Ong Eugene Mun Wai, Venkatesh Sudhakar Kundapur
Department of Diagnostic Radiology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore.
World J Gastroenterol. 2009 Jul 28;15(28):3576-9. doi: 10.3748/wjg.15.3576.
Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space (n = 2) and subhepatic collections (n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other inflammatory conditions that mimic appendicitis.
急性阑尾炎是一种常见的外科疾病，通常通过早期手术治疗，其发病率和死亡率较低。然而，一些患者可能有非典型症状和体征，这可能导致诊断延迟和并发症增加。非典型表现可能与阑尾的位置有关。升结肠后位阑尾炎表现为右上腹疼痛，在临床上可能与胆囊、肝脏、胆管、右肾和右尿路的急性病变难以区分。我们报告了一系列4例升结肠后位阑尾炎患者，他们均表现为急性右上腹疼痛。初诊时的临床诊断为2例急性胆囊炎、1例肾盂肾炎和1例输尿管绞痛。初诊时腹部超声检查显示2例患者肝下有积液，另外2例结果正常。计算机断层扫描（CT）在所有病例中均正确识别出升结肠后位阑尾炎和腹膜后炎症。此外，还发现了2例结肠后间隙脓肿和2例肝下积液。2例患者行急诊阑尾切除术，1例患者行择期阑尾切除术，另1例患者行半结肠切除术。手术结果证实存在阑尾炎及其腹膜后蔓延。我们的病例系列说明了CT在诊断升结肠后位阑尾炎及其蔓延情况以及排除其他类似阑尾炎的炎症性疾病方面的有用性。
