重视正常阑尾CT影像对鉴别急性阑尾炎的价值

目的：重视正常阑尾的CT影像表现,减少对急性阑尾炎的漏诊、误诊。方法：收集我院2010—09—2011-06行全腹部CT287例寻找正常阑尾,并进行MPR图像重建,同时收集我院经手术病理证实为急性阑尾炎18例,并进行回顾分析。结果：①287例中有26l例可发现正常阑尾（90．9％）。②急性阑尾炎18例,术前CT误诊10例：其中单纯急性阑尾炎1例漏诊,误诊为回盲部肿瘤4例、小肠肿瘤3例、右下腹附件炎性肿块2例。通过四顺分析误诊主要原因是未能充分认识正常阑尾影像表现。结论：多排螺旋CT晁示阑尾率高,掌握正常阑尾影像表现,有助于提高急性阑尾炎的诊断。     

Sonographic appearance of the normal appendix in adults.

OBJECTIVE: To evaluate the sonographic visualization of the normal adult appendix, a large series of sonographic images from consecutive asymptomatic patients was analyzed. METHODS: A total of 788 consecutive adult patients (402 male and 386 female; median age +/- SD, 51.1 +/- 17.2 years; range, 16-91 years) were examined by appendiceal transabdominal sonography with tissue harmonic imaging. The detection rate, outer appendiceal diameter, intraluminal content, and location of the appendix were estimated. The overall normal appendix was separated into appendix-visualized and appendix-not-visualized groups, which were then examined for the relationship with abdominal wall thickness, body mass index (in kilograms per square meter), age, and sex. RESULTS: The normal appendix was detected in 388 (49.2%) of 788 patients. The outer appendiceal diameter +/- SD was 4.27 +/- 1.2 mm (range, 1.0-11.1 mm). In 291 (75%) of the 388 patients, appendices could be depicted in the intra-luminal gas during sonography. The location of the appendix was classified according to the appendiceal tip, which was found to be abdominal in 37 (9.5%), pelvic in 291 (75%), retrocecal in 23 (6.0%), and a midline extension in 37 (9.5%). In both body mass index and abdominal wall thickness, significant differences were found between appendix-visualized and appendix-not-visualized cases (P < .05). There was no significant difference in age (P = .37) or sex (P = .23) between appendix-visualized and appendix-not-visualized cases. CONCLUSIONS: The results show that the normal adult appendix can be revealed by sonographic visualization in a large series of asymptomatic patients.     

Improved sonographic visualization of the appendix with a saline enema in children with suspected appendicitis.

OBJECTIVE: To determine whether abdominal sonography after a saline enema can identify the appendix that is not visualized at graded compression sonography in children with suspected appendicitis. METHODS: High-frequency compression sonography was prospectively performed in 120 consecutive children with suspected appendicitis; the appendix was not identified in 27 of these patients. Among the 27 patients with a nonvisualized appendix, abdominal sonography after a saline enema was performed in 12 to identify the appendix. RESULTS: Abdominal sonography after the saline enema revealed the appendix in all 12 children in whom the appendix was not visualized at graded compression sonography. A normal appendix was found in 11 children, and acute appendicitis confined to the appendiceal tip was found in 1. The appendix was located in the pelvis (n = 5), posterior to the cecum (n = 4), posterior to the ileum (n = 2), and anterior to the ileum (n = 1). The appendix could be identified by using a window of the saline-filled sigmoid colon (n = 5), saline-filled cecum (n = 4), and saline-filled terminal ileum (n = 2). CONCLUSIONS: Abdominal sonography after a saline enema is a helpful technique for depiction of the appendix that is not visible at graded compression sonography in children with suspected appendicitis. Key words: appendix, sonography; appendicitis; children, gastrointestinal tract.     

Differential expression of Chitinase 3‐Like 1 protein in appendicitis and appendix carcinomas

BackgroundChitinase 3‐Like 1 (CHI3L1) has been used as an inflammatory biomarker for a variety of diseases, but its expression in acute appendicitis and appendix carcinomas remains unclear.MethodsSixty cases of patients were studied, including 46 acute appendicitis and 14 appendix carcinomas. We divided the acute appendicitis group into acute uncomplicated appendicitis (AUA), suppurative appendicitis (SA), and gangrenous appendicitis (GA). The appendix carcinoma group was divided into appendiceal neuroendocrine neoplasms (ANENs) and appendiceal mucinous neoplasms (AMN). Controls were 32 healthy donors. Blood neutrophil to lymphocyte ratio (NLR), CHI3L1, C‐reactive protein (CRP), interleukin‐6 (IL‐6), and serum amyloid A (SAA) were measured in the patients. Meanwhile, immunohistochemistry and immunofluorescence were used to identify the expression level and location of CHI3L1 in different cell types in appendix tissues.ResultsCompared with the controls, CHI3L1 serum levels were up‐regulated in SA, GA, and AMN groups, while no significant difference was observed in the AUA and ANEN groups. Immunofluorescence revealed that CHI3L1 expression was high in macrophages and adenocarcinoma cells of appendix tissues but not in the neuroendocrine carcinoma tissues. Moreover, levels of NLR and CRP in the SA and GA groups were considerably higher than in the control group. IL‐6 and SAA in SA, GA, ANENs, and AMN groups were also increased compared with the control group. In addition, CHI3L1 displayed good performance in predicting appendicitis, with an AUC of 0.862.ConclusionCHI3L1 was highly expressed in acute appendicitis and appendiceal mucinous neoplasms, which can be used as a novel biomarker predicting appendicitis.     

