小儿尾性阑尾炎18例报告

报告小儿慢性阑尾炎１８例，其中１６例有典型急性阑尾炎病史，１８例患儿均行手术治疗，术中证实其病因主要为阑尾先天性异常和变异；阑尾腔内粪石，异物，寄生虫（卵）先天性和后天性阑尾粘连，以上原因导致的阑尾腔不完全阻塞，反复发作和长期刺激是病变的基础，阑尾纤维组织增生和淋巴细胞，嗜酸性粒细胞浸润是病理特征，认为小儿慢性阑尾炎一旦确诊，不管在发作期或发作期，均应于手术治疗。     

慢性阑尾炎腹腔镜手术治疗

目的 探讨腹腔镜下慢性阑尾炎治疗的可行性、方法和效果。方法 选择8例慢性阑尾炎病人行腹腔镜阑尾切除术。结果 8例均成功完成腹腔镜手术。平均手术时间30min，术中几乎不出血。术后胃肠功能平均恢复时间分别1．2d。术后平均进流质时间6h。无一例中转开腹，无一例手术并发症。结论 慢性阑尾炎行腹腔镜手术治疗安全、可行，具有创伤小、术后恢复快等微创手术优势，可获得与开腹手术相同的疗效。     

腹直肌外缘切口阑尾切除术126例临床分析

笔者采用腹直肌外缘切口行阑尾切除术１２６例,获得满意疗效。现报告如下。一般资料：男４９例,女７７例;年龄１４～８３岁,平均４８．５岁。急症手术８１例,其中急性化脓性阑尾炎阑尾穿孔１８例,急性坏疽性阑尾炎１２例,急性单纯性阑尾炎４６例,阑尾蛔虫症４例,...     

超声诊断阑尾炎50例分析

50例患者均以下腹及右下腹疼痛接受B超检查(采用美国GE-fino B型超声仪,探头频率3.5MH_2凸型线阵探头)。显示阑尾47例,其中急性阑尾炎32例,化脓性阑尾炎8例。慢性阑尾炎7例,误诊3例。经手术证实急性阑尾炎30例,化脓性阑尾炎10例(其中小范围点状化脓3例,慢性阑尾炎7例。3例误诊中1例阑尾根部和中部炎症轻微,仅在尖部充血、水肿;1例为高位阑尾;另1例为慢性化脓性阑尾炎其周围有较厚的大网膜包围误诊为右附件肿瘤。     

结肠癌并存阑尾炎91例临床分析

目的 探讨结肠癌并存阑尾炎临床特点、诊断及治疗。方法 对1985～2000年我院结肠癌并存阑尾炎临床资料进行回顾性分析。结果 37例诊断为急性闹尾炎或阑尾周围脓肿，急诊行阑尾切除术，19例术中发现并存结肠癌，一期行根治术15例，4例、Hartmann手术，J8例首次仅行阑尾炎切除术，术后消化道症状复诊，行相关检查确诊后再次手术，其中2例因广泛转移仅行捷径手术，平均出现时间46天。31例仅诊断为慢性阑尾炎，因反复出现不适行B超、钡灌肠或纤维结肠镜检首次术前确诊19例一期手术根治，其余12例漏诊结肠癌，7例行阑尾切除术中发现Ⅰ期手术根治，5例术后确诊再次手术根治，平均出现时间98天。结肠癌手术中发现阑尾有慢性炎症切除或手术标本中检出慢性阑尾炎23例。经随访首次手术时根治结肠癌病人3年、5年生存率为75％、68％，再次手术时根治结肠癌病人3年、5年生存率42％、10％。结论 结肠癌并存阑尾炎易漏诊漏治结肠癌，延误病情．直接影响根治率和预后，要加强本病的认识，争取一期手术根治，延长病人生存期。     

阑尾切除术后第5日综合征8例

阑尾切除术后第５日综合征是小儿阑尾切除术后的少见并发症,由于临床上对该症认识不足,故常易误诊。１９７５年至今,我院发现８例。现报告如下。临床资料：本组男５例,女３例;年龄４～１３岁,平均６．５岁。分别以急性阑尾炎或慢性阑尾炎急发作施行阑尾切除术,手术...     

