Conrad Robert Joseph, Riela Steven, Patel Ravi, Misra Subhasis
Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
BMJ Case Rep. 2015 Nov 26;2015:bcr2015212888. doi: 10.1136/bcr-2015-212888.
A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.
一名52岁的西班牙裔女性因右下象限腹部剧痛加重3天就诊于急诊科。腹部和骨盆CT显示，与肿大且壁厚的阑尾相邻的腹膜软组织有炎症迹象，存在阑尾结石，无脓肿形成，盲肠轻度增厚，符合急性阑尾炎表现。在腹腔镜阑尾切除术中，发现盲肠质地坚硬，怀疑为恶性肿瘤。咨询了外科肿瘤团队后，进行了开腹右半结肠切除术。病理报告显示，回盲部肿物并非恶性肿瘤，而是放线菌病。患者在医院接受了10天的静脉抗生素治疗后出院，诊断为腹部放线菌病。尽管该病例最初的临床和影像学表现高度提示急性阑尾炎，但腹部放线菌病也应作为右下象限疼痛的鉴别诊断之一，因为它可能无需手术治疗。
