新生儿阑尾炎的发病特点及误诊原因

目的分析新生儿阑尾炎的发病特点及误诊原因,并总结防范误诊措施。方法回顾分析2014年5月—2019年5月收治的病初曾误诊为其他疾病的新生儿阑尾炎12例的临床资料。结果12例患儿均有呕吐、哭闹、拒乳表现,其中发热10例,嗜睡9例,停止排气排便或大便减少7例。查体腹壁发红3例,肠鸣音减弱或消失11例,右下腹触及包块2例。查血白细胞、C反应蛋白升高。右下腹腹腔穿刺抽出淡黄色脓液8例。腹部立位X线片示10例不同程度肠腔胀气,2例见膈下游离气体;B超示10例右下腹肠管局限性扩张,8例腹腔积液,2例右下腹炎性液性包块。初步诊断为肠梗阻10例和消化道穿孔2例。误诊时间为8 h~1 d。术前诊断肠梗阻者,剖腹探查发现肠间脓苔引起粘连,局部肠管明显扩张,形成梗阻,术中及术后病理均证实为急性化脓性阑尾炎。拟诊消化道穿孔者,剖腹探查术中见阑尾穿孔,术中及术后病理均证实为急性坏疽性阑尾炎。术后所有患儿均康复出院,随访1年未见异常。结论新生儿阑尾炎临床罕见,且症状体征无特异性,加之难以获得可靠的病史及查体资料,故临床易误诊。加强对新生儿阑尾炎相关知识的学习,熟知其发病特点,尽可能获取详细的病史及查体资料,及时行相关影像学检查,必要时可行腹腔穿刺和(或)手术探查。

Characteristics and Misdiagnosed Causes of Neonatal Appendicitis

Objective To analyze the characteristics of neonatal appendicitis and the causes of misdiagnosis,and to summarize the preventive measures.Methods Clinical data of 12 cases of neonatal appendicitis misdiagnosed as having other diseases during May 2014 and May 2019 was retrospectively analyzed.Results All of the 12 cases had vomiting,crying and refusing breast milk,of whom there were 10 cases of fever,9 cases of drowsiness,and 7 cases of stopping exhaust and defecation or reducing defecation.The abdominal wall was red in 3 cases,bowel sounds were weakened or disappeared in 11 cases,and right lower abdomen mass was palpated in 2 cases.The white blood cells and C-reactive protein level were increased.Light yellow pus was extracted by right lower abdominal puncture in 8 cases.Abdominal vertical X-ray showed different degrees of flatulence in 10 cases,and free gas in the downstream of diaphragm in 2 cases;B-ultrasound showed localized expansion of right lower abdomen in 10 cases,ascites in 8 cases,and inflammatory liquid mass in the right lower quadrant of abdomen in 2 cases.The initial diagnosis was intestinal obstruction in 10 cases and gastrointestinal perforation in 2 cases.The duration of misdiagnosis time was from 8 h to 1 d.In the patients with intestinal obstruction diagnosed before operation,the adhesion caused by purulent coating between intestines was found by laparotomy,and the local intestinal tube was obviously dilated to form obstruction,acute suppurative appendicitis was confirmed by intraoperative and postoperative pathology.In the case of suspected gastrointestinal perforation,appendiceal perforation was found during exploratory laparotomy,and acute gangrenous appendicitis was confirmed by pathology results during and after operation.All the patients recovered and were discharged from hospital after operation,and no abnormality was found during the follow-up for 1 year.Conclusion Neonatal appendicitis is rare in clinical practice,and its symptoms and signs are not specific.In addition,it is difficult to obtain reliable medical history and physical examination data,therefore,it is more likely to be misdiagnosed.It is important to strengthen the study of knowledge related to neonatal appendicitis,be familiar with the characteristics of the disease,obtain detailed medical history and physical examination data as much as possible,conduct relevant imaging examination in time,and conduct abdominal puncture and(or)giving surgical exploration if necessary.