新生儿坏疽阑尾穿孔全腹膜炎1例的护理

新生儿阑尾炎甚为罕见,临床表现不典型,早期诊断困难,易误诊为消化道穿孔、肠梗阻等行急诊手术。术中诊断为阑尾炎,其并发症及死亡率较高。我院2008—04收治新生儿坏疽性阑尾炎、阑尾穿孔全腹膜炎患儿1例,现将护理体会如下。     

小儿急性阑尾炎误诊分析

目的:探讨小儿急性阑尾炎临床特点及误诊原因.方法:回顾性分析2008年1月至2010年1月急诊收治155例小儿急性阑尾炎的临床资料,其中39例误诊.结果:术前诊断为其他疾病,手术确诊为阑尾炎23例:术前诊断为阑尾炎,手术证实为其他疾病16例.结论:对小儿急性阑尾炎的临床特点缺乏认识,腹部体征的掌握不准确及过多依赖辅助检查是误诊的主要原因.     

70例新生儿阑尾炎的临床分析

新生儿阑尾炎甚为罕见，临床表现极不典型，早期诊断困难，误诊率高。我科近20年，只收治1例新生儿阑尾炎，最初误诊为肠穿孔伴腹膜炎、肠梗阻，巨结肠不除外。因此。本人对1994～2003年报道的新生儿阑尾炎69例，加上本科1例，共70例进行总结，供同行参考。     

右下腹疼痛疾病的诊断和处理

右下腹疼痛是腹部疾病中最常见的症状,多表现为急性腹痛,其中急性阑尾炎居首位,由于此病发病率高,临床上屡有误诊和漏诊发生。为了获得正确的诊断,对右下腹疼痛首先应弄清起病时病情,如急性阑尾炎发病时常为脐周疼痛,数小时后疼痛则转到右下腹,且以持续性隐痛为其特点,十二指肠溃疡穿孔的一瞬间剑下疼痛难忍,往往大汗淋漓,小的隐蔽性穿孔可以表现为右下腹疼痛和局部的腹膜刺激征,而缺乏通常见到的穿孔后弥漫性腹膜炎体征,如果注意到起病时疼痛的特点,就不致误诊为急性阑尾炎,在选择麦氏切口时给手术造成困难;女性患者突起右下腹剧痛,疼痛范围逐渐扩大则应想到子宫的附件破裂或扭转。     

急性阑尾炎与其他疾病相互误诊的原因

目的:分析阑尾炎及与其他疾病易相互误诊的原因,降低误诊率.方法:我院1987年1月～2004年12月共施行急性阑尾炎手术1 437例,其中52例误诊,对误诊病例相关临床资料进行回顾性分析,查找误诊原因.结果:本组29例术前诊断为阑尾炎,手术证实为其他疾病;23例术前诊断为其他疾病,手术确诊为阑尾炎.术后经相应治疗均痊愈.结论:对急性阑尾炎的临床症状多样性缺乏认识,腹部体征的掌握不准确及医技检查不充分是造成阑尾炎与其他疾病相互误诊的主要原因,对酷似阑尾炎临床表现的病例,应注意诊断和鉴别诊断,以减少误诊误治.     

小儿阑尾炎误诊31例分析

目的；分析小儿阑尾炎误诊原因，寻求降低误诊率的方法。方法；回顾我院近10年首诊误诊的31例小儿急性阑尾炎的临床资料，分析误诊原因。结果：术前诊断为其他疾病，手术确诊为阑尾炎27例；术前诊断为阑尾炎，手术证实为其他疾病1例。结论：对小儿急性阑尾炎的临床症状特点缺乏足够的认识，腹部体征掌握不准确及过多依赖辅助检查是误诊的主要原因。     

新生儿阑尾炎19例临床观察

目的:总结新生儿阑尾炎的临床特点,提高新生儿阑尾交诊治水平.方法:回顾性分析19例新生儿阑尾炎的临床资料.结果:19例均行手术治疗,1例术后出现呼吸衰竭,放弃治疗,余18例术后治愈.伤口Ⅰ期愈合16例,发生伤口感染2例.结论:新生儿用尾炎临床表现不典型,易误诊,仔细的体格检查结合辅助检查有助于诊断,及时手术及加强围手术期管理是治愈的关键.     

