradiņš University
    We report a case of a 1-year-old girl, operated on due to the symptoms of acute appendicitis. Torsion, necrosis and perforation of the large diverticulum of the appendix vermiformis, causing peritonitis were found during the operation. The complete luminary connection between appendix and the diverticulum was proved. Although appendix vermiformis itself was not the reason for the peritonitis, it was removed together with the diverticulum. The child’s recovery after the operation was stable. The morphology revealed that the diverticulum of appendix vermiformis generally possessed features typical of a large intestine columnar epithelium, while its other layers, including a muscular layer and an irregularly expanded sub-mucosal layer, remained similar to the wall of the appendix. We suggest that the torsion of the true congenital diverticulum of the vermiform appendix mimicked acute appendicitis and caused peritonitis in the above-mentioned girl.