穿孔性阑尾炎CT征象

目的 探讨阑尾穿孔具有诊断价值的CT征象。方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像。观察12项急性阑尾炎的CT征象,采用χ²检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率。采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象。结果 205例中,40例(40/205,19.51%)阑尾穿孔与165例(165/205,80.49%)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均<0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00%(32/40)、97.58%(161/165)、94.15%(193/205),阑尾壁强化缺损50.00%(20/40)、98.79%(163/165)、89.27%(183/205),蜂窝织炎37.50%(15/40)、95.76%(158/165)、84.39%(173/205),阑尾腔外积气27.50%(11/40)、99.39%(164/165)、85.37%(175/205),阑尾腔外粪石5.00%(2/40)、100.00%(165/165)、81.46%(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均<0.001)。结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象。     

Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old

Individually, trauma and appendicitis are some of the most common conditions in clinical practice, particularly in emergency medicine. In rare cases, trauma and appendicitis may co-exist, imposing a dilemma of whether these are only coincidence or appendicitis develops because of trauma. We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition.     

Acute recurrent appendicitis with appendicolith

Appendiceal disease can be acute, acute recurrent, or chronic. Acute appendicitis is the most common form. Acute recurrent appendicitis is more common than chronic appendicitis. In children the clinical manifestations of appendicitis are variable. Patients who have an appendicolith usually develop appendicitis, often with perforation. A case is presented of 3-year follow-up of a patient with an appendicolith and acute recurrent appendicitis. The literature about appendicoliths is reviewed. In the appropriate clinical setting, a history of prior episodes of similar right lower quadrant pain does not preclude the diagnosis of appendiceal disease. Awareness of the less common forms of appendicitis is important so that appropriate treatment is not delayed.     

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.     

Acute appendicitis associated with pneumoperitoneum

Spontaneous pneumoperitoneum is infrequently encountered as a radiographic finding in association with a perforated appendicitis. This may lead to diagnostic errors, of which every radiologist and surgeon should be aware. We report a case of perforated appendicitis associated with free intraperitoneal gas.     

Different urinalysis appearances in children with simple and perforated appendicitis

PurposeThis study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children.Basic proceduresWe prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed.Main findingsUrine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children.Principal conclusionsRoutine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.     

儿童急性阑尾炎穿孔超声征象分析

目的 分析儿童急性阑尾炎穿孔超声征象,探讨其临床意义。方法 2008年9月至2009年8月共123例患儿因急性阑尾炎在我院行阑尾切除术,其中91例患儿术前进行了超声检查且结果为阳性,手术病理结果显示这91例患儿中穿孔46例(穿孔组)、未穿孔45例(未穿孔组)。回顾性分析两组患儿的超声检查资料和临床资料并进行比较。结果 发炎阑尾超声表现为右下腹肿大的条状低回声,伴或不伴盆腔积液。穿孔组中,47.8%(22/46)的患儿表现为盆腔积液,60.9%(28/46)的患儿表现为阑尾内强回声,80.4%(37/46)的患儿表现为阑尾轮廓不清,91.3%(42/46)的患儿表现为阑尾周围网膜回声增强,均高于未穿孔组的8.9%(4/45)、35.6%(16/45)、8.9%(4/45)和44.4%(20/45),差异均有统计学意义(χ2=16.899、5.837、47.036、23.005,P均<0.05)。穿孔组的住院天数为(7.7±3.3)d,比未穿孔组的(6.3±1.2)d长,差异有统计学意义(t=2.683,P=0.009)。超声表现为盆腔积液、阑尾轮廓不清、阑尾周围网膜回声增强的患儿住院时间分别为(8.2±3.0)d、(7.9±3.3)d、(7.4±2.9)d,均长于无上述超声征象患儿的住院时间[(6.5±2.2)d、(6.2±1.4)d、(6.0±1.3)d],差异均有统计学意义(t=2.952、3.152、2.445,P均<0.05)。结论 盆腔积液、阑尾轮廓不清和阑尾周围网膜回声增强是儿童急性阑尾炎穿孔较为可靠的超声征象。当超声检查显示了上述征象时,患儿的住院时间可能延长。     

老年急性阑尾穿孔76例治疗分析

目的分析老年人阑尾炎穿孔的临床特点和处理治疗要点。方法对2003年1月至2009年12月收治的老年急性阑尾穿孔76例进行回顾性分析。结果手术治疗76例,治愈71例,治愈率93.4%,16例发生并发症(21.1%),再手术3例(3.9%),死亡5例(6.6%)。结论早期诊断,尽早手术是提高老年急性阑尾炎穿孔治疗救治的关键,手术术式强调简单有效确切安全,重视老年人并存疾病的诊治和术后围手术期处理,强调整体治疗等均为减少术后并发症、降低病死率的重要因素。     

穿孔性阑尾炎的临床表现及CT表现

目的 比较穿孔性和非穿孔性阑尾炎的CT及临床表现,探讨CT对穿孔性阑尾炎的诊断价值.方法 术后回顾性分析109例阑尾炎患者,将其分为穿孔性阑尾炎和非穿孔性阑尾炎2组,分析及比较二组临床症状、体征、实验室检查及CT征象.结果 症状持续超过3d、右下腹痛性包块,CT上阑尾管壁缺损、阑尾周围积气、阑尾腔外结石、腹腔脓肿、蜂窝组织炎等对于穿孔性阑尾炎的诊断具有较大的特异性,而反跳痛、腹肌紧张及CT上阑尾直径、阑尾周围肠壁增厚在穿孔性阑尾炎组中出现的概率也高于非穿孔性阑尾炎组(P＜0.05).结论 结合CT征象及临床表现可提高穿孔性阑尾炎的诊断,对于手术方案的选择具有较大的意义.     

Acute appendicitis in a femoral hernia: an unusual presentation of a groin mass

Although most groin masses are simple hernias, occasionally these hernias contain more than just small intestine. Femoral hernias, which are less common than inguinal, are more often found in females. Stomach, omentum, colon, or an appendix each has been reported to be contained in a femoral hernia. Having an acutely inflamed appendix contained in a femoral hernia sac in a male is extraordinarily rare. We report a case of acute appendicitis contained in a femoral hernia of a 76 year old man. This entity presents much like an incarcerated hernia, and differentiating the two can lead to changes in the surgical management.     

Unusual perforated appendicitis within umbilical hernia: CT findings

We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location.     

Acute urinary retention in a 9-year-old child: an atypical presentation of acute appendicitis

Acute urinary retention is unusual in childhood and when present is likely to have an identifiable cause. Although the evaluation is often performed by the urologic specialist after relief of the obstruction, it is imperative that some causes be identified in the Emergency Department. This is a case of a 9-year-old boy in acute urinary retention caused by a ruptured appendix with a periappendiceal abscess.     

Acute isolated tuberculous appendicitis

Non-pulmonary tuberculosis is found with different frequencies in different countries of the world. It is said to constitute about 4% of all tuberculosis cases in Poland, about 25% in England and Wales and about 17% in the USA. It seems that these differences are the result of differences in rates of diagnosis and registration of new tuberculosis cases. This in turn is influenced by public health funding in the individual countries. In this work, we present a case of acute, isolated, tuberculous inflammation of the appendix. We call attention to the fact that pre-operative diagnosis is practically impossible. Clinical symptoms do not point to inflammatory changes. Only surgical evaluation, and especially the result of histopathological examination make it to possible to establish the final diagnosis to initiation of anti-tuberculous treatment.