Oren R, Rachmilewitz D
Department of Medicine, Hadassah University Hospital-Mount Scopus, Jerusalem, Israel.
J Clin Gastroenterol. 1992 Dec;15(4):306-10. doi: 10.1097/00004836-199212000-00008.
Twelve patients who underwent laparotomy for suspected acute appendicitis were found to have Crohn's disease of the terminal ileum. Appendectomy was performed in all although in only four patients was the appendix grossly inflamed. Postoperative complications, either abscess or fistula, developed in four patients (33%). Careful investigation of the records revealed some preoperative diagnostic clues: a history of recurrent abdominal pain and/or diarrhea (83%), physical examination revealing normal temperature (50%), and laboratory results compatible with a chronic process such as microcytic anemia (33%) and hypoproteinemia/hypoalbuminemia/hypocholesterolemia (50%). As the differential diagnosis between Crohn's disease and appendicitis is difficult and the surgical approach to the appendix in the presence of Crohn's disease is controversial, we illuminate some practical points in the preoperative evaluation of these patients and deal with the question of whether appendectomy should be performed in these patients.
12例因疑似急性阑尾炎接受剖腹手术的患者被发现患有回肠末端克罗恩病。所有患者均接受了阑尾切除术，尽管只有4例患者的阑尾有明显炎症。4例患者（33%）出现了术后并发症，包括脓肿或瘘管。仔细查阅病历发现了一些术前诊断线索：反复腹痛和/或腹泻史（83%）、体温正常的体格检查结果（50%）以及与慢性病程相符的实验室检查结果，如小细胞性贫血（33%）和低蛋白血症/低白蛋白血症/低胆固醇血症（50%）。由于克罗恩病和阑尾炎的鉴别诊断困难，且存在克罗恩病时阑尾的手术方式存在争议，我们阐述了这些患者术前评估中的一些实用要点，并探讨了这些患者是否应行阑尾切除术的问题。