妊娠合并急性阑尾炎误诊16例临床分析

目的:探讨妊娠合并急性阑尾炎患者的诊治方法,以提高诊治水平,减少误诊。方法:对我院自1995-2005年收治的首诊误诊的16例妊娠合并急性阑尾炎病例情况进行回顾分析。结果:16例妊娠合并急性阑尾炎患者中,阑尾穿孔14例,发生率88%;1例术后流产;5例新生儿产后窒息,其中1例新生儿死亡;3例腹部切口感染延期愈合;1例败血症。结论:妊娠合并阑尾炎具有与非孕期阑尾炎不同的临床特征,应综合分析做出诊断,及时手术,提高围产儿的成活率,降低母亲的并发症。     

急性阑尾炎误诊分析（附26例报告）

目的:提高急性阑尾炎鉴别诊断能力,减少误诊率。方法:对我院2003～2006年800例阑尾切除手术中发现误诊的病例作回顾性分析。结果:26例其他急腹症误诊为急性阑尾炎,误诊率为3.25%。结论:阑尾炎误诊率高,误诊病种多,重视术前检查及详细病史询问可减少误诊,腹部B超、CT检查对确诊及鉴别诊断有重要价值。     

小儿阑尾炎17例诊治失误回顾分析

目的:探讨小儿急性阑尾炎诊治失误的原因,总结其临床特点及防范措施.方法:回顾性分析我院自2004年1月～2007年7月延误诊治的17例小儿急性阑尾炎病例资料.结果:单纯性阑尾炎5例;化脓性阑尾炎2例;坏疽性阑尾炎2例;阑尾穿孔7例,其中阑尾穿孔并局限性腹膜炎2例,阑尾穿孔并弥漫性腹膜炎5例;单纯性阑尾炎并臀部外伤1例.17例中3例误诊,其余均属不同程度的治疗不及时或处理不当所致,如化脓性与坏疽性阑尾炎术中均未行腹腔冲洗,导致术后并发腹膜炎、肠梗阻、盆腔脓肿及切口裂开等.结论:小儿阑尾炎由于临床症状、体征不典型,又不能准确获取病史,且有并发症及并存病的影响,均易导致误诊或延误治疗,故需反复查体,完善检查,明确诊断后及时手术,术中操作宜仔细、认真,以防术后并发症的发生.     

新生儿阑尾炎12例诊治分析

目的探讨新生儿阑尾炎的临床特点、诊断和治疗方法。方法回顾性分析我科2013年5月至2019年12月收治的12例新生儿阑尾炎患儿的临床资料。结果男7例,女5例,手术治疗11例(手术及病理均证实为阑尾炎),保守治疗1例。手术治疗患儿中,10例行阑尾切除术,1例行阑尾切除+回肠造瘘术;12例患儿中10例治愈出院,死亡2例。结论新生儿阑尾炎临床表现多无特异性,早期诊断难度较大,腹部超声检查可帮助诊断,积极手术和细致的围手术期治疗是提高治愈率的关键。     

新生儿阑尾炎临床及超声图像特点分析

目的总结新生儿阑尾的临床及超声图像特点。 方法选取2007年1月至2017年10月在首都医科大学附属北京儿童医院经手术或临床诊断的新生儿阑尾炎28例,总结其临床及超声图像特点。 结果28例新生儿阑尾炎患儿中超声可显示阑尾9例,其中3例阑尾外径<0.4 cm,6例阑尾外径≥0.4 cm;2例阑尾壁厚<0.2 cm,7例阑尾壁厚≥0.2 cm。19例新生儿阑尾显示困难,则重点观察阑尾周围改变。超声扫查提示：28例右下腹可见阑尾周围系膜肿胀,26例可见阑尾周围积脓或炎性包块;超声提示诊断新生儿阑尾炎22例,新生儿坏死性小肠结肠炎4例,消化道穿孔1例;1例因腹胀明显,初诊超声无异常发现,腹胀缓解后超声诊断新生儿阑尾炎。28例患儿中2例继发近端小肠粘连梗阻,2例阴囊内混浊积液。超声随访观察28例新生儿治疗后改变,其中保守治疗21例,18例1个月内超声复查可见周围炎症范围较上次检查缩小（4例5~10个月复发,2例再次手术,2例保守治疗后均好转）。7例手术治疗的患儿中,4例术后1周行超声复查,原病变区局部仅可见少许粘连。 结论新生儿阑尾炎临床症状多样,超声图像表现为阑尾周围系膜肿胀,阑尾外径增大（≥0.4 cm）和（或）阑尾壁增厚（≥0.2 cm）,可合并积脓和（或）炎性包块,超声检查可对患儿的诊断及治疗提供依据。     

Perforated neonatal appendicitis

We present a case of perforated appendicitis with peritonitis in a premature 920 gm neonate who survived. The incidence, etiology, and presenting signs and symptoms of appendicitis in the newborn are discussed.     

