Gas-filled appendix with meniscus: Outline of the appendicolith

A meniscus was produced in a gas-filled appendix by the outline of the obstructing appendicolith. This meniscus appearance should be specific for appendicitis since it represents the obstructing stone. This sign can be elicited by oblique or other projections, perhaps with fluoroscopic control.     

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.     

A Rare but Distinctive Cause of Acute Abdomen: Appendiceal Diverticulitis

Background

Diverticulosis and diverticulitis of appendix vermiformis is a rare diagnosis. Clinical and laboratory examinations do not show a difference between a progressing diverticulitis and simplex appendicitis. But this entity has a higher mortality rate than common appendicitis.

Objective

This case is presented to illustrate the point that preoperative simple diagnosis of acute appendicitis according to the clinical signs and physical examination may not only be insufficient, but could be fatal in certain circumstances, like appendiceal diverticulitis, if surgical intervention is delayed.

Case Report

Here we present a female patient with a history of right lower abdominal pain and fever of 3 days duration. She was diagnosed with acute appendicitis according to the preoperative physical, laboratory, and imaging examinations. The appendiceal diverticulitis accompanying acute appendicitis was an intraoperative finding, which was proven by histopathologic examination.

Conclusion

It is not easy to document this entity preoperatively. When diagnosed either preoperatively by imaging studies or intraoperatively, the only choice is appendectomy to prevent its serious complications.     

急性阑尾炎超声影像分析

目的结合阑尾炎的病理分型,分析急性阑尾炎声像图特征以提高其诊断准确率。方法应用凸阵、线阵探头分析41例阑尾炎患者的临床资料,总结不同病理分型的声像图表现。结果 41例患者超声发现病变阑尾40例,其中单纯性阑尾炎17例,化脓性阑尾炎15例,坏疽性阑尾炎8例,手术证实坏疽性阑尾炎1例;超声显示阑尾长轴呈肿大盲管样结构、短轴呈靶环征,壁增厚,无蠕动,管腔压闭性消失及穿孔阑尾管壁回声中断等自身变化继发改变。"超声麦氏征"阳性率100%。结论超声可清晰显示盲肠壁、阑尾孔及阑尾盲端,其典型的声像图特征有助于准确诊断急性阑尾炎。     

误诊为妇科疾病的急性阑尾炎临床分析

目的:探讨被误诊为妇科急腹症的阑尾炎的临床特点及误诊原因。方法:对2002年1月-2010年7月在我科以妇科急腹症住院并手术后最终确诊的急性阑尾炎或妇科疾病并发急性阑尾炎患者20例进行回顾性分析。结果:20例患者中被误诊为急性盆腔炎12例、卵巢囊肿并蒂扭转2例、卵巢畸胎瘤2例、右侧附件炎4例。结论:不典型阑尾炎特别并发妇科原有疾病往往容易导致误诊。详细询问病史,仔细查体,密切观察疾病发展态势以及与外科医生保持紧密联系是避免误诊的关键所在。     

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。     

尿胰蛋白酶原-2在急腹症中筛选急性胰腺炎的价值

目的：探讨尿胰蛋白酶原．2测定在急腹症中筛选急性胰腺炎的价值。方法：对68例因腹痛就诊的病人。在检测血、尿淀粉酶的同时做尿胰蛋白酶原．2测定及B超检查。结果：24例经B超及血、尿淀粉酶等联合确诊为急性胰腺炎中有22例尿胰蛋白酶原．2阳性，敏感性为91．7％，另44例非胰腺炎的腹痛病人有2例假阳性，特异性为95．5％。其敏感性和特异性均较血、尿淀粉酶为优，24例急性胰腺炎中B超发现有胆囊结石胆囊炎者9例。结论：尿胰蛋白酶原．2测定是急诊科急腹症筛查和诊断急性胰腺炎的良好检验指标。     

Rectus sheath hematoma caused by non-contact strenuous exercise mimicking acute appendicitis

