结肠镜检查后发生的穿孔性阑尾炎。
Perforated appendicitis after colonoscopy.
作者信息
Johnston Paul, Maa John
机构信息
Department of Surgery, University of California at San Francisco, San Francisco, California 94103-0790, USA.
出版信息
JSLS. 2008 Jul-Sep;12(3):335-7.
BACKGROUND
Acute appendicitis is a rare complication of colonoscopy that has been reported only 12 times in the English-language literature and is usually associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. None of the previous reports have described findings of perforation of the appendix within 24 hours of colonoscopy.
METHODS
We present the case report of a patient who underwent urgent laparotomy within 16 hours of colonoscopy for findings of free intraabdominal air and peritonitis from acute perforated appendicitis.
RESULTS
Laparoscopy confirmed 2 perforations of the appendix and diffuse peritonitis. Laparotomy was necessary to perform appendectomy, exclude a right colonic injury, and control intraabdominal sepsis.
CONCLUSION
In patients with abdominal pain who have had a recent colonoscopy, a high index of suspicion is necessary for accurate diagnosis of perforated appendicitis. Perforation can occur hours after colonoscopy even when a biopsy is not performed.
背景
急性阑尾炎是结肠镜检查的一种罕见并发症，英文文献中仅报道过12例，通常与结肠镜检查期间阑尾腔被粪便阻塞有关。既往报道均未描述结肠镜检查后24小时内阑尾穿孔的表现。
方法
我们报告一例患者，其在结肠镜检查后16小时因急性穿孔性阑尾炎导致腹腔内游离气体和腹膜炎而接受紧急剖腹手术。
结果
腹腔镜检查证实阑尾有2处穿孔及弥漫性腹膜炎。必须进行剖腹手术以切除阑尾、排除右半结肠损伤并控制腹腔内感染。
结论
对于近期接受过结肠镜检查且出现腹痛的患者，必须高度怀疑以准确诊断穿孔性阑尾炎。即使未进行活检，穿孔也可能在结肠镜检查数小时后发生。
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