Rehman Abdul
Department of Surgery, PAEC Hospital, Chashma, Mianwali.
J Coll Physicians Surg Pak. 2015 Apr;25 Suppl 1:S17-8.
Acute appendicitis after prior appendicectomy is highly difficult to diagnose, especially in face of definite history of appendicectomy and presence of appendicectomy scar in the right iliac fossa. We are highlighting a case report of a 40 year old woman who despite having had appendicectomy 2 years back presented with severe abdominal pain in the right iliac fossa in association with anorexia, nausea, vomiting and low-grade pyrexia of one day duration. On the basis of clinical evaluation and haematological and radiological investigations, diagnosis of perforated appendicitis was made. After thorough counselling of the patient and relatives, re-exploration of the patient was performed after excision of previous appendicectomy scar. The appendix was found to be perforated with an extraluminal faecolith and purulent exudate in the right iliac fossa. Appendicectomy and local peritoneal lavage resulted in uneventful recovery of the patient. Histopathology of the specimen revealed acutely inflamed appendicitis.
既往阑尾切除术后发生急性阑尾炎极难诊断，尤其是在有明确阑尾切除病史且右下腹存在阑尾切除瘢痕的情况下。我们在此重点介绍一例40岁女性病例，该患者尽管两年前已行阑尾切除术，但仍出现右下腹严重腹痛，并伴有厌食、恶心、呕吐及持续一天的低热。基于临床评估以及血液学和影像学检查，诊断为穿孔性阑尾炎。在对患者及其家属进行充分的咨询后，切除先前的阑尾切除瘢痕后对患者进行了再次探查。发现阑尾穿孔，右下腹有腔内粪石及脓性渗出物。阑尾切除及局部腹腔灌洗使患者顺利康复。标本的组织病理学显示为急性炎症性阑尾炎。