A healthy 26-year-old man visited the Emergency Department due to right lower quadrant pain of 2 days' duration that developed after wakeboarding. There was no history of direct trauma to the abdomen. Physical examination revealed tenderness and rebound tenderness on the right lower quadrant area. There was no palpable abdominal mass. Computed tomography (CT) of the abdomen was undertaken to discern the causes of acute abdomen, including acute appendicitis. CT revealed a small-size rectus sheath hematoma beneath the lower end of the right rectus muscle. The patient was admitted for supportive care including pain control and was discharged with improvement after 5 days. Rectus sheath hematoma can be caused by not only a direct blow but also non-contact strenuous exercise, for example, wakeboarding in this case. Although the majority of rectus sheath hematomas are self-limiting, some can cause peritoneal irritation signs, mimicking acute abdomen, and eventually lead to unnecessary laparotomy without clinical suspicion and ancillary tests including CT scan and ultrasonography.     

临床不典型阑尾炎的CT诊断

目的 探讨CT扫描对临床不典型阑尾炎的诊断价值。方法 搜集临床症状和体征不典型．经手术和病理证实为阑尾炎者14例，回顾性分析其CT表现。结果 13例具有阑尾炎的CT表现：5例阑尾增粗、壁增厚．其中2例阑尾内见结石．1例结石位于穿孔阑尾周围；盲肠周围炎8例，腰大肌前方脓肿2例，盲肠末端局限性增厚4例，右侧结肠旁沟及盆腔积液3例。另1例表现为右下腹脓肿因而误诊为盆腔炎。结论 临床症状和体征不典型的阑尾炎临床诊断困难，易造成误诊，多数病例根据其CT表现可做出正确诊断。     

Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis

Objective : To estimate the frequency of abnormal clinical symptoms, laboratory tests, and diagnostic imaging studies in the ED assessment of elderly (≥65 yr) patients with acute cholecystitis, and to compare these factors in the young-old (65–74 yr), middle-old (75–84 yr), and old-old (≥85 yr) population groups.
Methods : A retrospective, cross-sectional study was performed by review of ED records, hospital charts, and surgical operative reports of consecutive elderly ED patients determined at surgery to have acute cholecystitis. Records were reviewed between April 1990 and April 1995 at a large Midwestern tertiary care facility with 65,000 annual ED patient visits. Clinical signs and symptoms were compared in the young-old, middle-old, and old-old population groups.
Results : Of the 168 patients reviewed, 141 (84%) had either epigastric or right upper quadrant abdominal pain, and 8 (5%) had no pain whatsoever. Only 61 patients (36%) had back or flank pain radiation. Ninety-six (57%) experienced nausea, 64 (38%) had emesis, and 13 (8%) had visible jaundice. Ninety-four (56%) patients were afebrile and 69 (41%) had no increase of white blood cell count. Twenty-two (13%) patients had no fever and all tests were normal. No statistical difference was noted in any symptom or laboratory factor for the 3 age groups, except jaundice was more common among the patients aged ≥85 years. Ultra-sonography was diagnostic for 91%, and CT was beneficial for only 1 patient. Eight patients had normal results on their ultrasonographic and CT studies.
Conclusion : Classic symptoms and abnormal blood test results are frequently not present in geriatric patients with acute cholecystitis. Increasing age does not appear to affect the clinical and test markers used by clinicians to diagnose this illness. A high degree of awareness is essential for correct diagnosis of acute cholecystitis in geriatric patients.     

Pneumoperitoneum and appendicitis

Pneumoperitoneum was observed in five patients with acute perforative appendicitis (APA). In each case this radiographic observation led to an incorrect diagnosis. Free intraperitoneal gas is found in a small number of patients with APA and has no apparent effect on the course or prognosis of the disease.     

Sonography of acute appendicitis in pregnancy

Background: Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. Methods: We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. Results: The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Conclusions: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.     

Acute appendicitis caused by acute myeloid leukemia

A case of appendiceal involvement by acute myeloid leukemia (AML) in an adult with recent history of AML transformed from myelodysplastic syndrome (MDS) was presented. Being aware of this rare presentation in particular in a patient with history of MDS and/or AML is important for prompt clinical diagnosis and management.     

