伴有左上腹疼痛的急性阑尾炎罕见病例。
Unusual case of acute appendicitis with left upper quadrant abdominal pain.
作者信息
Tawk Charbel M, Zgheib Rana R, Mehanna Seba
机构信息
Department of General Surgery, Notre Dame Des Secours University Hospital, Byblos, Lebanon.
出版信息
Int J Surg Case Rep. 2012;3(8):399-401. doi: 10.1016/j.ijscr.2012.05.002. Epub 2012 May 17.
INTRODUCTION
Acute appendicitis is one of the most frequent causes of surgical abdominal pain presenting to the Emergency Department. The diagnosis is confirmed by a set of clinical signs, blood tests and imaging. The typical presentation consists of periumbilical pain radiating to the right lower quadrant with peritoneal reaction on palpation (Mac Burney).
PRESENTATION OF CASE
In this article, we report a case of acute appendicitis presenting with a left upper quadrant pain due to intestinal malrotation and we describe the radiologic findings on computed tomography.
DISCUSSION
With an Alvarado score of 4 and a nonconclusive abdominal U/S, the diagnosis of acute appendicitis was a long shot. Persistence of pain and increasing inflammatory parameters in her blood exams pushed the medical team to further investigate and a CT scan revealed intestinal malrotation with acute appendicitis.
CONCLUSION
An examining physician should not be mislead by the atypical presentation of acute appendicitis and should bear in mind the diagnosis to avoid serious complications.
引言
急性阑尾炎是急诊科外科腹痛最常见的病因之一。诊断通过一系列临床体征、血液检查和影像学检查来确认。典型表现为脐周疼痛放射至右下腹，触诊时有腹膜反应（麦氏点）。
病例介绍
在本文中，我们报告一例因肠旋转不良导致左上腹疼痛的急性阑尾炎病例，并描述计算机断层扫描的影像学表现。
讨论
阿尔瓦拉多评分为4分且腹部超声检查结果不明确，急性阑尾炎的诊断可能性不大。她血液检查中疼痛持续存在且炎症指标不断升高，促使医疗团队进一步检查，计算机断层扫描显示肠旋转不良合并急性阑尾炎。
结论
检查医生不应被急性阑尾炎的非典型表现误导，应牢记诊断以避免严重并发症。
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