Poole G V
Department of Surgery, USAF Hospital, Chanute AFB, Rantoul, Ill.
South Med J. 1990 Jul;83(7):771-3. doi: 10.1097/00007611-199007000-00013.
Gangrene or perforation of the appendix is often caused by failure to make an early diagnosis of appendicitis. Variability in the anatomic location of the appendix can be responsible for atypical manifestations of appendicitis and diagnostic errors. Over a 52-month period, 125 appendectomies were done for suspected appendicitis at a military hospital. After excluding cases in which the location of the appendix was not provided, 106 cases were available for review. Fifteen patients (14%) did not have appendicitis. The appendix was found in the true pelvis, was behind the ileum or ileocolic mesentery, or was both retrocolic and retroperitoneal in 11 of 16 patients (69%) with gangrenous or perforative appendicitis. In contrast, the appendix was in one of these three sites in only four of 75 patients (5%) with simple appendicitis (P less than .001). Both physicians and patients were responsible for diagnostic delays, but the paucity of symptoms and signs in patients with a "hidden" appendix was the most likely cause of failure to diagnose appendicitis before perforation.
阑尾坏疽或穿孔常因阑尾炎未能早期诊断所致。阑尾解剖位置的变异可导致阑尾炎的非典型表现及诊断失误。在52个月的时间里，一家军队医院对125例疑似阑尾炎患者实施了阑尾切除术。排除未提供阑尾位置的病例后，有106例可供分析。15例患者（14%）并无阑尾炎。在16例坏疽性或穿孔性阑尾炎患者中，有11例（69%）阑尾位于真骨盆、回肠或回结肠系膜后方，或位于结肠后和腹膜后。相比之下，75例单纯性阑尾炎患者中只有4例（5%）阑尾位于上述三个位置之一（P<0.001）。医生和患者均对诊断延误负有责任，但“隐匿性”阑尾患者症状和体征的缺乏是穿孔前未能诊断阑尾炎的最可能原因。