急腹症腹腔镜手术25例分析

急腹症急诊腹腔镜手术25例，其中急性胆囊炎胆囊切除术12例，急性阑尾炎阑尾切除术6例，消化性溃疡穿孔穿孔修补术3例，胃大部切除、毕氏Ⅱ式吻合术1例，左侧腹股沟斜疝嵌顿、肠梗阻疝修补术1例，仅1例肠梗阻表现的升结肠癌和1例粘连性肠梗阻转剖腹手术。腹腔镜确诊率为100％，腹腔镜手术成功率为92％。     

Necrotizing fasciitis due to acute perforated appendicitis: case report

Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in treatment increases the likelihood of complications such as perforation, which is associated with an increase in morbidity and mortality rates. We herein present the case of a 76-year-old woman presenting with necrotizing fasciitis of the abdominal wall and right flank regions due to a perforated appendix. Such complication is extremely rare but life-threatening. It may be confused with cellulitis, causing a delay in aggressive treatment. This case represents an unusual complication of a common disease. Also, acute appendicitis or intra-abdominal pathologies should be taken into consideration in determining the cause of necrotizing fasciitis presenting over abdominal, flank, or perineal regions.     

急性阑尾炎的超声表现与病理对照分析

目的探讨超声在急性阑尾炎诊断中的应用价值。方法通过对临床诊断为急性阑尾炎行超声检查的218例患者的回顾性分析，比较超声检查、手术及病理结果。结果218例中167例超声诊断为阑尾炎。均为手术、病理所证实；20例为其他急腹症；33例超声检查阴性，其中11例为阑尾炎，8例为单纯性阑尾炎，3例为后位阑尾炎，超声诊断急性阑尾炎的敏感性为94．5％，特异性为100％。结论超声检查是急性阑尾炎简便有效的辅助诊断方法，对可疑病例进行常规检查可明显降低误诊误治率。     

体外受精与胚胎移植术后急腹症67例临床分析

目的：探讨体外受精与胚胎移植（IVF-ET）术后急腹症的发生种类、临床特点及误诊情况。方法：回顾性分析1534个胚胎移植周期术后发生的急腹症,分析其病因,发生率,临床特点,与妊娠的关系,本院与外院医生的首诊误诊情况。结果：急腹症的总发生率为4.3%（67/1534）,主要的病因有：卵巢过度刺激综合征、异位妊娠、卵巢扭转等,其中卵巢过度刺激综合征和异位妊娠占92%（62/67）,自然妊娠中罕见的宫内外复合妊娠占异位妊娠总数的13.8%（4/29）。IVF-ET后妊娠组急腹症的发生率显著高于非妊娠组（11.7%和0.7%,P=0.000）,67例急腹症患者有60例（89.6%）合并妊娠。外院医生的首诊误诊率显著高于本院医生（33.3%和5.5%,P〈0.05）。结论：IVF-ET相关急腹症的主要病因是卵巢过度刺激综合征和异位妊娠,与妊娠显著相关;宫内外复合妊娠发生率增高。应普及IVF-ET知识,降低误诊率。     

多层螺旋CT对急性阑尾炎的诊断价值

目的探讨多层螺旋CT（MSCT）对急性阑尾炎的诊断价值。方法收集临床疑诊和／或经手术和病理证实为急性阑尾炎患者35例,回顾分析其CT表现。结果26例确诊急性阑尾炎病例中主要CT征象有：阑尾肿大24例（92％）,阑尾粪石10例（38％）,回盲部肥厚12例（46％）,阑尾周围炎20例（77％）,局限性脓肿2例（8％）。对照手术病理,MSCT诊断急性阑尾炎准确率89％、敏感性92％、特异度74％、阳性预测值92％、阴性预测值71％。结论MSCT显著提高了急性阑尾炎的术前诊断能力,应成为临床首选的影像学检查方法。