Nhamoucha Yassine, Bouabdellah Youssef
Service de Chirurgie Pédiatrique, CHU Hassan II, Fès, Maroc.
Pan Afr Med J. 2018 Aug 8;30:267. doi: 10.11604/pamj.2018.30.267.5563. eCollection 2018.
Primary epiploic appendagitis brings together torsions and primary inflammations of epiploic appendices. These pathological events are rare and, for a long period of time, have been exceptionally diagnosed in preoperative period. The progress of medical imaging allow, now, to avoid unnecessary surgical interventions. We report the case of a 14-year old child who was admitted to hospital with left iliac fossa pain evolving over six days and gradually worsening. He didn't suffer from transit disorders or associated urinary functional symptoms and he was afebrile. Abdominal palpation showed right iliac fossa tenderness. He was overweight with a BMI of 29. Laboratory tests didn't show any inflammatory syndrome. Cytobacteriologic examination of the urine was negative. Abdominal x-ray without treatment didn't show any hydroaeric level or calcification in urinary tract projections. CT scan objectified fat infiltration in the coeco-appendicular junction, with shuttle image containing fat surrounded by hyperdense ring, suggesting a torsion of the epiploic appendice. The child underwent symptomatic treatment with good clinical evolution.
原发性网膜附件炎包括网膜附件扭转和原发性炎症。这些病理情况较为罕见,长期以来,在术前阶段极难诊断。如今,医学影像学的发展使得避免不必要的手术干预成为可能。我们报告一例14岁儿童病例,该患儿因左下腹疼痛入院,疼痛持续6天且逐渐加重。他没有排便障碍或相关泌尿系统功能症状,体温正常。腹部触诊显示右下腹压痛。他超重,体重指数为29。实验室检查未显示任何炎症综合征。尿液的细菌学检查为阴性。未经治疗的腹部X线检查未显示尿路投影中有任何气液平面或钙化。CT扫描显示盲肠-阑尾交界处有脂肪浸润,呈含有脂肪的梭形影像,周围有高密度环,提示网膜附件扭转。该患儿接受了对症治疗,临床病情好转。