Koch W, Walser A, Itin H
Chirurgische Klinik, Kantonales Spital, Flawil/CH.
Dtsch Med Wochenschr. 2001 Apr 27;126(17):496-8. doi: 10.1055/s-2001-13054.
A 39-year-old patient was admitted because of pain in the right mid and lower abdomen of 2 weeks duration with vomiting and postprandial nausea. He complained of changing stool habits with diarrhoea and constipation. Clinically he showed a slight tenderness in the right lower abdomen.
Routine laboratory test were normal including CRP and WBC. Ultrasound showed a non-compressible mass with low intensity echoes, 3.6 x 4.6 cm in diameter in the right mid abdomen, slightly tender, surrounded by a circular, intestine-like structure. A gastrografin-swallow didn't reveal any obstacle in the proximal small intestine and was inconclusive further distal. A CT scan demonstrated a ileocoecal invagination extending in the colon ascendens to the right flexure with suspicion of a tumor. At the colonoscopy on the next day the invagination was not apparent any more, but a well-rounded tumour in the appendix region was seen.
DIAGNOSIS, TREATMENT AND COURSE: Suspecting a coecal tumour with remitting ileocoecal invagination a ileocoecal resection was performed on the third day. The tumour proved to be a mass of mucus with parts of a villo-mucinous cystadenoma of the UMP type. Recovery was uneventful.
Mucoceles of the appendix can cause ileocoecal invagination in the adult.
一名39岁患者因右中下腹疼痛2周入院，伴有呕吐和餐后恶心。他主诉大便习惯改变，有腹泻和便秘症状。临床检查发现右下腹有轻微压痛。
常规实验室检查包括C反应蛋白（CRP）和白细胞（WBC）均正常。超声显示右中腹部有一个不可压缩的低回声肿块，直径3.6×4.6厘米，有轻微压痛，周围有一个圆形的肠样结构。吞服泛影葡胺后，近端小肠未见任何梗阻，更远端情况不明确。CT扫描显示回盲部套叠延伸至升结肠至右曲部，怀疑有肿瘤。次日结肠镜检查时，套叠已不再明显，但在阑尾区域可见一个圆形肿瘤。
诊断、治疗与病程：怀疑为盲肠肿瘤伴缓解期回盲部套叠，于第三天进行了回盲部切除术。肿瘤病理结果为黏液性肿块，部分为UMP型绒毛黏液性囊腺瘤。恢复过程顺利。
成人阑尾黏液囊肿可导致回盲部套叠。
