Department of Pediatrics, Hitachiomiya Saiseikai Hospital, 3033-3 Tagouchi, Hitachiomiya, 3192256 Ibaraki, Japan.
Clin Res Hepatol Gastroenterol. 2011 Oct;35(10):678-81. doi: 10.1016/j.clinre.2011.05.009. Epub 2011 Jun 23.
Cyclic vomiting syndrome is a disorder characterized by recurrent, discrete, stereotypical episodes of nausea and vomiting. Although chronic or recurrent appendicitis may be a cause of recurrent abdominal pain, it rarely meets the diagnostic criteria for cyclic vomiting syndrome. Furthermore, mast cell counts are histologically high in chronic appendicitis. We report a 10-year-old Japanese girl with a cyclic pattern of vomiting that met the stringent diagnostic criteria for cyclic vomiting syndrome, and which was resolved after appendectomy. Histopathologic examination of the resected appendix showed not only acute mucosal inflammation but also chronic inflammatory changes. Because we speculated that recurrent or chronic appendicitis may have been related to the patient's vomiting bouts, we also immunohistochemically investigated the density of mast cells in the specimen. We found that the mast cell density was markedly high in the lamina propria of the appendix. In our patient, a type I hypersensitivity reaction with release of mediators by mast cells could have been the initial factor triggering the recurrent appendicitis, and this stressor could have initiated the vomiting cascade. In conclusion, chronic or recurrent appendicitis could be one of the causes of cyclic vomiting, and must be considered in the differential diagnosis of cyclic vomiting syndrome.
周期性呕吐综合征是一种以反复、离散、刻板的恶心和呕吐发作为特征的疾病。虽然慢性或复发性阑尾炎可能是反复腹痛的原因，但它很少符合周期性呕吐综合征的诊断标准。此外，慢性阑尾炎的组织学中肥大细胞计数较高。我们报告了一例 10 岁日本女孩，其呕吐呈周期性模式，符合周期性呕吐综合征的严格诊断标准，阑尾切除术后得到缓解。切除阑尾的组织病理学检查不仅显示急性黏膜炎症，还显示慢性炎症改变。因为我们推测反复或慢性阑尾炎可能与患者的呕吐发作有关，所以我们还对标本中肥大细胞的密度进行了免疫组织化学研究。我们发现阑尾固有层的肥大细胞密度明显升高。在我们的患者中，肥大细胞释放介质的 I 型超敏反应可能是触发反复性阑尾炎的初始因素，这种应激因素可能引发了呕吐级联反应。总之，慢性或复发性阑尾炎可能是周期性呕吐的原因之一，在周期性呕吐综合征的鉴别诊断中必须考虑到这一点。