便携式彩色多普勒超声在急性阑尾炎诊断中的价值

目的探讨便携式彩色多普勒超声在诊断急性阑尾炎中的临床应用与诊断价值。方法将227例下腹痛临床疑诊阑尾炎的患者分为两组，对照组接受普通超声检查，干预组接受便携式彩色多普勒超声检查，分别将两组超声诊断结果与手术病理结果比较后，对比分析两组相关数据。结果干预组超声诊断急性阑尾炎且进入手术88例，经病理证实84例，阳性符合率95．45％（84／88），误诊4例，误诊率4．55％（4／88），漏诊2例，漏诊率2．33％（2／86）；对照组超声诊断急性阑尾炎且进入手术86例，经病理证实80例，阳性符合率93．02％（80／86），误诊6例，误诊率6．98％（6／86），漏诊5例，漏诊率5．88％（5／85）。干预组平均候检时间1．5h，平均住院时间124h；对照组平均候检时间5．9h，平均住院时间147h。结论便携式彩超检查体积小巧，方便快捷，性能更佳，可以随时反复进行，及时发现早期病变，及时接受手术治疗，缩短住院时间和减少不良并发症，对于帮助临床医师提高早期诊断率，减少不良并发症有重要价值。     

Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography.

OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.     

Preoperative sonographic diagnosis of acute appendicitis caused by Ascaris lumbricoides

Acute appendicitis caused by Ascaris lumbricoides is an uncommon variant of a common disease. We describe a case in which sonography was used for preoperative diagnosis of ascaris appendicitis. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:96–97, 1999.     

多层螺旋CT在阑尾炎诊断中的应用

目的回顾性分析阑尾炎在多层螺旋CT中的表现及其诊断价值。方法14例阑尾炎患者应用16层螺旋CT进行扫描，以0．75mm薄层行多平面重建(MPR)及最大密度投影(MIP)后处理，并将其诊断结果与手术、病理结果进行对照。结果CT发现8例阑尾增祖、增大，其中2例伴有粪石，2例内见小气泡影，2例伴有局部脂肪间隙模糊；2例回盲部软组织块影伴有小肠低位梗阻；2例盲肠壁增厚，腔内见密度不均的软组织样影，邻近见多个淋巴结；2例仅见周围脂肪间隙模糊。结论多层螺旋CT能更清晰的显示阑尾炎病变，有较高的临床应用价值.     

实验室检查在急性阑尾炎诊断中的意义

目的探讨急性阑尾炎轻重程度与白细胞计数、中性粒细胞百分比、胆红素的关系。方法2004年我院收治的121例急性阑尾炎患者,术前行实验室检查对比术中所见(术后病理)作回顾性分析,将结果进行两组独立样本计量资料的t检验和分组计数资料的四格表卡方检验。结果重型阑尾炎(坏疽性、穿孔性、坏疽合并穿孔性)较轻型阑尾炎(单纯性、化脓性)中性粒细胞百分比高(t检验,P<0.001;χ2检验,P=0.015)、胆红素增高异常〔总胆红素(TB):t检验,P<0.001;χ2检验,P<0.001;直接胆红素(DB):t检验,P=0.032,χ2检验,P<0.001;间接胆红素(IB):t检验,P<0.001,χ2检验,P=0.004〕。白细胞计数在重型与轻型之间无显著差异(t检验和χ2检验双重证实)。被调查的病例中有109例(90.1%)患者表现了不同形式的肝功异常。结论急性阑尾炎时中性粒细胞百分比较白细胞计数能更准确地反映疾病的严重程度,胆红素异常多预示重型阑尾炎,急性阑尾炎致肝功异常局部解剖特点占有相当重要的作用。     

Sonographic appearance of an appendiceal diverticulum.

The increasing use of sonography for evaluating acute abdomen has brought greater recognition of appendicular abnormalities. We present an incidental finding of an appendiceal diverticulum during a sonographic examination of a 4-year-old child with acute appendicitis. Abdominal sonography showed an enlarged, swollen appendix with a diameter of 1.1 cm and a small, fingerlike lateral projection approximately 2.0 cm from its tip. The specimen, resected during an appendectomy, was 5.5 cm long and 1.0 cm in diameter and had a 0.3-cm outpouching. Microscopic examination revealed a pseudodiverticulum composed of mucosa and muscularis mucosa.     