电子内镜下尼龙绳圈套结扎取阑尾蛔虫成功1例

阑尾蛔虫病是肠道蛔虫的并发症之一,易梗阻引起急性阑尾炎而行急诊手术,或误为慢性阑尾炎。我院做肠镜时发现阑尾蛔虫1例,采用尼龙绳圈套结扎取出,现报告如下。     

术中阑尾寻找困难的原因及处理（附32例报告）

1991年10月～1996年5月,我院施行阑尾切除术467例,其中32例术中阑尾寻找困难,现报告如下。1 临床资料 本组32例中,男19例,女13例;年龄7～63岁。术前诊断急性阑尾炎25例,单纯性6例,化脓性10例,坏疽、穿孔性7例,阑尾周围脓肿2例,慢性阑尾炎4例,慢性阑尾炎急性发作3例。常规行阑尾切除24例,逆行阑尾切除6例,脓肿切开引流2例。开腹后均未顺利找到阑尾,其中因手术野显露不好5例,将横结肠或乙状结肠误为盲肠2例,阑尾溃烂2例,手术区粘连9例,阑尾萎缩变小2例,盲肠后腹膜外阑尾4例,盲肠过度游离或位置异常7例,内脏转位1例。手术时间为45～210分钟。32例全部治愈。2 讨论     

经根部浆膜下切开阑尾切除术124例分析

1995年 10月～ 2 0 0 2年 3月 ,我院应用经根部浆膜下切开阑尾切除术 (下称浆膜下阑尾切除术 )共治疗各种病理类型的阑尾炎 12 4例 ,取得了良好的临床效果。现报告如下。临床资料 :本组男 84例 ,女 4 0例 ;年龄 13～ 79岁 ,平均4 2岁 ;发病时间 4小时～ 4天 ,平均 1天。入院后均急症行浆膜下阑尾切除术。 12 4例中术后病理诊断为阑尾粘液囊肿伴慢性炎症 2例 ,急性单纯性阑尾炎 19例 ,急性化脓性阑尾炎6 5例 ,阑尾坏疽、穿孔 38例。手术方法 :选择硬脊膜外麻醉 10 4例 ,局部浸润麻醉 16例 ,全麻 4例。均选用 Mcburney斜切口 ,距阑尾根部 0 .…     

阑尾炎患者阑尾切除181例体会

１９８９年１０月～１９９９年４月,我院行阑尾切除术１８１例。现将阑尾切除的手术时机探讨如下。 一般资料：本组１８１例中,男１２４例,女５７例;年龄５岁～７４岁,平均３１．５岁。其中急性阑尾炎９２例,慢性阑尾炎急性发作 ８８例,慢性阑尾炎（无症状期） １例。 手术情况：发病３天内手术９８例,发病３天后手术８３例。术中探查证实,单纯性阑尾炎９２例,化脓性阑尾炎６１例,坏疽性阑尾炎２８例（其中１１例出现了穿孔）,且在上述病例中有８７例阑尾与肠系膜、肠管或腹膜出现了不同程度的粘连。 结果：本组除１２例出现并…     

Duplicated appendix complicated by appendiceal cancer

A 37-year old male presented with an acute abdomen suggestive of an appendiceal perforation.Urgent laparotomy showed a duplicated appendix with one of the lumens involved with appendicitis and a focal periappendicular abscess while the other lumen had a localized appendiceal cancer.Recognition of congenital intestinal duplications in adults is important to avoid serious clinical consequences.     

Electron microscopic study of microfold cells (M cells) in normal and inflamed human appendix

Electron microscopic observation was made on microfold cells (M cells) in the covering epithelium of the lymphoid follicle (dome epithelium) of the intestine. Materials consisted of ten human appendices, five of those were inflamed and obtained from children with acute appendicitis. The remainder was not inflamed macroscopically, and there was one human Peyer's patch for control. The results indicate that in the human appendix, the elevated surface type of M cells named by protruding apical cytoplasm to the lumen was more conspicuous than the depressed surface type. The latter type was named by shorter irregular microvilli than those of neighboring cells, and was present dominantly in human Peyer's patch. M cells with enfolded lymphocytes consisted of the stumpy type and the slim type in the whole shape. M cells in the inflamed appendix showed their apical cytoplasm swelling like a balloon and microfolds disappearing, and seemed vulnerable to inflammation. It is considered that the M cell surface structure changes not only in accordance with enfolded lymphocytes and the uptake of antigenic materials, but also according to the organ in which M cells are present and whether inflammation is present or not.     

Diverticula of the vermiform appendix

The vermiform appendix can be the site of development of diverticula which may suffer either inflammatory complications with or without appendicitis or may only be an incidental finding in an uninflamed appendix. This is a retrospective study of 10 of 575 cases of consecutive appendices removed and examined within a year, with single or multiple appendiceal diverticula with diverticulitis and peridiverticulitis. In six of the 10, the lumen of the appendix did not show any inflammatory changes. In conclusion, one could assume that inflammatory complications of the appendiceal diverticula, although they may mimic acute appendicitis, are quite distinct clinical entities. Acute appendicitis in the presence of appendiceal diverticula may carry an earlier and higher rate of perforation and appendiceal diverticula, as an incidental finding, may justify appendectomy on occasion.     

Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy： A case report

Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of the lumen due to various causes is believed to be the most common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microscopic documentation of the case is also presented.     

