结肠镜辅助下腹腔镜手术治疗表现为急性阑尾炎的盲肠黏膜下粪石：一例报告
Laparoscopic surgery assisted by colonoscopy for a submucosal cecal fecalith presenting as acute appendicitis: A case report.
作者信息
Ruan Xiao-Jiao, Ye Bai-Liang, Zheng Zhi-Hai, Zhou Huan-Hao, Zheng Xiao-Feng, Zhou Zhen-Xu
机构信息
Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China.
出版信息
Medicine (Baltimore). 2017 Nov;96(47):e8872. doi: 10.1097/MD.0000000000008872.
RATIONALE
A cecal submucosal fecalith is extremely rare and is likely to be misdiagnosed as appendicitis with an incarcerated fecalith.
PATIENT CONCERNS
This review presents the case of a female patient complaining of recurrent abdominal pain in the right lower quadrant, similar to the clinical symptoms of appendicitis. Physical examination revealed an abdominal tenderness in the right lower quadrant without rebound tenderness or muscular tension. An ultrasound examination found a mass located in the right lower abdomen. Computed tomography showed a high-density shadow in the cecal cavity.
DIAGNOSES
A fecalith was detected in the submucosal cecal wall. The postoperative pathologic examination showed that the fecalith was located in the submucosa.
INTERVENTIONS
A partial cecal excision was performed under laparoscopic surgery assisted by colonoscopy.
OUTCOMES
The patient was discharged 1 week after surgery without postoperative complications.
LESSONS
Fecaliths should be considered in the differential diagnosis of submucosal occupying lesions of the cecum.
理论依据
盲肠黏膜下粪石极为罕见，很可能被误诊为伴有嵌顿粪石的阑尾炎。
患者情况
本病例报告了一名女性患者，主诉右下腹反复疼痛，与阑尾炎临床症状相似。体格检查发现右下腹压痛，无反跳痛或肌紧张。超声检查发现右下腹有一肿块。计算机断层扫描显示盲肠腔内有高密度影。
诊断
在盲肠壁黏膜下检测到粪石。术后病理检查显示粪石位于黏膜下层。
干预措施
在结肠镜辅助下行腹腔镜下部分盲肠切除术。
结果
患者术后1周出院，无术后并发症。
经验教训
在鉴别诊断盲肠黏膜下占位性病变时应考虑粪石。
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