Gastroenterology and Hepatology Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
Singapore Med J. 2011 Feb;52(2):90-3.
Tuberculous appendix is surprisingly rare, even in countries where this infection is common. We report our experience with tuberculous appendix over a 15-year period.
A search for cases of tuberculous appendix was conducted from January 1995 to December 2009 on the databases of the National Tuberculosis Centre and the Departments of Pathology and Surgery of Raja Isteri Pengiran Anak Saleha Hospital.
There were five cases of tuberculous appendix, giving a cumulative incidence of 0.08 percent of all appendectomies (n is 6,593), 0.2 percent of tuberculosis (TB) cases (n is 2,876) and 8.6 percent of abdominal TB (n is 58). Three patients were male and two were female, with a median age of 27 (range 25-48) years. Four patients presented with symptoms of acute appendicitis and one with an appendiceal mass following treatment for acute gastroenteritis. Only one patient had constitutional symptoms. Four patients had appendectomies (one laparoscopic and three open) within the same admission and one had interval appendectomy. Operative findings included perforated appendix (n is 1), appendiceal mass (n is 1) and acute appendicitis (n is 3). In all cases, the diagnoses were made only after review of the histology. None of the patients had pulmonary TB. Delay in initiating anti-TB treatment in one patient resulted in the development of an ileocutaneous fistula following appendectomy. This was resolved by excision, followed by anti-TB treatment.
Tuberculous appendix can present as acute appendicitis, and the diagnosis is often made after surgery. Any delay in treatment can lead to significant complications.
阑尾结核非常罕见，即使在结核病高发的国家也是如此。我们报告了在 15 年期间的阑尾结核经验。
从 1995 年 1 月至 2009 年 12 月，在国家结核病中心和 Raja Isteri Pengiran Anak Saleha 医院病理科和外科的数据库中搜索阑尾结核病例。
共发现 5 例阑尾结核，阑尾切除术的累积发病率为 0.08％（n 是 6593），结核病（TB）病例的发病率为 0.2％（n 是 2876），腹部结核的发病率为 8.6％（n 是 58）。3 例为男性，2 例为女性，中位年龄为 27 岁（范围 25-48 岁）。4 例患者表现为急性阑尾炎症状，1 例患者在急性胃肠炎治疗后出现阑尾肿块。只有 1 例患者有全身症状。4 例患者在同一住院期间接受阑尾切除术（1 例腹腔镜，3 例开放性），1 例患者接受间隔性阑尾切除术。手术发现包括穿孔的阑尾（n 是 1），阑尾肿块（n 是 1）和急性阑尾炎（n 是 3）。所有病例均在回顾组织学后才做出诊断。所有患者均无肺结核。1 例患者因延迟开始抗结核治疗，导致阑尾切除术后发生回肠皮肤瘘。通过切除后进行抗结核治疗得到解决。
阑尾结核可表现为急性阑尾炎，且通常在手术后才做出诊断。任何治疗延迟都可能导致严重的并发症。