Computed tomography of superior mesenteric vein thrombosis following appendectomy

During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after an appendectomy. No sign of SMV was present at appendectomy, and a period of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, the appendicitis was complicated. These patients had nonspecific signs and symptoms, although two of them had elevation of blood hepatic enzyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an intraluminal clot. In one case, CT showed extension of the thrombus to the portal vein with the presence of low-attenuation areas in the liver, consistent with hepatic infarcts. Two patients had predisposing diseases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicitis, and early appendectomy in appendicitis can prevent this complication. Moreover, as in any abdominal surgery, early appendectomy may be complicated by thrombosis of the SMV, thus creating problems of postoperative diagnosis. The complication is more frequent when the initial operation is performed under difficult conditions (peritonitis), or when the patient presents with a coagulopathy. CT is useful in the diagnosis of SMV thrombosis, thus leading to early management with anticoagulant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction. Received: 19 March 1997/Accepted after revision: 15 July 1997     

Abdominal pain secondary to stump appendicitis in a child

We report a case of an 11-year-old male who presented with abdominal pain and vomiting. The patient had a notable past medical history of having had an appendectomy at our institution 1 year previously. Because of progressive clinical signs of peritonitis, an exploratory laparotomy was performed and the patient was found to have stump appendicitis. The entity of stump appendicitis is always possible when evaluating patients with abdominal pain who have a history of appendectomy.     

It is not always appendicitis

BACKGROUND: Patients who are suspected of having acute appendicitis usually undergo surgery in order to avoid life-threatening complications such as perforation and peritonitis. However, acute appendicitis is difficult to distinguish from other sources of right-sided abdominal pain. The clinical picture is almost indistinguishable from appendiceal diverticulitis, which is a rare entity and remains a difficult diagnostic problem. PATIENTS AND METHODS: We describe the case of a 39-year-old male with perforated appendiceal diverticulitis. The patient was admitted to our surgical unit with acute appendicitis-like symptoms and underwent surgery with a diagnosis of suspected acute appendicitis. RESULTS: The patient was found to have perforated appendiceal diverticulitis and standard appendectomy with abdominal lavage was carried out. DISCUSSION: Most patients presenting with acute right-sided peritonitic pain are diagnosed and managed as cases of acute appendicitis. Acute pain in the lower right side of the abdomen caused by appendiceal diverticulitis is very rare and clinically indistinguishable from acute appendicitis. Inflammatory complications of appendiceal diverticula mimic acute appendicitis. CONCLUSION: Every surgeon should be aware of the possibility of diverticulitis of the appendix in the operating room, even if this does not change the operative management. As diverticula of the cecum can be found as solitary lesions, as multiple lesions confined to the right colon, or as part of a generalized disease of the entire colon, postoperative barium enema examination may be useful.     

新生儿先天性巨结肠的早期诊断与治疗

目的探讨新生儿先天性巨结肠的早期诊断与治疗方法。方法回顾分析28例新生儿先天性巨结肠临床表现、直肠指检、直肠肛管测压、钡灌注x线、病理检查结果等临床资料。28例经术前积极支持治疗，其中3例于生后28d内行结扎肠造瘘术，7例行改良Soave术；19例1—4个月内行改良Duhamel术以根治。结果3例死亡（11％），其中2例死于术前腹膜炎、感染中毒性休克、巨结肠危象，1例死于术后严重小肠结肠炎，手术后病死率为4．0％。25例随访6个月-3年，23例生长发育良好，能控制排便；2例生长发育良好，偶有污粪。结论新生儿先天性巨结肠应早期诊断，早期选择适宜根治术．能降低死亡率和提高其生活质量。     

Sonographically detected free appendicolith as a sign of retrocecal perforated appendicitis in a 2‐year‐old child

Prompt and accurate diagnosis of perforated appendicitis is crucial for proper and timely treatment. The appendix, however, cannot always be identified with sonography (US). We report the case of a 2‐year‐old child with atypical clinical presentation, and US detection of a free appendicolith as a sign of perforated appendicitis, without visualization of the appendix itself. Laparoscopy revealed a retrocecal, gangrenous, perforated appendix with autoamputation, fibrinopurulent peritonitis, and a free appendicolith within the abdominal fluid. US detection of a free appendicolith in a child is a very rare, but unequivocal sign of perforated appendicitis, which should be sought. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44 :395–398, 2016     

Acute appendicitis,an unusual presentation of Streptococcus pyogenes infection

The incidence of invasive streptococcal pyogenic infections has been on a worldwide increase. The most frequent clinical manifestations start with cutaneous septicemias. We report an unusual case of Streptococcus pyogenes–based septicemia, secondary to appendicitis with rapidly evolving peritonitis.     

Pinch-an-inch test for appendicitis

Rebound tenderness is a widely used examination technique for patients with suspected appendicitis, but it can be quite uncomfortable. An alternative test for peritonitis is termed the "pinch-an-inch" test. This report describes two patients who presented with mild abdominal pain who subsequently were found to have appendicitis. In both patients, classic peritoneal signs were absent, but the pinch-an-inch test was positive. The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying peritonitis. Although rebound tenderness is a widely used examination, it is uncomfortable and may be inaccurate. To perform the pinch-an-inch test, a fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis probably is present.