Diagnostic value of maximal-outer-diameter and maximalmural-thickness in use of ultrasound for acute appendicitis in children

MM： To evaluate the maximal-outer-diameter （MOD） and the maximal-mural-thickness （MMT） of the appendix in children with acute appendicitis and to determine their optimal cut-off values to diagnose acute appendicitis.
METHODS： In total, 164 appendixes from 160 children between 1 and 17 years old （84 males, 76 females; mean age, 7.38 years） were examined by high-resolution abdominal ultrasound for acute abdominal pain and the suspicion of acute appendicitis. We measured the MOD and the MMT at the thickest point of the appendix. Patients were categorized into two groups according to their medical records： patients who had surgery （surgical appendix group） and patients who did not have surgery （non-surgical appendix group）. Data were analyzed by MedCalc v.9.3. The rank sum test （Mann-Whitney test） was used to evaluate the difference in the MOD and the MMT between the two groups. ROC curve analysis was used to determine the optimal cut-off value of the MOD and the MMT on diagnosis of acute appendicitis.
RESULTS： There were 121 appendixes （73.8%） in the non-surgical appendix group and 43 appendixes （26.2%） in the surgical appendix group. The median MOD differed significantly between the two groups （0.37 cm vs 0.76 cm, P〈 0.0001）, and the median MMT also differed （0.15 cm vs 0.33 cm, P 〈 0.0001）. The optimal cut-off value of the MOD and the MMT for diagnosis of acute appendicitis in children was 〉 0.57 cm （sensitivity 95.4%, specificity 93.4%） and 〉 0.22 cm （sensitivity 90.7%, specificity 79.3%）, respectively.
CONCLUSION： The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD 〉 0.57 cm and an MMT 〉 0.22 cm are the optimal criteria.     

Perforated acute appendicitis resulting from appendiceal villous adenoma presenting with small bowel obstruction: a case report

Background  

A villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.     

Atresia of the appendix vermiformis:A rare case of developmental abnormality

Acute appendicitis,which requires immediate surgical intervention,is an important diagnosis in patients with acute abdomen.However,developmental abnormalities may interfere with the preoperative diagnosis and surgical treatment in some cases.Agenesis and atresia of the cecal vermiform appendix is an extremely rare clinical diagnosis.In addition,preoperative diagnosis may be difficult in some cases.Thus,diagnosis of the congenital absence of the vermiform appendix requires a thorough exploration of the retrocecal and ileocecal regions.A 59-year-old male was admitted from the emergency services with right lower abdominal pain.A celiotomy was performed with the suspicion of acute appendicitis.However,an atresia of the vermiform appendix was observed.The patient’s appendix was thus removed.Pathological examination confirmed suppurative appendicitis.This case underlines the importance of the clinical entity for surgeons who may deal with a similar case.     

Appendicitis following esophagogastroduodenal study: report of a case

Retention of barium within appendix following a gastrointestinal tract study may predispose in rare instances to narrowing of appendiceal lumen, thus contributing to development of acute appendicitis. We present the case of a 42-year-old woman in whom this sequence of events was recognized who presented with clinical signs of acute appendicitis 9 days after barium swallow test was performed. Patients must be informed increased chance for development of appendicitis in these cases and be instructed to recognize early symptoms. Surgical treatment is reserved for symptomatic patients and prophylactic appendectomy is not reccommended.     

Eosinophilic appendicitis caused by Schistosoma japonicum: a case report and review of the literature

Parasitic appendicitis is uncommon. The authors reviewed the pathology of 4,130 appendices resected over the past 10 years (2000 to 2009). Only one case of eosinophilic appendicitis caused by Schistosoma japonicum was identified. The overall prevalence of schistosomal appendicitis was 0.024%. The case was a 61-year-old woman who presented with right lower quadrant abdominal pain. She had been a farmer in Chumphon and Surat Thani Provinces, which are endemic for schistosomiasis in Thailand. Physical, laboratory and ultrasound examinations were suggestive of acute appendicitis. She underwent emergency appendectomy. Intraoperative findings revealed a ruptured appendix with a fecalith in the appendiceal lumen. The histopathologic diagnosis was suppurative eosinophilic appendicitis with schistosomal ova in the mucosa, submucosa, muscular layer and vascular lumens, identified as S. japonicum eggs. The patient was treated for the parasite with praziquantal. We briefly review the clinicopathologic features and pathogenesis of schistosomal appendicitis.     

Does breast feeding provide protection against acute appendicitis? A case-control study

Breast feeding stimulates a more tolerant lymphoid tissue at the base of the appendix and this could provide protection against acute appendicitis. Two studies reported that children and adolescents with appendicitis were less likely to have been breast fed. In a case-control study of 200 children with histologically confirmed acute appendicitis matched by 200 siblings with the same sex and difference age - up to three-year-old - we found breast feeding in at least the first two months of life and for more than four months provides protection against acute appendicitis. These findings suggesting that breast feeding may possibly give protection against the development of appendicitis.