Bakti N, Hussain A, El-Hasani S
Minimal Access Unit, General Surgery Department, Princess Royal University Hospital, Farnborough Common, Orpington, Greater London BR6 8ND, United Kingdom.
Int J Surg Case Rep. 2011;2(8):250-2. doi: 10.1016/j.ijscr.2011.08.003. Epub 2011 Aug 22.
Very few cases of superior mesenteric vein thrombosis have been reported as a complication of appendicitis. In these handful of cases, the thrombosis was identified early with computerised tomography scan and patients have been managed conservatively with antibiotics and anticoagulation.
A 45-year-old gentleman presented to the emergency department with a 13-day history of right lower quadrant abdominal pain and rigors. CT scan of the abdomen revealed an appendicular mass and superior mesenteric vein thrombosis. The patient was initially managed by anticoagulation and antibiotics for two weeks and was discharged after satisfactory clinical improvement. He represented after discharge for increased severity of his abdominal pain and abnormal inflammatory markers. Emergency open appendicectomy for complicated appendicitis was performed and his postoperative course was unremarkable. He was discharged on the 7th postoperative day with anticoagulation. Outpatient review at two months was unremarkable.
Acute appendicitis is a common surgical presentation where history and examination is key in clinching the diagnosis. Inflammatory markers and imaging modalities such as a CT scan can be helpful. Although surgical intervention is the mainstay of treatment, conservative management with antibiotics is an option if the diagnosis of appendicitis is equivocal. Recent evidence has revealed that elective appendicectomy is not necessary upon successful conservative management. Acute appendicitis can lead to local perforations and abscesses. Complications such as thrombosis in the superior mesenteric vein are rare and can be managed successfully with anticoagulants.
Although this is a rare complication of appendicitis, the case was managed successfully with a conservative approach. This is inline with the general consensus which is to treat superior mesenteric vein thrombosis secondary to appendicitis conservatively unless the patient deteriorates.
作为阑尾炎的并发症，肠系膜上静脉血栓形成的病例报道极少。在这少数病例中，通过计算机断层扫描早期发现了血栓形成，患者接受了抗生素和抗凝治疗等保守治疗。
一名45岁男性因右下腹痛和寒战13天就诊于急诊科。腹部CT扫描显示阑尾包块和肠系膜上静脉血栓形成。患者最初接受了两周的抗凝和抗生素治疗，临床症状改善满意后出院。出院后，他因腹痛加重和炎症指标异常再次就诊。因复杂性阑尾炎行急诊开放性阑尾切除术，术后病程平稳。术后第7天，他在继续抗凝治疗的情况下出院。术后两个月的门诊复查未见异常。
急性阑尾炎是常见的外科疾病，病史和体格检查是确诊的关键。炎症指标和CT扫描等影像学检查可能会有帮助。虽然手术干预是主要治疗方法，但如果阑尾炎的诊断不明确，抗生素保守治疗也是一种选择。最近的证据表明，保守治疗成功后无需进行择期阑尾切除术。急性阑尾炎可导致局部穿孔和脓肿。肠系膜上静脉血栓形成等并发症罕见，抗凝治疗可成功处理。
尽管这是阑尾炎的罕见并发症，但该病例通过保守方法成功治疗。这与一般共识相符，即除非患者病情恶化，否则对阑尾炎继发的肠系膜上静脉血栓形成应采取保守治疗。