Uterus-like mass involving the appendix: Us and CT findings

Uterus‐like mass is a rare extrauterine mass composed of a central cavity lined by endometrium and surrounding smooth muscle. Uterus‐like mass has frequently been reported in the ovary, but has rarely been found in extraovarian regions. We report a case of uterus‐like mass involving the appendix in a woman who presented with right lower abdominal pain indistinguishable from acute appendicitis. Sonography revealed a heterogeneous mass of mixed echogenicity with inner cystic change, abutting the appendix. CT depicted an enhanced mass with inner cystic change abutting the appendix. Histopathologic examination confirmed the diagnosis. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:518–521, 2012     

急性阑尾炎的超声诊断及分型探讨

目的 分析急性阑尾炎的超声表现及病变程度，探讨急性阑尾炎超声分型的临床价值。方法 回顾分析122例经手术及病理证实急性阑尾炎的超声图像资料，对其声像图特征进行分型。结果 本组122例中，急性单纯性阑尾炎21例，超声诊断符合率76．2％（16／21）；急性化脓性阑尾炎66例，超声诊断符合率90．9％（60／66）；急性坏疽性阑尾炎18例，超声诊断符合率83．3％（15／18）；阑尾周围脓肿17例，超声诊断符合率100％。结论 超声对急性阑尾炎的诊断及分型具有重要的临床价值。     

内镜逆行阑尾炎治疗术诊治急性阑尾炎的初步尝试

目的:探讨内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)诊治急性阑尾炎的临床意义。方法:回顾性分析2018年1月至2019年9月复旦大学附属金山医院收治的30例行ERAT治疗的急性单纯性、化脓性、穿孔性阑尾炎和阑尾周围脓肿患者的临床资料。术后通过门诊或电话进行随访,分析ERAT治疗成功率、治疗后情况以及随访情况。结果:在30例急性阑尾炎患者中,ERAT成功治疗29例,成功率为96.7%(29/30)。此29例患者腹痛症状均即刻缓解。随访过程中,1例患者复发,复发率为3.4%(1/29)。结论:ERAT可有效、安全地治疗急性阑尾炎。     

An unusual complication of missed appendicitis

A case of necrotizing fasciitis complicating missed appendicitis with perforation and abscess formation in a 63-year-old diabetic is presented. The case emphasizes the importance of thorough, conservative evaluation and management in elderly diabetic patients. The ED management of patients with necrotizing fasciitis is also briefly reviewed.     

Culture-based bacterial evaluation of the appendix lumen in patients with and without acute appendicitis

PurposeControversy exists over whether bacterial flora within the appendix differs between patients with and without appendicitis. To examine these potential differences, we cultured the appendiceal luminal microbiota of patients with and without acute appendicitis, and identified the bacterial species therein.MethodsFifty-seven patients with acute appendicitis and 37 patients without acute appendicitis who underwent curative resection of colorectal cancer and prophylactic appendectomies (control group) were included. Appendicitis patients were classified into the phlegmonous group or the gangrenous appendicitis group histopathologically. There was no patient with perforated appendicitis. Aerobic isolates were identified using standard identification schemata, and anaerobic isolates were identified according to the Japanese guidelines.ResultsThere were no significant differences among the three groups in the median number aerobe species present per patient. However, the median number anaerobe species in the gangrenous appendicitis group was significantly higher than that of the control group and the phlegmonous appendicitis group. In addition, the incidence of patients with Bacillus species, Fusobacterium nucleatum, and Bilophila wadsworthia increased as the disease progressed from phlegmonous to gangrenous appendicitis.ConclusionThe present results suggest that increased diversity of anaerobes and the translocation of Bacillus species, F. nucleatum, and B. wadsworthia are associated with the progression of acute appendicitis.     

超声对急性阑尾炎的诊断价值

目的 探讨阑尾炎的声像图特征及超声对阑尾炎的诊断价值.方法 应用低频结合高频超声对142例急性阑尾炎患者进行检查,并将观察结果 与手术结果 对照.结果 阑尾炎的超声诊断符合率为83.10%.142例中急性单纯性阑尾炎53例,占37.32% ;急性化脓性阑尾炎71例,占50%;坏疽性阑尾炎13例,占9.15%;阑尾周围脓肿5例,占3 .52%.结论 超声检查尤其是高频超声对急性阑尾炎的诊断具有重要价值 .     

急性阑尾炎CT检查的临床意义

目的 分析急性阑尾炎的临床、CT特征，探讨CT检查的临床意义。方法 回顾性分析经临床、CT随访和（或）手术、穿刺病理证实的急性阑尾炎45例（男21例，女24例），年龄38～86岁（平均66岁）。结果 45例中CT诊断为急性阑尾炎可能1例（2．22％）；急性阑尾炎8例（17．78％）；急性阑尾炎并阑尾周围炎14例（31．1l％）；急性阑尾炎并穿孔5例（11．11％）；阑尾脓肿13例（28．89％）；阑尾炎性肿块4例（8．89％）。急性阑尾炎的CT直接征象为阑尾肿大增粗（直径〉6mm）、阑尾壁增厚和阑尾石，间接征象有阑尾一盲肠周围脂肪内条索影等。临床诊断为急性阑尾炎可能6例；急性阑尾炎2l例；阑尾炎包块16例；另有2例因右上腹痛而拟诊胆囊炎，假阴性率为4．44％（2／45）。结论 CT对急性阑尾炎的诊断特别是对临床表现不甚典型的阑尾炎及其并发症的诊断，具有很高准确率。